What is VBAC?
VBAC is a term used to describe people giving birth vaginally when they have previously had a caesarean section. Standing for vaginal birth after caesarean, your midwife will discuss this as a potential option if you have had a c-section in the past.
During your antenatal appointments, your midwife will discuss your birth options with you so you can decide what you would like to do. If you have had a previous c-section, you can choose to have another one and you will be booked in for an elective caesarean.
However, you may also be given the opportunity to choose a VBAC, which means you will be supported to have a vaginal delivery if that is what you want. VBAC will not be a suitable option for everyone, it will depend on your medical history and whether there are any additional complications.
NHS figures show that between 70% and 80% of women who have had one caesarean section in the past are capable of delivering a baby vaginally. Expectant mothers who have had a vaginal birth in the past as week as their c-section are even more likely to be able to have a VBAC.
What are the benefits of a VBAC?
Research suggests that women are less likely to experience complications with a VBAC than they would if they choose an elective caesarean section. Having a VBAC also means they are more likely to be able to have a vaginal birth if they go on to have more children.
The recovery time after a vaginal birth is usually less than after a c-section and you can return to doing normal everyday things more quickly. You are likely to spend less time in hospital after the birth and you avoid the risks involved in having surgery and being given anaesthetic.
It is also easier for you to have skin-to-skin cuddles with your baby straight after they are born if you have a vaginal delivery.
Are there any risks to having a VBAC?
Whether a VBAC is suitable for you will largely depend on why you needed a c-section in the past, your own medical history and whether your current pregnancy has any complications which make it high risk. If you have previously had issues with your scar rupturing, have needed surgery on your uterus, have a vertical c-section scar or have placenta praevia, you may be advised not to have a VBAC
One of the potential risks to VBAC is the scar from the previous c-section opening up during the birth. Known as uterine rupture, this only happens in about one in 200 cases, but the risk is higher if labour needs to be induced.
This may mean that even if you choose to try for a VBAC, you may be offered an elective caesarean again if your baby goes overdue as an alternative to being induced. There is also the chance that you may need to have an emergency caesarean anyway to make sure your baby arrives safely.
Around one in four women who attempt to have a vaginal birth after having a caesarean will end up having another c-section. Some expectant parents may choose an elective caesarean over a VBAC because they don’t like the element of uncertainty and they want to know how their baby will be delivered.
Is a VBAC different to a normal vaginal birth?
Women who have previously had c-sections are likely to be monitored more closely during labour. Once your contractions are coming regularly, your midwife will continuously monitor your baby’s heartbeat to check that all is well.
The team caring for you during your labour and birth will be aware of your medical history and will be looking out for any signs of problems with your c-section scar. You will be encouraged to give birth in a maternity unit where you can be quickly taken into theatre for an emergency caesarean if necessary.
You will be advised against having a home birth as you will not have access to blood transfusion facilities if needed and it will take longer to transfer you to theatre if you do end up needing another c-section.
Can I have a VBAC if I have had more than one c-section?
Different hospital trusts may have different guidelines which they follow. In general, the more c-sections you have had, the higher the risk involved with having a VBAC.
VBAC is usually offered as an option to women who have previously had one caesarean. However, if you have had more than one and you want to try for a vaginal delivery, this may still be possible.
Let your midwife know your wishes. You are likely to need to have a discussion with a senior obstetrician who can explain the risks and discuss the success rates to see if it is a suitable option for your individual circumstances.
What if I am advised against having a VBAC?
There will always be a good reason why your midwife or obstetrician advises against a VBAC. If you do not agree with the decision, you can ask them to explain their reasoning further and request a second opinion.
In the UK, you have the right to refuse any medical procedure if you are considered to have mental capacity but think carefully before going against the advice of healthcare professionals.