Understanding Vaginal Birth After Caesarean (VBAC)

Across cultures and throughout time, childbirth has been a transformative experience, revered for its power and wonder. From honouring this rite of passage with birthing rituals to recognising the inherent strength of bringing new life into the world, our focus has always been on the profound nature of birth. However, in recent times, the medical landscape has evolved, introducing interventions that can be definitely valuable tools when needed but are not something that are always necessary.

One procedure that has particularly impacted the foundations of normal delivery is the caesarean section, or c-section. What was once an emergency procedure reserved for the most complex deliveries has now become almost routine, with quite alarming c-section rates in India. 

However, there’s a growing interest in revisiting the childbirth experience. This movement aims to reconnect with the inherent power and emotional aspects of birth. This movement is called VBAC: Vaginal Birth After C-section. And it is nothing short of revolutionary.

Going back to VBAC!

VBAC delivery is the process by which a woman who has previously had a caesarean delivery opts to have a vaginal birth for her subsequent pregnancy. It offers a chance to experience bodily autonomy, the visceral connection, and the sheer primal power of unmedicated childbirth. Medical research has shown that for many women, it is a safe and viable option. Studies have found that VBAC childbirth has a success rate of 60-80% for eligible candidates. The risks, while present, are low – with uterine rupture occurring in less than 1% of VBAC attempts. Repeat c-sections also carry increased risks of complications, such as haemorrhage and infections.

Despite these compelling statistics, VBAC faces an uphill battle. Many hospitals and providers are hesitant to offer or support the procedure, fearing liability issues. And there is still a pervasive cultural narrative that paints c-sections as the “easy” or “convenient” choice and the ever-present “once a c-section, always a c-section”.

This is where you, the expectant mother, have the power to change the tide. By educating yourself, advocating for your preferences, and actively participating in your birthing journey, you can help shift the paradigm. You can reclaim the primal rite of passage that is childbirth.

It starts with candidacy. Not every woman will be eligible for a VBAC attempt, but many more are than you might think. 

Are you the right candidate?

To help you navigate this decision, let’s dive into the key considerations that will determine if you’re a suitable candidate for VBAC. By understanding the nuances and addressing the common concerns, you’ll be better equipped to make an informed choice that aligns with your personal preferences and medical history.

• First and foremost, the number of previous c-sections you’ve had plays a crucial role. Contrary to popular belief, you may very well be a candidate for VBAC even if you’ve undergone one c-section in the past. The key is the placement of your previous incision – a low, horizontal “low transverse” incision is generally considered the most favourable for a successful VBAC.

• Another important factor is whether your previous labour was induced or occurred spontaneously. You are a more favourable candidate if your previous labour was spontaneous, and if you progressed well last time.

• The timing between your pregnancies is also a consideration. Ideally, a woman with a previous c-section may want to wait at least 18 months before becoming pregnant again. This allows the uterine scar to heal properly, reducing the risk of complications like uterine rupture.

• It’s important to remember that VBAC is a possibility for many women who have had a previous caesarean section. Certain factors, like breech presentation or placental issues in the first pregnancy, don’t necessarily exclude you from VBAC. These are often one-time occurrences, and your healthcare provider can help you determine if VBAC is a safe and achievable option for your individual situation.

Equally important is finding a supportive care team – one that will empower you to make informed decisions. Interview potential providers, ask about their VBAC rates and policies, and don’t be afraid to switch if you don’t feel heard. Throughout your pregnancy, educate yourself on the VBAC process, the risks and benefits, and your rights as a mother. And when the time comes to deliver, remember to breathe, to trust your body, and to allow the primal rhythms of birth to guide you. 

So, VBAC is not merely a medical procedure…

It is an act of self-determination. As you take on this journey, remember the words of the legendary midwife Ina May Gaskin: “We must trust the wisdom of the female body.” Myths and passed down wisdom does not necessarily define you. Your power, your autonomy, your baby – they are yours to reclaim.