Vaginal birth after cesarean (commonly known as VBAC) is an option for mothers who birthed via a Cesarean section prior to their current pregnancy. While vaginal birth after cesarean was not previously considered a safe option for moms, the most recent research shows that VBAC can be a great option when the patient is an appropriate candidate.
Why Consider a VBAC?
Why choose a VBAC over a repeat cesarean? There are MANY reasons one might chose a VBAC over repeat cesarean, but some of the more common reasons include:
- An individual’s first (or most recent delivery) was an unplanned cesarean and they want the opportunity to experience a vaginal delivery.
- Cesarean births require major abdominal surgery and therefore can have longer and more difficult recoveries.
- Cesareans require an epidural and some women may not tolerate anesthesia well.
- Repeat cesareans come with a risk of increased scarring along the incision which can lead to difficulty with bowel and bladder function, low back pain, pain with intercourse, and infertility. This risk increases to 24.5% for a second cesarean and 46.1% for a third cesarean.
- Cesarean births are 4x more likely to cause blood clots than a vaginal delivery.
It should be noted that uterine rupture was cited as the largest anticipated complication and risk of attempting a VBAC. However, recent research has shown that the risk of uterine rupture is only 0.2% – 0.4% in women who have a bikini cut incision and have at least 2 years between deliveries. It should also be noted that there is a 60 – 80% success rate with attempted VBAC according to the Mayo Clinic.
VBAC Is Not a One-Size-Fits-All Approach
What criteria make a patient a good candidate for VBAC? Those criteria are not limited to, but include the following.
- Low risk pregnancy
- Low-transverse (bikini cut) incision from prior cesarean
- Single delivery ( i.e. not twins)
- 2 cesarean deliveries or less prior to attempted VBAC
- 2 years or more between deliveries
- Spontaneous labor versus induction
- Familiarity of medical team with VBAC deliveries
Some criteria that might make a patient a non-ideal candidate for VBAC are:
- Placenta Previa
- High risk pregnancy
- Multiple birth (twins)
- Breech position of the baby
- Fetal distress
- Medical care team with limited knowledge or experience with VBAC
- Gestation longer than 40 weeks
It should also be noted that no one component alone will make a patient an ideal or non-ideal candidate for VBAC. To have a successful VBAC, there should be great consideration into the patient’s history, desired experience, and presentation at the time of delivery.
So, You’ve Decided to Give VBAC a Try… Now What?
Believe it or not, there are things you can do to prepare your body for a vaginal birth after cesarean. One of the first things I would recommend is having a lengthy discussion with your OB/GYN or midwife. Here are a few things to cover in conversation:
- Discuss their comfort level in attempting a VBAC and their recommendations for what you can do for VBAC preparation.
- Ask if they have experience with vaginal delivery after cesarean, and make sure the facility where you plan to give birth has experience with VBAC deliveries.
- Ask your healthcare provider about the risks associated with VBAC and how those risks apply to you specifically.
- Discuss the reasons for your prior cesarean delivery and ask if that will impact your ability to attempt a VBAC for this delivery safely.
Bottom line: make sure you and your healthcare provider are on the same page. If you are hiring a doula, I would recommend including them in the care plan as well so they can advocate for you if need be. Once you feel confident in the care plan you and your birth team have established, you can start working on the physical preparation for VBAC attempt.
Pelvic Physical Therapy for the Win!
Pelvic PT can be hugely beneficial in helping prepare your body for a VBAC. Here is a look into some of the insights Pelvic PT’s can provide in the VBAC preparation process:
- Pelvic PTs can help assess the muscles of your pelvic floor to ensure that there are no issues that may hinder effective pushing during delivery.
- We can also assess and treat any residual scar tissue along your cesarean scar and in the surrounding tissues of your abdomen. This can help improve pelvic floor function and motor control as the pelvic floor muscles are tied closely to the function of the transverse abdominis (deep abdominals).
- Lastly, we can help instruct you on how to push effectively without excessive strain on your pelvic floor. This typically includes education on the phases of labor, proper timing for an epidural, positioning to assist with cervical dilation and engaging of the baby, and an internal exam to improve the effectiveness of your pushing without placing unwanted strain on the muscles of your pelvic floor and perineum.
Tips for an Empowered VBAC
Knowing more about the labor and delivery process can also help empower you during you VBAC. Here are a few key tips to try and keep in mind in the moment:
Tip Number One: Your Uterus Pushes Your Baby Out
One of the key factors to remember during delivery is that your pelvic floor does not push your baby out… your uterus does. That’s right, your uterus is doing most of the work during delivery and your pelvic floor is just there to assist. So all that breath holding, straining, and excessive pushing you see in the movies… yeah, that’s not right. We want your pelvic floor to eccentrically load (lengthen in a controlled manner like slowly lowering your arm out of a bicep curl) during delivery.
Tip Number Two: Breathe and Release
We also focus on releasing any pressure that has built up in your abdomen as this is happening. That means NO breath holding. To prevent this, you should slowly exhale as you push. This will reduce the pressure in your abdomen and limit excessive strain on the pelvic floor muscles and perineum.
Tip Number Three: The Magic of Motion
Allowing yourself to move for as long as possible can also help progress labor and limit the need for excessive intervention. Movement can help the baby engage into the birth canal and ultimately help progress cervical dilation. Therefore, it is often best to wait until you are between 5 and 6 cm dilated before you receive the epidural. This will ensure you are in the active phase of labor, and will most likely continue to progress without added intervention.
Whichever Way Baby Arrives
Ultimately, you want to choose the birth plan that brings you the most comfort and helps you stay the most relaxed. If that happens to be a VBAC, great. If that happens to be a repeat cesarean, also great! There are cases in which the birthing momma’s anatomy just does not allow for the baby to drop down into the birth canal, no matter what you try. In those cases, the baby has to come out of the sunroof (aka tummy), and that’s okay.
If you do have a repeat cesarean birth, many hospitals have begun offering a family-centered Cesarean. This allows a clear shield to allow mom to view the baby’s arrival along with immediate skin-to-skin with the baby, which can be beneficial for both momma and baby.
Remember, pelvic floor physical therapists specialize in postpartum treatment to help you recover from ALL types of birth experiences. So, whether you have a VBAC or repeat cesarean, be sure to find a pelvic PT in your area to help with your recovery. Lastly, be sure to check out our recommended product list for all the postpartum recovery goodies for both vaginal and cesarean deliveries. Happy birthing to all!
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