Previous C-section?

If you’ve already given birth by cesarean section, you’ve probably heard the term VBAC (vee-back). It stands for, you guessed it, vaginal birth after cesarean.

And if you know that lingo, you probably know how controversial VBACs are. Your provider may be discouraging it, the hospital may not allow it, and your family and friends may be begging you not to do it.

Here’s the truth about VBAC: Because you had surgery last time, you have scar tissue. Just like the scar you can see on your belly, there’s one on your uterus and abdominal lining — on every layer that was cut. The scar on your uterus can complicate future pregnancies. Statistically, you’re more likely to develop placenta previa (when the placenta implants over the cervix) and other serious placental complications, called accreta, when the organ grows into the scar. Once extremely rare, accretas are on the rise as the C-section rate increases, which is one big reason to avoid an unnecessary cesarean in the first place.

The other concern with this scar is that when you go into labor it could separate, or “rupture.” According to the many studies looking at women who plan VBACs in hospitals, the chance of a rupture is very small, about 1 in 200, or half a percent. If a rupture happens, you have an emergency cesarean, and 9 times out of 10, the baby is healthy and fine. Statistically, this works out to 1 in 2000 VBAC babies who are harmed or don’t survive due to a uterine rupture.

And those odds are excellent. Consider this: a healthy woman having a first-time vaginal birth has the same odds of losing her baby.

Most women who try VBAC have a vaginal birth — around 75% in hospitals. So, if you’re a woman in the difficult situation of making this choice — VBAC or repeat surgery — it might help to think about it this way: if you choose surgery, you have a 100% chance of having surgery and the risks it entails, plus the added risk to your next pregnancy of those placental complications. And remember that other scar tissue? In surgeon’s terms they’re called “adhesions.” They make repeat surgeries more difficult, risking you more blood loss and damage to the surrounding organs.

If you choose to plan a VBAC, you have a 75% chance of avoiding all that, and while you do have the very small risk of a rupture, you’re weighing that against the many risks and drawbacks of repeat surgery. Plus, as a recent CDC study suggests, babies born by cesarean are less likely to survive the first three months of life. Again, spontaneous, physiological, vaginal birth is optimal, for both you and your baby.

Be aware though: VBAC women are often encouraged to induce and be monitored continuously during labor — a textbook pushed birth. That means you might have to fight for a physiological VBAC (and you have good reason to; induction drugs increase your chance of a rupture!). All this is stress you don’t need. And according to surveys, more than half of you will be told by your OB, midwife, or hospital that you’re not “allowed” to VBAC. If that is what’s happening, your right to choose isn’t being respected, and you may need to look for a new provider.

For this, you’ll need all the help you can get:

  • ICAN – The International Cesarean Awareness Network has a lively and supportive e-list that can connect you with pro-VBAC docs, midwives, and doulas in your neighborhood. Sign up for it here.
  • Childbirth Connection — A group devoted to providing women with accurate scientific information, it has published an exhaustive review of the medical literature on cesarean and VBAC. This primer will be most helpful.
  • National Advocates for Pregnant Women — Believe it or not, some women have been forced into the operating room, in complete violation of their constitutional rights. If you’re in need of legal help to give birth, these are the folks to call.

Click here for VBAC-related stories.