Is vaginal birth after caesarean (VBAC) possible? Learn about the suitability assessment, possible benefits and risks, and the decision process.
Vaginal birth after caesarean means a person who had a caesarean in a previous pregnancy trying for a vaginal birth in a later pregnancy. Whether this option is suitable is assessed by your doctor according to your previous caesarean and the features of this pregnancy. The general logic of the assessment, the possible benefits and risks, and how the decision is made are covered in turn.
What is vaginal birth after caesarean (VBAC)?
A trial of vaginal birth after caesarean, known in medicine as "VBAC" (vaginal birth after caesarean), describes trying for a vaginal birth in a later pregnancy even though you have had a previous caesarean. It is not an option that is suitable in the same way for everyone; it is assessed specifically for you according to your history.
Who can this option be considered for?
Most people who have had one previous caesarean are informed about this and the option is offered to them; this assessment is made in a setting where a quick caesarean can be done if needed. The reason for and number of your previous caesareans and the general course of your earlier births are among the factors that play a part in this assessment. None of these factors on its own gives a definite "yes" or "no"; your doctor assesses your whole history together. If your previous caesarean was for an urgent reason, this does not automatically restrict your preference this time; the reason for the previous caesarean is one of the factors taken into account in the assessment, and it is not approached in a blaming way.
What are the possible benefits of a trial of vaginal birth after caesarean?
This trial may have some possible benefits that vary from person to person; your doctor shares them with you according to your situation. How important these possible benefits are for you depends on your own values and priorities; for this reason there is no single "right" answer for the decision. To help you understand what the decision means for you, this conversation can be started early in your pregnancy.
What are the possible risks of a trial of vaginal birth after caesarean?
In a trial of vaginal birth after caesarean there is a small likelihood of the womb tearing; this likelihood is lower when labour starts by itself. This is mentioned as part of the informed decision process rather than as a reassurance about safety; even so, it is important to remember that you should not wait if you notice symptoms such as severe or sudden abdominal pain and heavy bleeding.
When and how is this decision made?
The basis of this decision is your doctor giving you enough and understandable information and this information being assessed together with you. The conversation can go on throughout your pregnancy, and starting it early is recommended. The trial is assessed in a setting where a quick caesarean can be done when needed; institutional practice on this should be asked of your doctor or your institution.
Should labour start by itself?
When labour is induced or augmented, the likelihood of the womb tearing may change to some extent. This does not mean that induction or augmentation is completely ruled out; whether it is needed and how it will be done is assessed by your doctor according to your situation.
What happens if a problem arises during the trial?
The health team closely monitors the trial. If the situation changes, an explanation is given to you and, if needed, a move to a caesarean can be made; this does not mean a decision taken beforehand was wrong, it is a decision suited to the situation at that moment.
How can you think about your worries about birth after a caesarean?
The idea that a trial of vaginal birth after caesarean carries no risk at all, or that it is excessively risky, is not balanced; the decision is made by weighing the possible benefits and risks together. This assessment is not left only to your wish or only to your doctor's decision; it is an informed and shared process. Your own birth history is treated in its own right; you do not need to compare it with someone else's experience.
How can you support yourself?
- Share information about your previous caesarean (the reason, and the type of cut if known) with your doctor.
- Start this conversation early in your pregnancy.
- Go to your appointment with your questions written down.
- Share your worries, or your feelings about your earlier birth experience, with your doctor.
- Try to share records and documents about your previous caesarean (if you have them) with your doctor.
What can you ask your doctor during the assessment?
- According to my history, can this option be considered?
- What are the possible benefits and risks of this trial?
- What changes if labour does not start by itself?
- In which setting can this assessment be done?
- How does the process go if a problem arises during the trial?
- If I want to get a second opinion, how does this process go?
Frequently Asked Questions
I have had a caesarean; does this mean I definitely cannot have a vaginal birth?
No. Having had a caesarean does not mean a vaginal birth is definitely not possible in a later pregnancy. A previous caesarean is not an obstacle to talking about this option but the starting point of the conversation. Saying "it is not yet known, we will look together" is not the same as saying "you are not suitable".
How do I find out where I can give birth?
You can ask the institution where you are thinking of giving birth, early in pregnancy, whether a trial of vaginal birth after caesarean is assessed there. You can also ask the doctor following your pregnancy for help in getting the answer.
I cannot get hold of the record of my previous caesarean; is that a problem?
If possible, trying to get hold of the records of your previous caesarean (such as the reason and the type of cut) helps the assessment. If you cannot get the record, giving what information you remember can also be part of your doctor's assessment; this does not prevent you from talking about this option.
Does having had a caesarean mean this option is suitable for everyone?
No. The option is assessed with your previous caesarean and the features of this pregnancy. It is not suitable in the same way for everyone.
Does the reason for the previous caesarean decide on its own?
No. The reason for and number of caesareans and the course of earlier births are assessed together. That the previous caesarean was for an urgent reason does not automatically restrict your preference.
Can I start this assessment early in pregnancy?
Yes. Starting to talk about the possible benefits and risks early is recommended. The conversation can go on throughout pregnancy.
Do the facilities of the institution matter for the trial?
Yes. It is assessed in a setting where a quick caesarean can be done when needed. You should ask your doctor or the institution where you are thinking of giving birth about institutional practice.
Are induction or augmentation of labour completely ruled out?
No. The likelihood of the womb tearing may change; but this does not mean these practices are completely ruled out. Whether they are needed and the method are assessed according to your situation.
Does a move to a caesarean during the trial show the first decision was wrong?
No. If the situation changes, an explanation is given to you and, if needed, a move to a caesarean is made. This is a decision suited to the situation at that moment.
Should I wait if there is severe or sudden abdominal pain or heavy bleeding?
No. It is important that you do not wait when you notice these symptoms. While talking about the possible benefits and risks, you can also put your questions about seeking care to your doctor.
Does the decision depend only on my wish or only on the doctor's?
No. The decision is a shared process based on enough and understandable information. Your values and priorities are also taken into account.
Does someone else's birth experience show whether I am suitable?
No. Your own birth history is assessed in its own right. You do not need to compare it with others' experiences.
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