Have you heard of Vaginal Birth After Cesarean or VBAC? Did you know that more and more women in the Philippines who had a caesarean delivery are choosing this birth option for themselves and their children?
Simply put, a VBAC is a vaginal birth after a previous caesarean birth. A wonderful r
esource to learn more about VBAC is the book “The VBAC Companion (Expectant Mother’s Guide to Vaginal Birth After Cesarean)” by Diana Korte. “Having a VBAC is not exactly the same as “just” having a vaginal birth. You need to look at the big picture. It is important that you know why you had your caesarean/s and what you can do differently in order to have a vaginal birth,” says Korte. “Armed with sound information and moral support—and with no true contraindication for a vaginal birth—the odds are good that you will have a VBAC this time around.”
VBAC or Repeat Caesarean?
In any pregnancy and birth, there are risks involved. VBAC has risks and so do repeat caesareans. For the past decades, studies show that VBACs pose fewer risks than repeat caesareans, and repeat caesareans more than triple the risk of maternal death,[1] and each caesarean increases the mother’s risks to placenta complications.[2] Still, VBAC is underused. Ninety percent of women with past caesarean are actually candidates, yet only 10% get a VBAC because of fears and wrong information.[3]
Top on the list of fears for many women is the dreaded idea of uterine rupture, or the sudden opening of the caesarean scar. Obstetrician Bruce Flamm and his team studied 11,000 VBAC women in California in 1994, and observed a rupture rate of only 0.5%. Also, the risk of uterine rupture decreases by 50% after the first successful VBAC and did not increase with additional VBACs.[4] The safest incision for a VBAC and the least likely to rupture is the low left-to-right horizontal incision. Some doctors would require your incision to be so in order to count you as a candidate. Good news, most, if not all, caesarean incisions are done in this way for the past decade or so.
Key Ingredients of a VBAC
One key ingredient in one’s VBAC journey is education. Knowledge is power for Claire who had her VBAC in 2017. “If I had not known that there is such a thing as VBAC, then it was not an option for me at all. After reading a lot of VBAC stories, I found my supportive OB and gained the support of my husband who helped me all the way despite his initial apprehension,” shared Claire.
Mithi, who also had her VBAC in 2017, says, “Educate yourself! At the start of your pregnancy, read books and do research. It is important to attend childbirth classes and prepare yourself physically through exercise and healthy eating. Closer to birth, create a birth plan with Plans A and B, which you have carefully studied with your partner, doctors and midwives, and doulas. ”
Another key ingredient for a VBAC is a supportive and skilled provider, not just one who
will let you try.[5] The American College of Obstetricians and Gynecologists (ACOG) strongly urges its members to encourage women to plan for labor rather than schedule a repeat surgery, simple because they had a previous caesarean.
The ACOG, American Academy of Pediatrics, and the American Academy of Family Physicians base this recommendation from a multitude of research that prove that babies are healthier, mothers have fewer problems, and both go home sooner from the hospital after vaginal births.
Advantages of a VBAC
In “The VBAC Companion”, Korte discussed the advantages of having a VBAC.
- Babies born vaginally are usually born when they are ready, rather than prematurely by surgery. Waiting for labor to start on its own is a first step to a natural birth.
- When born through the birth canal, babies and mothers experience a late-stage adrenaline rush that allow them to go past the exhaustion of labor and prepare for bonding. It has always been observed that mothers who give birth naturally find a second wind close to when baby is about to come out, and even more when baby is finally in her arms. The newborn, even having to go through his/her own challenge of navigating the birth canal also has energy to suckle on the breast as an instinct for survival. In addition, the baby’s passage through the birth canal and exposure to adrenaline also allows for a manual squeeze that puts pressure on the baby’s chest to push fluid out of the lungs, esophagus, nose, and throat. Babies born this way have healthier lungs.
- In the immediate postpartum stage, babies enjoy early and frequent contact with mothers. As a result, they are most likely to breastfeed and to be nursed for a longer period.
- For mothers who had VBAC, the risk for infection after the birth drops from as high as 35% (with a caesarean) down to 2-4%. They also recover more quickly physically, sometimes by many months, and do not experience caesarean depression.
- On the practical side, the parents will also probably save out-of-pocket money because of a shorter hospital stay, no operating room costs, and fewer drugs and less anaesthesia.
Overcoming Self-Doubt
The average VBAC success rate is 70-80%.[6] But because of their previous experience and society’s misconceptions about birth, many women still have doubts about their ability to give birth. Especially for those who were previously disappointed or traumatized, some women believe that their bodies are not fit for labor, that they can’t stand the pain, or that their babies are too big and can’t fit the birth canal. Some may even think that attempting a VBAC is self-indulgent and does not take into consideration the safety of their child. There may be others who fear being disappointed if they end up going through another cesarean in the end.
Junessa had her repeat caesarean after labouring strong in 2016. “After having gone under repeat caesarean, I initially had some sadness because it was not the birth story I really wanted. But I realized that this day is the bravest day of my life! I couldn’t believe that I went up to almost 10 cm without complaining and without asking for pain medications. With every breath I took, I inhaled love for my child and exhaled confidence that I can give birth. I knew I did a great job, up to the last minute, to the best I can!”
Mothers like Junessa compare their first and second caesareans, and find achievement in their attempt for a VBAC. Their stories are just as full of triumph and insight as other VBAC stories. They also serve to remind us that in any effort, no one can be guaranteed a 100% success rate, but an important factor is that they did everything in their capacity to try.
Mithi concludes, “Please do not ever doubt your ability to give birth. My belief in my strength was my driving force from the beginning of my pregnancy until the end.”
Read more of their birth stories here:
Claire’s 3-Part Birth Story: My Dream Birth, My VBAC
Junessa’s Birth Story: The Bravest Day of My Life
And many others in the Pinay Doulas Collective blog.
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[1] Crowther, C.A., et al (2012). Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial. PLoS Med. 2012
[2] National Guideline Clearinghouse (NGC). Guideline synthesis: Vaginal birth after cesarean (VBAC).
[3] Ibid.
[4] Mercer, B., et al (2008). Labor Outcomes with Increasing Number of Prior Vaginal Births after Cesarean Delivery. Obstetrics & Gynecology.
[5] National Guideline Clearinghouse (NGC). Guideline synthesis: Vaginal birth after cesarean (VBAC).
[6] Ibid.
Doula Ros Padua is a Certified Birth Doula under DONA International (Doulas of North America) and a Lamaze Certified Childbirth Educator (LCCE) of Lamaze International.
She is also a mom who gave birth to her second child via VBAC on October 2019. Stay tuned to this blog for her birth story to be shared soon.