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Sources:
Mercer, B. M., & Gilbert, S., et al. Labor outcomes with increasing number of prior vaginal births after cesarean delivery. Obstetrics & Gynecology. 2008; 111: 285-291.
Silver, R. M, & Landon, M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics & Gynecology. 2006; 107: 1226-1232.
Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveries. Obstetrics & Gynecology. 2006; 108: 21-6.
Click on a question below to see the answer.
Induction during labor after a cesarean
Induction is not contraindicated in most labors after cesarean, however, the majority of studies show significant risks associated with the use of prostaglandin cervical ripeners in TOLAC. Chemical induction in general has been shown to increase the risk of uterine rupture. When the benefits of induction outweigh the personal risk factors, some may feel comfortable creating an induction plan with their provider.
VBAC after multiple cesareans?
Many women have delivered their babies vaginally, even with more than one prior cesarean. A vaginal birth after multiple cesareans, for many woman, may be a low risk option. It is important that a woman is well-educated and informed before making the choice to VBAC after multiple cesareans. You should discuss this risks, benefits, and alternatives with your healthcare practitioner.
Help! My hospital has a VBAC ban. What can I do?
Many hospitals have bans on laboring after one cesarean, or laboring after multiple cesareans. These bans can make it harder to have a VBAC, however, it does not mean that a repeat cesarean is required. Every patient has the right to informed decision making, which includes the right to accept or decline procedures or medications. You may find the hospital complaint system to be a good starting point in determining birth options.
Who is a good candidate for a VBAC?
Every pregnancy is different and it is important to evaluate your situation carefully with a trusted healthcare provider. Although there are some specific definitions set in place by organizations such as ACOG defining who is and isn’t considered a “good candidate” for a trial of labor after cesarean, they also recommend evaluating individual circumstances with your healthcare provider.
What are the risks of laboring after cesarean?
When discussing a VBAC, uterine rupture is a specific risk that is typically mentioned. Uterine rupture occurs with a separation of the uterine wall. Uterine rupture can be life-threatening and serious, however, the risk of uterine rupture occurring is very rare, affecting less than 1% of those laboring after cesarean with a low transverse incision. Studies show the risk of uterine rupture decreases with each VBAC.
What is a VBAC?
As the meaning behind the acronym implies, a VBAC is a vaginal birth after a prior cesarean. Many people that labor after cesarean will go on to have their babies vaginally (VBAC).
What does ‘VBAC’ stand for?
“VBAC” is an acronym for vaginal birth after cesarean. Other variations of this acronym may be used to describe more specific birth situations, such as HBAC (home birth after cesarean), or VBA2C (vaginal birth after two cesareans).
What are some common reasons a provider might recommend a cesarean?
This is not a comprehensive list.
Obstetrical emergencies like:
-prolapsed cord (where the cord comes down before the baby)
-placental abruption (where the placenta separates before the birth)
-placenta previa (where the placenta partially or completely covers the cervix)
-placenta accreta (where the placenta is too deeply embedded in the uterine wall and has potential for maternal hemorrhage)
-eclampsia/pre-eclampsia (pregnancy-induced high blood pressure, causes severe swelling due to water retention, and can impair kidney and liver function. If it progresses to eclampsia, toxemia is potentially fatal for mother and child.)
Other common reasons we hear for cesarean are:
-fetal malpresentation such as transverse lie or breech (many are not given a full range of options such as vaginal breech birth with a skilled provider or external cephalic version to turn a malpositioned baby)
-suspected cephalopelvic disproportion aka CPD – (meaning that the head is too large to fit through the pelvis. Actual condition is very rare. This is often over diagnosed, and many women do go on to have vaginal births after a cesarean for CPD)
-Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc.)
-fetal distress. (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.)