Vaginal Birth and VBACs

Vaginal Birth and VBACs

Vaginal birth & VBACs: an overview.

In the video below Dr. Dorcas McLennan, Medical Director of the Family Childbirth Center at Swedish/Ballard, discusses c-sections and VBACs (vaginal birth after cesarean section) including who might be a good candidate for a VBAC. 

Read the full video text/transcript

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Most babies are born vaginally, and you can read more about a typical vaginal birth on our stages of labor page. A growing number of vaginal births are what’s called a VBAC (pronounced vee-back), which stands for vaginal birth after caesarean.

The primary concern about a VBAC is uterine rupture, a rare but serious risk. However, more studies are showing that VBACs are actually safer than having another C-section. Roughly 90 percent of women who have had C-sections are good candidates for VBACs.

 If you meet the following conditions, you’re probably fine to do a VBAC:

  • No more than two prior low transverse C-section deliveries
  • No additional uterine scars, irregularities or previous ruptures
  • No major medical issues or pregnancy complications (such as diabetes or high blood pressure)
  • You’re carrying a head-down, single baby of a normal size

Some evidence suggests a greater risk of uterine rupture in VBACs where moms have their labor induced or helped along with Pitocin. And if you had a prior C-section for any of the following reasons, you’ll want to talk with your provider about risks and benefits of a VBAC:

  • Dystocia, which is a long and difficult labor due to slow cervical dilation, a big baby, or a small pelvis
  • Genital herpes
  • Fetal distress


Full video text/transcript for "What about C-Sections and VBACs?" video

The way I look at C-sections, this is a tool in our toolkit to get a safe delivery of a healthy baby and a healthy mom. I think when it really comes down to it, the point is we all want a healthy outcome for both parties, we have 2 patients we're taking care of. The providers at Swedish have a very appropriate C-section rate. You have to remember a tertiary care center is going to have a slightly higher C-section rate because they deal with the highest risk patients. So when you look at Ballard and it's slightlly lower, it's not magic. It's just the reality of a moderate and low-risk group of patients being delivered at a community hospital in an urban setting as opposed to a tertiary care center. But even at Swedish/First Hill, the rate is about the same as it is nationally. VBAC, otherwise know as vaginal birth after cesarean,  is widely practiced in the Swedish system currently. So now we are able to take care of women who really do want a trial labor after cesarean. If you've had 2 or fewer cesarean sections and are otherwise a good candidate you can try for a trial of labor although there are of course caveats to that and of course there's a list of things that make you a less optimal candidate and ones that make you a better candidate and it probably depends a lot on why you had your first c-section, what the circumstance was, what your current circumstance is, how healthy are you and a variety of other things.  So, throughout the system, VBACs are offered and there may be some cases the community or suburban hospital think that if you want a VBAC you might be best served at First Hill, but in most cases we're able to manage those out in the community and suburban hospitals.

 

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