Making Informed Decisions About VBAC or Repeat Cesareans

Some mothers who have a cesarean know before becoming pregnant again that next time they want to plan a VBAC. Other mothers are  sure they want a repeat operation. For some mothers the decision is sometimes difficult to make.  Each woman is different and has the right to decide for herself based on the best evidence, her prior birth experience, and what medical care and support is available to her to make the decision that feels best for her and her family.

What You Should Know About VBAC

VBAC is a safe alternative to a routine repeat cesarean. If you have a healthy pregnancy, have a low horizontal scar on the uterus and go into labor on your own at term you have about a 70% to 75% chance that you and your baby will have a safe normal birth. Many hospitals and care providers no longer support women who want to plan a VBAC, not because it is not safe, but because of fear of a malpractice suit. Many hospitals  feel it is too expensive to keep a full surgical team and anesthesia on stand-by, “immediately available”  as recommended by the American College of Obstetricians and Gynecologists guidelines for VBAC. The National Institutes of Health states that this recommendation is not based on  high quality evidence.

Not all hospitals can provide an “immediate” cesarean, but most can provide one in 30 minutes or less. The American Academy of Family Physicians (AAFP) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) disagree with the “immediately” available recommendations. The AAFP states that health outcomes are not improved for mothers or babies when women labor in a facility that can perform an “immediate” cesarean.

Who Can Plan a VBAC?

Women with one or two low horizontal  uterine scars or a low vertical scar. Women who had one vaginal birth or not. Women who had a cesarean for a “big” baby, “failure to progress”, a breech, or non-reassuring fetal heart tones (fetal distress). Some women expecting twins or a “big” baby. Women who go past their due date or go into labor before their due date and the baby is expected to be of normal weight. Women who will labor for a VBAC  18 to 24 months after  their prior cesarean. Women who may want an epidural for pain relief.

Where is it Safe to Labor for a VBAC?

Thousands of VBACs have taken place in a hospital. So we have much information about the safety of laboring for a VBAC in a hospital. However, hundreds of hospitals In the U.S. have decided they will no longer care for women who want a VBAC. The International Cesarean Awareness Network has documented over 300 U.S. hospitals that do not offer medical care for VBAC.

Although obstetric professional societies worldwide do not recommend laboring for a VBAC at home, many women are choosing to have a VBAC at home rather than be forced to have a repeat cesarean when no medical reason exists.

Although some women plan to have their VBAC at home, to date there is not enough information about the health outcomes of home VBACs. So it’s difficult to know. Some caregivers support women who want a home VBAC and have established a relationship with a local medical facility and a physician in case of complications.

If you plan to have a VBAC at home, think about what you would need to have in place in case you needed to be transferred quickly to a hospital.

  • How far is the nearest medical facility?
  • Who will go with you?
  • How will you get there?
  • How will you be cared for until you arrive?
  • When you arrive will the medical staff be ready to care for you?
  • Will there be an obstetrician available?
  • Will there be an operating room available if you need surgery?
  • Will there be appropriate emergency care for your newborn if needed?

Where You Can Find Out About VBAC-Friendly Providers?

Although many hospitals have stopped providing care for women who want to plan a VBAC, there are resources you can access. At this time, in the United States all Level III hospitals, those that have emergency obstetric services available at all times and a neonatal special care nursery meet the current ACOG recommendations for VBAC. These are usually large hospitals affiliated with a medical school. Call the hospitals covered under your medical insurance plan, ask if they support VBAC. If they do ask for the names of three providers on their staff.

You can also access childbirth educator and doula organizations websites. Find members’ names in your city or state. They may be familiar with VBAC-friendly providers. Check also midwifery organizations www.mothersnaturally.org, www.mymidwife.org,  the American Academy  of Family Practioners www.aafp.org,  and  BirthNetwork National to find out about VBAC-friendly care providers.

VBAC Finder lists hospital VBAC rates for each state in the U.S.A.

If you are thinking about having a VBAC in a birth center.

Women who labor  in a birth center are more likely to have a VBAC. Find out more about having a VBAC in a birth center by contacting the American Association of Birth Centers. Find out what emergency measures are available to you in the event that you develop complications in labor.  Women who labor for a VBAC in a birth center and do not develop complications are more likely to have a normal birth. However, if you need an emergency transfer timing is very important.

Resources To Make Informed Decisions About VBAC Or Repeat Cesarean

For women to make a truly informed decision about how to give birth after a prior cesarean they need access to comprehensive, accurate, evidence-based information. The following reliable resources can give women a better understanding of the benefits and risks of VBAC and repeat cesarean.

InformedMedicalDecisions.org

Childbirth Connection, Should I Choose VBAC or Repeat C-Section?

Coalition for Improving Maternity Services, The Risks of Cesarean Section & Expectant Mothers’ Checklist

Lamaze International, Preparing for Natural Birth: Pushing Past a Previous Cesarean (webinar)

About VBAC, Natural Childbirth Tips From Midwives, a video

British Columbia Women’s Hospital, Power To Push Campaign, Vaginal Birth After Cesarean

British Columbia Women’s Hospital, Birthing Misconceptions

Science & Sensibility Blog, A Woman’s Guide to VBAC,

The Vermont/New Hampshire VBAC Project, Birth Choices After Cesarean

King Edward Memorial Hospital, Western Australia, Vaginal Birth After Cesarean

Royal College of Obstetricians and Gynaecologists, Birth After Previous Cesarean: Information For You

Our Bodies, Ourselves, VBAC or Repeat Cesarean Section?

Society of Obstetricians and Gynecologists of Canada, Vaginal Birth After Cesarean Section (VBAC)

Inne-Cesarea, Spanish Language website

Updated January 4, 2014. .

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