Vaginal Birth After Cesarean — VBAC - Oakdale ObGyn
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Services Vaginal Birth After Cesarean — VBAC

If you have had one or two prior cesarean deliveries, you have options for your delivery with this baby. Like most choices in life, there are risks and benefits to each option. A successful vaginal delivery after cesarean (VBAC) carries the fewest risks to both mother and baby. At Oakdale ObGyn, we support your decision to attempt a VBAC.

It is important to note that there are some instances when it is not safe for you to labor after having a cesarean. Typically this is because of a “classical” or up and down incision on your uterus. Your scar, or skin incision, is not always the same as your uterine incision. If your cesarean was performed at another hospital, it will be important to obtain your medical records to determine what type of uterine incision was made.

Here are some frequently asked questions we hear from our patients. Review these and let us know if you have more questions. We’re here to listen and help.

What are the risks to VBAC?

The most concerning risk associated with a VBAC is uterine rupture, which can happen in labor. A trial of labor after a cesarean section is sometimes abbreviated TOLAC. The risk of uterine rupture is small, however several factors can increase the chance of this complication. If you go into labor spontaneously, the risk is estimated at 0.5%. This is 1 woman in 200. If your labor is induced, the risk is estimated at 1.5%, 3 women in 200, and rises to 3% if you are induced past your due date, 6 women in 200.

In addition to induction, obesity, an unfavorable (not dilated) cervix, a large baby (greater than 9 pounds), a short time between your cesarean and your next delivery (less than 18 months), all increase the risk of rupture. If at the time of cesarean, your uterus was closed with only one layer of suture, this can increase your risk of rupture as well. While uterine rupture is rare, it can be very serious for both mom and baby. If rupture occurs, hysterectomy may be needed, and there is a 1 in 12 chance that baby will not survive.

What are the risks of scheduled repeat cesarean section, typically performed at 39 weeks?

There are always risks with a surgical procedure. Any time an incision is made in the skin, bleeding occurs. Blood loss with a cesarean section is typically about 700 ml, or about 3 cups. With a vaginal delivery, blood loss is usually about 300 ml, or just over 1 cup. There is a risk of infection after surgery as well. There is a risk of damage to other organs near the uterus. This includes your bladder and bowel.

The most concerning risk with cesarean section is an abnormal growth or location of the placenta in a future pregnancy. Your placenta can be over the cervix, called placenta previa, and this can cause significant vaginal bleeding. Your placenta can grow abnormally deep into the uterine muscle, and sometimes through the entire muscle and into other organs. This is called placenta accreta, increta, or percreta, depending on the depth of the growth. Your risk of these conditions goes up with more cesarean sections. After one cesarean, your risk is about 0.9%, after two cesareans 1.7%, and after three cesareans 3%.

Can I schedule a repeat cesarean section, but attempt a VBAC if I go into labor before my scheduled surgery date?

Yes. Many women with a prior cesarean choose this option. You may schedule a repeat cesarean between 39 and 41 weeks, and then attempt a VBAC if you labor prior to that date.

What are my chances of having a successful VBAC?

In general, patients who attempt a vaginal delivery after a cesarean section are successful three out of four times, or 75%. There are factors that increase and decrease your chance of success. The lowest success rates are in women who underwent cesarean section after becoming fully dilated and pushing for a long time. Those women have a successful VBAC about 12% of the time.

An obstetrician at the University of Utah developed a system to estimate your personal chance of having a successful VBAC. Your provider will fill in the chart below, and discuss the results with you. The primary factor is your cervical exam at the end of your pregnancy.

20 and greater = 91% to 96%

No matter how you deliver, whether it is repeat cesarean or successful VBAC, our number ONE priority at Oakdale ObGyn is a happy and healthy mother, and a happy and healthy baby!

Calculating VBAC Success

An obstetrician at the University of Utah developed a system to estimate your personal chance of having a successful VBAC. Your provider will fill in the chart below, and discuss the results with you. The primary factor is your cervical exam at the end of your pregnancy.

20 and greater = 91% to 96%

No matter how you deliver, whether it is repeat cesarean or successful VBAC, our number ONE priority at Oakdale ObGyn is a happy and healthy mother, and a happy and healthy baby!

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