Choosing Between Vaginal Birth After C-section Or Repeat C-section

GENERAL INFORMATION:

What is it? A vaginal-birth after a cesarean (suh-sair-e-in) is also called a "VBAC" (v-back). It means delivering a baby through the vagina (vuh-ji-nuh) after having had a baby before by cesarean section (C-section). A cesarean section is when caregivers make an incision (cut) in your lower abdomen (belly) and into the uterus (womb). The baby is delivered through this incision. The reason why you had the cesarean before may not be present in this pregnancy. Most women (60% to 80%) who have had a C-section before can plan to have a VBAC.

Why do I want a vaginal birth? The following is information that may help you decide if you want to try having a VBAC.

• Emotional: Having a vaginal birth lets you be more involved with your child's birth. You may feel better emotionally having a vaginal birth, because some people feel it is the "natural" way. General anesthesia is sometimes used during a C-section. This means that you may not be awake to see your child being born. People that you might want to have in the delivery room may not be able to be present during a c-section.
  
  
• Quicker Recovery: Your stay in the hospital is usually shorter after a vaginal delivery. You will also have less pain than after a C-section. Your body will recover more quickly if you deliver your baby vaginally. And, you may be able to do certain activities more quickly after a vaginal delivery, such as driving a car.
  
  
• Risks: There are always risks with surgery and anesthesia. These may include infection, bleeding, injury to the bowel, bladder, or to your baby. There is an increased chance of placenta previa in future pregnancies after having had a C-section. Placenta previa is when the placenta grows and covers the cervix (opening out of your uterus). No incision (cut) is made in your abdomen with a vaginal delivery. Because you walk sooner after a vaginal birth, there is less chance of getting blood clots in your legs.

Why might I not want to have a vaginal birth? You may be afraid of having a vaginal birth because of labor pain. Caregivers may be able to give you epidural anesthesia (an-iss-thee-zuh) to numb the lower half of your body. Ask for the CareNotes™ handout about anesthesia for more information.

How do I know if I can have a VBAC? Caregivers will want to know what kind of incision you had with your C-section. Two incisions are made during a cesarean. One incision is made in your abdomen and the other is made into your uterus. There are 3 kinds of incisions that can be used to open your uterus. You cannot tell what kind of incision was made in your uterus by looking at your abdomen.

• It is possible that the old scar left by the earlier uterine incision could rupture (separate) during a vaginal delivery. This can cause serious bleeding. The risk is higher for women having VBAC than for women who have never had a C-section.
  
  
• Your caregiver may get records from the hospital where the C-section was done. After reviewing the records, you and your caregiver will decide if you can try a vaginal birth. Whether you have your baby by a C-section or vaginal birth, your health and the health of your baby always come first.

What may keep me from having a VBAC? Following are some things that may effect whether you can have a VBAC:

• More than one baby: You may need a C-section if you have 2 or more babies in your uterus.
  
  
• Baby's position: You may not be able to a VBAC if your baby is breech. This means the baby's buttocks (rear end) or feet are pointing downward.
  
  
• Small pelvis/large baby: You may have problems delivering a large baby vaginally if your pelvic bones are too small. It is difficult to predict this and is often unknown until labor begins.
  
  
• Other problems: You may not be able to have a VBAC if you are having pregnancy problems, such as high blood pressure or infections like herpes or HIV. A C-section may be needed if your baby is having problems.

Planning for your VBAC:

• Learn as much as you can about VBACs. You may want to talk to other women who have had a VBAC. But remember that every labor and delivery is different. This may help you feel better about your decision to try to have a vaginal birth. Talk to your caregiver often about any concerns you may have about a VBAC.
  
  
• Try to exercise often and eat healthy foods during your pregnancy. This helps keep you and your baby healthy. Your labor may also move more quickly if you are in good physical shape. When you go into labor, your care in the hospital is the same as for any other woman in labor. Caregivers will watch you and your baby carefully for problems.

Care: You will be put in the hospital when your contractions are strong, getting closer together, and your cervix is opening. Other reasons for going into the hospital are if your bag of water has broken or if you are bleeding. Whether your are having a VBAC or C-section, ask for the CareNotes™ handouts about a vaginal delivery or C-section.

Coping: Labor and delivery can be an exciting but scary time. Knowing what to look for and what to expect can help these feelings. You and a support person may want to take childbirth classes together to prepare for your baby's birth. You will feel less scared and more in control and will go through labor and delivery with greater comfort if you are prepared.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how to treat it. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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