Planning a VBAC after a Caesarean

Posted on 14/09/2017 by Antenatal Online | Leave a Comment

Vaginal birth benefits mum and baby both physically and psychologically and having a one C-section doesnít necessarily mean that will be your only option for subsequent babies. How you feel about VBAC however will depend a lot on the circumstances leading up to your caesarean birth, such as:-

  • Whether the baby was breech or in an unstable position
  • Was there presumed slow progress/ failure to progress in labour?
  • Fetal distress
  • Whether you had twin or multiple birth
  • Placenta malposition

Only you can decide whether you want to try for a VBAC but it is well worth talking to your midwife or obstetrician as they will be able to advise and support you.

Many hospitals will offer a birth choice clinic where they can talk you through the statistics and give advice based on local and national guidelines (National Institute of Clinical Excellence (NICE)). There are also several other organisations that can support you and help you make an informed choice. These include the National Childbirth Trust (NCT), The Positive Birth Movement or AIMS.

Itís important to remember that whilst guidelines and protocols are in place, you are under no obligation to comply. You will still be supported in your choices and will be eligible to be cared for by the hospital and midwifery team of your choice in the setting you choose.

Most hospitals will recommend that your VBAC takes place on an Obstetrician- led Labour ward with continuous electronic fetal monitoring and will recommend Intravenous (IV) access which involves a cannula in the back of the hand that can be readily attached to a drip in the event of an emergency. This may not be how you envisaged your birth to happen. Most units will have a birth centre lead midwife and/ or a consultant midwife who can design a birth plan with you to suit your needs and wishes. You can opt to be supported by your midwife in a home birth setting or on the birth centre if you wish. You can also opt to not have IV access - the risk of a sudden emergency in VBAC labour isnít much difference to any other labour and IV access can easily and quickly be sited by the medical team if necessary.

What are the risks of a VBAC?

VBAC can be safer due to increased risks of infection with Caesarean section. With repetitive Lower Segment Caesarean Sections (LSCS) there is an increased risk of placenta praevia in future pregnancies and therefore an increased chance of an emergency hysterectomy.

The risk associated with VBAC and scar rupture (when the previous scar opens and causes bleeding) is 0.35% and the risk of scar dehiscence (when the previous scar becomes thinner and begins to separate) is 0.5%.

These risks are slightly lower if there is a longer time frame between pregnancies. These risks can be monitored closely in labour through careful observation of your pulse rate, babyís heart rate and observing for scar pain or bleeding. It is important to be cared for on a 1:1 basis by your midwife.

How can I improve my chances of a VBAC?

Approximately 70% of women who opt for VBAC are successful. You can optimise your chances of a successful VBAC by:-

  • Discussing and formulating a birth plan with your midwife
  • Waiting for spontaneous onset of labour (Induction of labour increases the chance of scar dehiscence)
  • Opt for intermittent monitoring of your babyís heartbeat- NICE guidance recommends continuous electronic fetal monitoring however the Cochrane review found that continuous electronic fetal monitoring is not more effective and does not reduce mortality or morbidity.
  • Stay upright, mobile and ensure you have a supportive birth partner.

 

Nina, Antenatal Online Midwife

 



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