VBACs are Here
Labor and Delivery is now open at Medical City Frisco. We are excited about the facilities, the staff and our ability to resume offering opportunities to VBAC to more patients.
A VBAC (“V-back”) is an acronym for Vaginal Birth After Cesarean and occurs when a woman who was previously delivered by a Cesarean delivery later has a vaginal birth with a subsequent pregnancy. A successful VBAC allows a patient to avoid another major surgery and affords new moms a quicker recovery and return to normal activity. It also permits the options for future vaginal deliveries for patients who desire a larger family.
The Cesarean delivery rate in Texas is around 34% with many of these deliveries now representing elective repeat Cesarean section without labor. In the 1990s, about 40-50% of women who had a previous Cesarean delivery were offered an attempt to VBAC. That number has dwindled to about 10%. We would like to help more of our patients attempt a trial of labor after their first Cesarean delivery. The VBAC success rate is typically quoted at 60-80%. There are factors concerning the patient and the context of the first Cesarean delivery that influence the rate of a successful vaginal birth after a Cesarean delivery. Clinical predictors of success include a prior vaginal delivery, a prior successful VBAC, going into spontaneous labor, and having a non-recurring indication for the first Cesarean delivery (like breech presentation, baby not tolerating labor, or the placenta being too close to the cervix). Clinical factors that reduce the chance of success include obesity, short stature, carrying a baby weighing over 10 lb., an older mom, induction of labor, failure to progress in previous labor or a Cesarean delivery while pushing, gestational age greater than 41 weeks, and diabetes. None of these clinical predictors are absolutes, they are simply information to take into consideration when deciding if a patient wants to attempt a trial of labor. What we and most of our patients who are interested in VBAC would like to avoid is going through a trial of labor only to end up with another Cesarean delivery, but it is also important to us that any patient who strongly desires a trial of labor after Cesarean and who can do so with reasonable safety be given the chance to try.
We know that recovery from a vaginal delivery is generally easier and faster than from a Cesarean delivery and that certain risks in pregnancy and delivery increase with an increasing number of Cesarean deliveries, so why wouldn’t everyone try for a VBAC? Each of us has a different experience with labor. Some women who delivered by Cesarean section were not given an opportunity to go into labor at all because of a real or perceived contraindication to vaginal birth. Examples include a breech presentation (whether they were offered an attempt at external cephalic version), some twin deliveries, anticipation of a “big baby”, or abnormal location of the placenta. Those patients may have a strong interest in attempting VBAC since they did not get the chance to see if they could have a vaginal birth in the first place. Other patients may have labored for hours (or days) and/or gotten to the pushing stage only to end up with a Cesarean delivery. The memory of that experience can be traumatic and may deter that patient from trying again for a vaginal birth. Despite the potential benefits of a successful VBAC, there are some risks associated with a trial of labor after Cesarean delivery.
- Attempting a VBAC does not guarantee that you will avoid a Cesarean section. The course of labor for an individual patient is unpredictable. Labor could stall or stop, or a situation could arise that necessitates a Cesarean delivery for the safety of a mother or her baby.
- There is a small risk of uterine rupture. After a Cesarean delivery, the weakest part of the uterine muscle is at the site of the previous scar. The stress of the contractions on that scar can cause it to pull apart. The is called a uterine rupture and is a medical emergency. The rate of uterine rupture with one previous Cesarean delivery is 0.5-1%. For some patients, this risk is acceptable and for others it is not.
- We do not offer induction of labor or augmentation of labor for women undergoing a trial of labor after Cesarean delivery. This is related to the risk of uterine rupture. The rate of success for a VBAC is lower with induction of labor and the rate of uterine rupture could potentially increase if the contractions are too strong. Some patients value being able to schedule their delivery or do not go into labor on their own. Scheduling an induction will not be an option for patients attempting a VBAC, whether it is elective (patient’s choice) or because of a medical indication.
The safety of both mother and baby are our top priority. Your eligibility for a trial of labor after Cesarean delivery will depend on the number of previous Cesarean deliveries, the indication for the Cesarean delivery, the type of incision made on the uterus, whether there have been any previous scars on the uterus besides the Cesarean section or previous uterine ruptures. A good candidate for an attempt to VBAC has had only one prior Cesarean delivery, has no reason not to deliver vaginally in the current pregnancy, and we will need to confirm the location of the uterine scar by reviewing the operative report from the previous Cesarean section. After determining from an individual patient’s clinical and surgical history if she is reasonably safe to attempt a VBAC, we will go over the risks/benefits in detail and approve a patient to try for a VBAC if she wants to.
Medical City Frisco is the only hospital we will offer opportunities to VBAC as there is 24-hour on site coverage by a board-certified obstetrician. This enables the physicians at our practice to continue their clinical duties while our VBAC patients are laboring.
Please inquire about VBAC when scheduling your new obstetrical visit if this is something that interests you!