VBAC or Vaginal Birth After Caesarean

A mother can end up giving birth by caesarean section either because of an emergency (if the baby was in distress during labour and could not be delivered naturally), or because the mother and the experts agreed prior to birth that this is the best way forward for delivery.

There can be a variety of reasons why women have to have caesareans and some women can feel cheated out of the birthing process or feel ashamed that they did not give birth 'properly'. This is a perfectly natural feeling to have and there is no need to be worried about it.

Of course, you want the best for your baby from the moment you find out you are pregnant and having a vaginal delivery, when nothing has gone wrong, is the best way to go. But you have to keep things in perspective if you are disappointed with giving birth by caesarean section; your pregnancy has resulted in something that everyone wanted - the birth of a healthy baby and it does not really matter how it came about.

Positive aspects of caesareans

You also have to remember that if it were not for caesareans being available then a lot of babies and mothers might not have made it through the birth.

If you had a caesarean first time around and then want to try for a vaginal birth after caesarean (VBAC) there is no reason why you cannot, unless you have a medical condition that prevents this or something goes wrong with the birth. If the baby was too big to fit through your pelvis, which is called cephalo-pelvic disproportion, then the chances are this will be the same the next time around and you will be strongly advised to have another caesarean.

There are many women who go on to deliver naturally after having a caesarean, so it is well worth talking it through with your consultant obstetrician to see what can be done to ensure a vaginal delivery. Depending on why you had a C-section previously, the decision might be an easy one to make.

What doctors have learned

It was once commonly believed that a woman who had had a caesarean would never be able to give birth naturally. This was because in the past, most caesareans were performed by making a vertical incision within the uterus which left the muscle very weak all the way along its length. Because of this, doctors advised women not to go for a vaginal delivery subsequently for fear of rupture of the scar during contractions.

Nowadays, the incision is made horizontally in the lower part of the uterus which is much thinner and stronger and therefore heals more quickly and more effectively. This means it is less likely to tear during a vaginal delivery. If there are no other complications, the chances are you can go for a natural birth after a caesarean if that is what you would like.

Although there is still a small risk of rupture, it is less than 1%. However, doctors still advise you to go into hospital to give birth rather than trying for a home birth. This is to ensure you can get immediate attention should anything go wrong.

Trial of labour

A trial of labour is when a woman chooses to go for a vaginal delivery after a previous caesarean section where a non-recurring cause has been established. This means if your section was carried out because of an emergency that happened at the time, then you are given about a 70% chance of going forward and having a vaginal delivery.

However, because the scar will still be there, doctors are keen to keep a close eye on you during labour with the possibility that if anything goes wrong you will be taken into theatre for another C-section.

When a VBAC is not possible

If your caesarean was because of an underlying medical condition that you have then you will not be able to have a vaginal delivery. It is the same if you have severe heart problems because the stress on your heart during labour can be immense.

However if the reason why you had a C-section first time round was due to the baby's positioning, foetal distress, pre-eclampsia or placenta praevia, (where the placenta is positioned over the cervix), then these are unlikely to repeat themselves and you could be one of the 75 - 90% of women who go on to have a successful vaginal birth after a caesarean.

Trusting the professionals

The doctors, consultants and other medical professionals involved in your labour and birth have the experience and knowledge to advise you beforehand on what is the best thing to do.

There is a suggestion that doctors are hasty to advise a caesarean because they are concerned about legal actions being taken against them should anything go wrong with the birth. This is a rather cynical view. A caesarean is a surgical procedure not to be performed lightly and doctors know that the mother's body will recover much quicker after a vaginal birth as opposed to a C-section.

The main thing to remember is to talk through all your worries and fears about the process and to make sure your consultant knows that you want to try for a vaginal delivery. Then everything will be made possible for this to happen.