To VBAC or not to VBAC? What you need to know about vaginal birth after caesarean

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 Photo: Getty Images

When Erin Reynolds fell pregnant with her second child, she immediately knew that she wanted to try for a VBAC – that is, a vaginal birth after having a caesarean with another birth.

"I had an emergency c-section with my first child, and the pain was horrible for months after," Erin says.

"I felt like a vaginal birth was the natural and best thing for me second time. Because my husband is in a FIFO role, I was also going to be caring for a newborn and a 17 month old by myself so needed a quick recovery."

Despite being told that her chances of having a successful VBAC were slim, Erin remained positive.

"I felt like I knew that my body could do what it was made for," she says.

And she was right – with the help of a supportive medical team, who kept her informed through the pregnancy and birth, she succeeded in her goal of having the baby vaginally.

However, her story doesn't finish there: 10 weeks after giving birth, Erin found out she was pregnant again.

"The two VBACS were only 11 and half months apart, and I did worry that it wasn't going to be long enough. But with my third child I laboured very quickly and almost didn't make it to the hospital on time," she says.

With two successful VBACs under her belt, Erin has no regrets about her decision.

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"Having three under 2 1/2 was more of a worry to me than labour – or what could happen during labour," she says.

Unfortunately, it's not the same story for everyone.

Jade Glen wanted a VBAC with her second child, but things didn't go according to plan.

"I wanted a VBAC because I wanted to be able to pick up my toddler after birth," she says.

"I also felt some pressure that it was the 'right' way to birth."

Despite her hopes, when it came to her labour Jade's cervix didn't dilate and her baby went into distress.

"It ended up being a long labour, just the same as my first, and I was just happy to have her born safely," she says.

"In fact, I was almost relieved when they called for the c-section."

Fortunately for Jade, her recovery was really good the second time round.

With hindsight, however, she says there's not much information about when a VBAC fails. 

"A lot of the information online is from women who have had a successful VBAC and describe it as an excellent experience," she says.

So what are the things we need to know when considering a VBAC?

Dr Stephen Robson, president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, says that birthing is all about a woman's choice and this should be encouraged.

"I think it's important that women – and their partners, for that matter – spend time discussing every aspect of their pregnancy care and birth with the person caring for them," he says.

Dr Robson notes that every situation is different, and should be assessed that way.

But women should never feel forced into choosing a birthing option that's not right for them.

"If, after careful assessment by their maternity care provider, there seems to be no reason why a woman shouldn't be offered a chance at VBAC, then the opportunity should be provided," he says.

In terms of VBAC success rates, Dr Robson notes that these can vary anywhere from 30-75 per cent, depending on a number of factors. These include age, medical history and the history related to prior births.

Ther are some cases, however, where a VBAC would be ruled out.

"A VBAC should not be considered where the previous caesarean was complicated, such as requiring an up-and-down cut on the uterus, or where there was a complex tear," says Dr Robson.

"These make rupture of the uterus during an attempt at labour much more likely."

A VBAC should also be avoided if there are other pregnancy complications, such as a low-lying placenta (praevia).

"It's always important to be clear about what happened with the caesarean birth, or whether there are complications in the current pregnancy," says Dr Robson.

"Another key thing to consider is the place where the woman intends to have the baby. If the facilities to manage complications aren't available, then don't take risks."

In summary, Dr Robson says the main thing for women to do is have open conversations with their maternity carer throughout the pregnancy.

"Every woman and every pregnancy is different – there's no one-size-fits-all answer," he says.

"Take the time to talk things through, get as much quality information as possible, and decide on a plan that you're comfortable with."