Considering a vaginal birth after caesarean (VBAC)
If you’ve had a caesarean birth and are pregnant again, perhaps you’re deciding whether to have a VBAC (vaginal birth after caesarean) or another caesarean. The advice from the Royal College of Obstetricians is that people should be informed of risks associated with VBACs, but that this is a generally safe way to give birth. While we can’t speak to specific cases, three in four women or birthing people who decide to have a VBAC are successful, so what are the general benefits and risks to be aware of?
The benefits of a VBAC
For many people who have a caesarean birth, it wasn’t their first choice and they did so because it was the right decision for them and their baby in the circumstances. But you might feel that you still want to experience vaginal birth, so a VBAC is the way to do that.
Knowing all the risks associated with both caesarean and vaginal birth, you may feel that vaginal birth comes with a more acceptable risk to you and your baby.
Vaginal birth is associated with a shorter and more straightforward recovery time, especially beneficial if you have a busy homelife or toddler to look after.
Caesarean births can contribute to a delay in your milk coming in. So you might feel that a successful VBAC could result in a smoother breastfeeding journey.
If you would like to have further babies, a successful VBAC can mean that you are more likely to go on to have more successful vaginal births.
If you had a traumatic experience during your first birth, a successful VBAC can be a healing and positive experience, which in turn can lead to a positive postpartum period.
What are the risks of a VBAC?
The main concern that people talk about when it comes to VBACs is the risk of your scar rupturing. This carries a small risk of one in 200 (0.5%) women or people trying for a VBAC. A scar rupture is when the scar partially or totally separates along the length of the scar and the bag of water that holds the baby is broken as well. This would prompt an immediate caesarean birth.
The second concern to think about is the chance of ‘ending up’ having an unplanned or emergency caesarean. However the statistics are quite positive, with 72-75% achieving a vaginal birth. If you have had a vaginal birth previously, you have an even greater chance of a vaginal birth at 85-90% success rate.
If you accept an induction when hoping to have a VBAC, the chance of uterine rupture and unplanned caesarean increase slightly (by 2-3 times and 1.5 times respectively) - so that is something to weigh up.
Deciding whether or not to have a VBAC
In this blog, we haven’t covered the overall risks and benefits of vaginal births or caesarean births, but you should consider the whole picture when deciding whether to have a VBAC. The RCOG advises that when you take into account the full picture, overall VBACs pose the least risk and possibility of complications to the mother and baby, but you need to decide what the risk profile of each scenario means to you.
We always encourage you to use the BRAIN acronym when making choices around your birth preferences. What are the benefits, risks, alternatives. What is your instinct and what happens if you do nothing.
To help you weigh up the benefits and risks, make sure that the statistics your medical team share with you are personal to your situation. It can be helpful to ask for infographics too. A visual representation of 1 in 200 people highlighted on an image might look like a small risk to you, or it might feel like an unacceptable risk, that is completely personal to you.
How to have a positive VBAC
Preparing for a positive VBAC is very similar to preparing for other births, but the main difference might be that you could be carrying stress or trauma related to your previous birth that didn’t go to plan. If this relates to you, the first thing to do when preparing for a VBAC is to ensure you have processed as much earlier birth trauma or disappointment as you can. We have some resources here, but would advise you to ask your midwife if your hospital can signpost you for a birth debrief, to help you to make sure you fully understand decisions that were made. It may also help you to connect with other parents who have had a similar experience. If that’s the case, The Positive Birth Company’s Birth Reflections Group may be something you could use if you have access to the Hypnobirthing Pack. When planning for your next birth, ensure your birth preferences include any information, key triggers or areas that your birth team should be aware of from your previous birth. Speak to your midwife about any disappointments and how you can possibly avoid these again.
Once you have done this, it is all about getting your body and mind ready for birth. Hypnobirthing is especially useful for VBACs, helping you to relax through any anxiety and build the oxytocin you need for your body to progress through labour. If you already did a course first time round, make sure you refresh your knowledge and practice the techniques you have learnt in advance.
When it comes to the day, as with all births, make sure you have everything with you to help create a relaxing environment, like electric candles and calming sounds and scents (check out the Freya app). Ask if you can use a wireless monitor and have the sound at a lower level and the machine placed to the side. It may also be possible to labour in a pool if there is one available and the midwife feels she can safely monitor your baby.
If you want more information on VBACs, check out the Hypnobirthing Pack, which has a dedicated workshop.