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VBAC? Weighing the Pros and Cons

Updated: Jan 15, 2023


If you have had a prior Cesarean section, you may be faced with the choice of pursuing a VBAC. We will be discussing the pros and cons of proceeding with a VBAC as well as when VBAC may not be appropriate.



What Is a VBAC?


VBAC stands for vaginal birth after Cesarean section. Your provider may present you with the option of pursuing a VBAC depending on your clinical history and current pregnancy.


What Are the Benefits of VBAC?


One main benefit of VBAC is a quicker recovery time on average. There is no surgery, so physical healing is generally faster. This may allow you to feel better during your baby’s first few weeks. Since VBAC does not involve abdominal surgery, there is a lower risk of infection. Additionally, there is less blood loss. Some women with a history of Cesarean section may also desire to have the experience of vaginal birth. Finally, if multiple future pregnancies are planned, VBAC may help avoid issues with the placenta during future pregnancies.

What Are the Risks of VBAC?


The main risk of VBAC involves the potential that the scar from the prior Cesarean section may rupture. The type of incision that you had in the past may make rupture more likely. The most common type of Cesarean incision is low transverse. This involves a side-to-side cut made across the lower part of the uterus. This involves a lower risk of rupture. A second type of incision is a low vertical incision. This involves an up-and-down cut made in the lower part of the uterus. This type of incision involves a greater risk of rupture as compared to a low transverse incision. The third type of incision is a high vertical incision. This is an up-and-down cut made in the upper part of the uterus. This type of cut involves the greatest risk of rupture.


How Do I Determine the Incision Type?


Looking at the skin alone cannot reveal the type of cut made on the uterus. It is important to discuss this with your provider. Your prior medical records, including the operative report, should provide these details.


Will a VBAC Be Guaranteed?


Even if you desire to proceed with VBAC, some facilities or providers do not perform VBAC due to safety concerns. It is best to determine if this is an option at the outset of pregnancy. Additionally, there could be clinical changes that require a change in plan. Complications with labor may require a repeat Cesarean section.


Takeaway Message:


Women with a history of Cesarean section may be presented with the option of pursuing VBAC. Advantages of a VBAC include quicker recovery time and less risk of infection. The main disadvantage of VBAC is potential for uterine rupture. Your individual clinical presentation and type of incision play a role in the risk of rupture. It is important to fully discuss your options with your provider prior to making a decision.

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