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A VBAC, or vaginal birth after cesarean, is when a mother delivers her baby vaginally after having previously delivered a baby via cesarean, or c-section. Until the late 1970s, mothers could not hope to deliver a baby vaginally after having a c-section, due to the limits of medical knowledge at the time. The 1980s and 90s saw an increase in VBACs due to increased medical research and knowledge, as well as the increase in mothers demanding more freedom of choice in their deliveries. Now, due to legal restrictions, hospital policies, and soaring malpractice premiums, VBAC rates have dramatically dropped again.
Cesarean deliveries, which involve a horizontal incision below the “bikini line” and along the muscle fibers to deliver a baby, account for approximately one million births per year in the United States. In 1970, the rate of c-sections was about 5%, whereas in 2005, the rate stood at 28%.
Today, obstetricians are split on the VBAC debate. Some are cautious and deliver only via c-section after an earlier cesarean. Regardless of whether they believe it is safer to deliver vaginally or via cesarean, many of these doctors’ hands are tied by hospital policy, state regulations, or their malpractice insurance. Other obstetricians leave the decision to the mother, as long as she is a good candidate for a VBAC.
For those arguing against a VBAC, safety for the fetus and mother is their primary concern. They argue that risking a VBAC could result in rupture of the uterus, severe blood loss, lack of oxygen to the baby during delivery, infection, and at worst, infertility or death of both the baby and mother. Although the risk of uterine rupture in a VBAC is less than 1%, it is not a risk many doctors are willing to take. An unsuccessful VBAC can carry higher risks of complication than a successful VBAC, and the birth results in a c-section anyway. Supporters of cesareans argue that the convenience of the deliver is another plus; it is convenient, the mother avoids a long and painful labor, and she can choose her child’s birthday.
Women who want to attempt a VBAC have about a 60 to 80% chance of success, especially if they are a good candidate for it. Recent medical research supports VBAC, if only to avoid potentially dangerous major abdominal surgery. Proponents of VBAC argue that c-sections have a higher rate of re-hospitalization after birth, subsequent uterine rupture in following births, and infertility. A 2005 study showed that 11% of all c-sections were unnecessary, and 65% of second c-sections were unnecessary. Recently, Consumer Reports magazine named a cesarean number three on its list of “12 Surgeries You May Be Better Off Without.”
The debate rages on, and it is becoming more difficult for women to make the decision themselves. Over 300 American hospitals nationwide have banned VBACs. One hospital even went as far as to take a woman to court to force her to have a cesarean after an ultrasound revealed a possible 13 lb (5.9 kg) baby that would be difficult to deliver vaginally. She was able to successfully deliver what turned out to be an 11 lb (4.99 kg) baby vaginally at another hospital.
If your doctor is open to a VBAC, you will have to meet certain criteria to attempt one. You can only have had one c-section with a horizontal, or low-transverse, incision. Your pelvis should appear large enough to accommodate a baby’s passing through it. You should have had no other uterine surgery or past uterine rupture. In addition, you cannot have any other medical condition that would make vaginal delivery dangerous. As a precaution, a physician and anesthesiologist must be available throughout your entire delivery in case you require an emergency cesarean.
The requirement that an anesthesiologist be available right away is why a lot of hospitals don't "allow" VBAC. If you really have your heart set on a VBAC delivery, fight for it! Some very determined moms have actually had successful VBACs at hospitals that "forbid" them.
They just showed up at the hospital in labor and refused a C-section, as many times as necessary. Some have gone so far as to drive to the hospital and stay in the car until the last minute so they couldn't be forced into a repeat C-section. (I don't know that I would take the risk, personally, but then a repeat cesarean has its own, not insignificant, risks.)
There actually are some providers and facilities that will allow a "VBA2C" - a vaginal birth after two cesareans. You do face all the vbac risks and they're increased, but it's not out of the question, especially if the reasons for your earlier cesarean births no longer exist. (For instance, maybe your previous babies were breech, but this one is head-down.)