Due to the high rates of caesarean section in the western world (it’s around 28 per cent in Australia) there’s currently a push to encourage women who have previously had a caesarean birth to have a natural birth the next time. This is called VBAC (vaginal birth after caesarean) or NBAC (normal birth after caesarean).
Vaginal birth in a head-down presentation carries less risk than a caesarean section, and research shows that for most women VBAC is a safe option. Women who have had a previous caesarean should be encouraged to have a VBAC and the preparation starts soon after that first caesarean. Knowing exactly what happened during the first caesarean is the first step in the decision to have a VBAC for the next birth. Women need accurate information about what happened during their labour and birth and why they had the caesarean. This allows them
to make informed choices for a future pregnancy.
There are some things that have happened during the first caesarean, such as the cut in the uterus being extended or made in a different direction that would make it not advisable to have a natural birth with the next baby. The discussion regarding the previous caesarean and whether to have a VBAC needs to be with an experienced midwife or doctor.
The healing period
The difference in recovery after the birth is most important to consider. After a vaginal birth women are generally up and about immediately and able to care for the baby without the need for pain relief. Breastfeeding is started earlier, there is a shorter hospital stay and a significant increase in women’s satisfaction.
A caesarean is a major operation that requires more days in hospital and continuous pain medication in order to move around and care for the baby. The time after birth with the baby
is also important for bonding and after a caesarean the baby is taken to the postnatal ward while mum is stitched up and taken to recovery. After a vaginal birth, providing mother and baby are okay, they’re not separated.
What are the risks?
Before making a decision, women should be informed of the risks in having anothercaesarean. When a woman has had a previouscaesarean, the common fear that everyone talks about is the uterus rupturing where the previous cut was made, however, the chances of this happening are less than 1 in 200 (0.5 per cent). Overall, complications for a caesarean birth are higher (up to 28 per cent) than for a vaginal birth (up to 3 per cent) and include such conditions as increased blood loss, an increased likelihood of having blood clots after the operation and more wound infections.
The rate of successful VBACs in Australia isn’t as high as in other countries (around 25 per cent), so once the decision to have a VBAC has been made it’s important for the woman and her partner to have good support and advice regarding VBAC. Some hospitals are not as good as others in supporting the VBAC choice and women need to ask about thecaesarean and VBAC rates.
If the hospital supplies specific VBAC information for women this is a good sign that they’re supportive. Currently in Australia, the percentage of women that achieve a vaginal birth after caesarean is around 25 per cent but in a hospital supportive of VBAC and with experienced caregivers this increases to greater than 40 per cent. One-to-one care with your own midwife is ideal for successful VBAC and many hospitals now offer this type of care, or alternatively you can look into getting your own private midwife or doula.
Duringlabour it’s important that interventions are kept to a minimum to increase the success of a VBAC. The labour will be monitored closely and if the progress seems to be slow or the baby’s heartbeat abnormal then another caesarean will probably be recommended. Induction of labour isn’t recommended for VBAC as the induction process may put extra stress on the uterus. It’s also important for the woman to feel like she has enough time and not be pressured to labour according to the hospital’s time restrictions.
Preparation is key
It’s always wise for women planning a VBAC to prepare for the possibility of another caesarean and if they do have to have another one, to be proud of themselves and the effort they have made. No matter how the birth goes it’s still the birth of a baby, and that is the miracle! Once a woman has achieved a successful VBAC, her next and subsequent births are more likely to be vaginal as well.