Vaginal Birth After Cesarean (VBAC)

According to the AAFP, women who would like to attempt a VBAC should be informed that their chance for success is influenced by the following:

Positive Factors (increased likelihood of successful VBAC):

• Age – less than 40 years old
• Prior vaginal delivery (particularly prior successful VBAC)
• Favorable cervical factors
• Labor begins spontaneously
• Non-recurrent indication that was present for prior cesarean delivery

Negative Factors (decreased likelihood of successful VBAC):

• Increased number of prior cesarean deliveries
• Gestational age – baby is less than 40 weeks
• Birth weight – baby weighs less than 4,000 g (8.8 pounds)
• Labor must be induced or augmented

If you decide to attempt a VBAC and you wish to use pain medication, such as an epidural or narcotics, you should discuss this with your obstetrician well before your due date. Pain relief medications can be used with a VBAC; however, it's important to use them wisely. Epidurals can slow labor and may increase your chance of needing another c-section. However, some studies indicate that if you delay an epidural until you are dilated at least 5 centimeters, your chances of having a cesarean delivery drop dramatically. Narcotics can lessen your anxiety and help relax you and, while they do not increase your chances of having a cesarean, they do affect your physical mobility and may affect your baby because they enter your bloodstream and therefore can cross the placenta.

There are plenty of ways you can help ensure you and your baby are safe during a VBAC delivery. Consider taking a childbirth refresher course to brush up on breathing and relaxation techniques that will help you labor efficiently and reduce stress on your body, or hire a doula to help coach you through labor. And during labor, let your doctor know immediately if you feel any unusual abdominal pain or tenderness.

The best way to prepare for your VBAC is to educate yourself and your partner about the benefits as well as the risks, and what you can expect. Read everything you can on the subject, ask plenty of questions of your doctor or midwife, and talk to other mothers who have experienced a VBAC, as well as those who have never had a cesarean.

If you want to try a VBAC but your doctor is unwilling to let you, and you are not prevented by any physical or medical reasons, then ask to be referred to one who will support you and be with you from the beginning of labor through delivery.

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