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Vaginal Birth after C-Section (VBAC)

Vaginal Birth after C-Section VBAC - Los Angeles OBGYN Thais Aliabadi MDOne common myth about cesarean delivery is that after having one, you never deliver vaginally again. Although there are some risks and dangers to be aware of, this is simply not true. In general, women who plan to have children again after a C-section have two options for their next birth: another C-section, or a vaginal birth after cesarean delivery, also known as VBAC.

Most women who undergo VBAC give birth to healthy babies and suffer no complications.

What is TOLAC? TOLAC stands for a trial of labor after cesarean delivery. It refers to the mother’s attempt to deliver vaginally following a previous C-section. A TOLAC is a plan to deliver vaginally; at least until something occurs that changes the plan. About 40% of women who attempt a TOLAC will need to undergo another C-section to complete the delivery.

VBAC Benefits

A cesarean delivery is a major surgical procedure. Many women prefer to deliver vaginally for a variety of reasons, including:
Shorter hospital stays and quicker recoveries

  • Vaginal Birth After Cesarean Delivery (VBAC)
  • Less pain during recovery
  • Decreased risk of infection, scarring, and tissue damage
  • Ability to stay awake and involved in the birth of your baby
  • Decreased risk of complications associated with multiple C-sections (i.e. injury to the bladder or bowel, placenta abnormalities, and hysterectomy

TOLAC Risks

The greatest risk of TOLAC is the possibility of rupture of the surgical scar from a prior C-section. The surgical scar is located on your uterus, and if it ruptures, this could pose life-threatening consequences to you and your baby.

The rupture of this scar is rare; however some women are more at risk for rupture than others. The shape and location of the scar affects your particular risk.

  • Low risk: Transverse – The scar runs from the left to right side of the uterus. If you have had one or two transverse C-sections, you may be able to attempt TOLAC with relatively low risk.
  • High risk: Vertical – The scar runs from the top of the uterus to near the bottom. It is recommended that you do not attempt TOLAC.

You will also want to consider a few additional factors when deciding whether or not to try TOLAC.

  • Do you want to have more children after this birth? The greater number of C-sections you have, the riskier it becomes to attempt TOLAC.
  • Have you ever experienced a ruptured uterus before? This significantly increases your chances of a second rupture.
  • Is your birthing facility prepared to handle an emergency situation that may arise from a failed TOLAC?
  • Are there any other factors that may complicate your vaginal delivery (placental abnormalities, abnormally-shaped uterus, macrosomia, malpresentation, etc)?

Discuss your risk with your doctor to decide whether or not a TOLAC should be attempted.

The greatest risk of TOLAC is the possibility of rupture of the surgical scar from a prior C-section. The surgical scar is located on your uterus, and if it ruptures, this could pose life-threatening consequences to you and your baby.

The rupture of this scar is rare; however some women are more at risk for rupture than others. The shape and location of the scar affects your particular risk.

What medications may be used during VBAC?

Artificially inducing labor. As your approach delivery, your cervix will begin to dilate to prepare to allow the baby through. In some cases, a woman’s doctor may administer oxytocin to dilate the cervix earlier or strengthen contractions – this is called inducing labor. Inducing labor may not be recommended for some women attempting TOLAC, if it will increase the risk of uterine rupture.

Pain management. As with any vaginal delivery, women undergoing VBAC should be able to manage the pain with narcotic drugs, a local anesthesia, and/or an epidural, which will numb the body from the waist-down. There is no evidence to suggest that anesthesia will increase the risk of uterine rupture during TOLAC.

Changes to your Delivery Plan

In some cases, women may choose to attempt TOLAC and encounter complications during labor that may force you to change your delivery to C-section. This may occur if something is wrong with the baby, or if you need to have your labor induced. On the other hand, some women may choose to have a second C-section, but then change their plan if they go into early labor and the baby is healthy.

Whatever you decide, be sure to talk with your doctor about the possible changes that could occur during labor, so that you can carefully weigh the risks and benefits prior to the event. Include your birthing partner into your plans so that you have his or her full support throughout your delivery.

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