Editor’s note: Dr. Rebecca Jacobi blogs for momaha’s sister site, LiveWellNebraska.com
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Recent reports on C-section rates (they vary across the country) have lead to more conversations about VBAC (Vaginal Birth After C-section) and the growing number of women who are considering this as a birthing option.
While this choice is available at Methodist and other select hospital settings, it’s not a decision that should be taken likely without a serious consultation.
A woman considering VBAC must weigh numerous factors, fully understand the risks and benefits, and be in close communication with their physician from the start of the pregnancy.
VBAC is exactly what it sounds like, however, we refer to the process as “trial of labor” until the vaginal birth actually occurs.
Approximately, 60-80 percent of women who attempt to have a vaginal birth after a cesarean are successful. Benefits include a quicker recovery, and many women take pride in delivering a baby vaginally. By avoiding major surgery, a woman will also likely have less bleeding and risk for infection.
Some women are definitely better candidates than others, like those who have had a previous vaginal birth and those that go into spontaneous labor. Increased age of the mother, obesity, large babies and delivering past 40 weeks decrease the chance of having a successful VBAC.
At the Women’s Hospital, we have an OB physician in the hospital 24 hours a day, as well as anesthesiology and surgical availability. Facilities that don’t, may choose not to offer VBACS. These things are important in having a safe trial of labor just in case a cesarean is necessary or there is an emergency.
Despite a woman’s wishes to have a vaginal birth after a prior C-section, certain conditions would likely rule out VBAC as an option.
• Previous classical or t-shaped incision or extensive uterine surgery
• Previous uterine rupture
• Medical or obstetric complications that would prevent a vaginal birth
• Two prior uterine scars and no vaginal deliveries
• Breech delivery or malpresentation
More commonly put, if you had a C-section because your baby didn’t fit, there was arrested dilation during the delivery or you pushed and pushed and the baby didn’t come out, then VBAC might not be the best option.
Risks associated with VBAC can include a uterine rupture, excessive blood loss, organ injury, hysterectomy, fetal injury or death or even maternal death. These things aren’t common or meant to scare the patient, but should definitely be considered.
I certainly applaud women who want to go down this path, but the decision needs to be made following a good, honest discussion with your physician.
Some women have a “vagina or bust” mentality, and while I appreciate that, as an OB/GYN it will always come down to the safety of both mom and baby.
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