VBAC (Vaginal Birth After Caesarean)
If you’ve had an abdominal birth with a previous pregnancy and are planning a vaginal birth this time around, this is called a “VBAC” by medical professionals. You may also hear the terms “VBA2C” or “VBA[NUmber]C” if you’ve had multiple previous belly births, or “HBAC” (Home Birth After Caesarean).
Many women go on to choose a second abdominal birth after they’ve had one. This can be for many reasons, including (but certainly not limited to): wanting control and calm for their next birth after a traumatic previous experience, being pushed that way by health professionals, or assuming they could no longer have a vaginal birth.
“With a c-section rate of around 1 in 3 (Australia) a significant proportion of women approach their subsequent birth with a scarred uterus. Of those women, 84% will have another caesarean. I can’t find the stats re. how many of these repeat c-sections are planned vs emergency. But, considering the 50-90% ‘success’ rate for VBACs, I am assuming that most repeat c-sections are planned.
I wonder if more women would choose to experience a vaginal birth if they had adequate information and support from care providers who believed in them?”
- Dr Rachel Reed
I’d strongly recommed reading this article by Dr Rachel Reed on VBACs. She talks through the risks and explains them without scaremongering!
Ultimately, it’s your decision how you birth, and ideally this should be based on what is best for you, rather than based on fear alone.
The risk of uterine rupture is very, very small; there is a 99.5% chance that all will be well on that front.
The risk of a further abdominal birth is increased by much the same factors as it would be for any birth; lack of mobility and movement, prohibited oxytocin due to stress and a sub-optimal birth environment, and so on. You can use your protective factors and personal coping tools to give your VBAC as much chance of success as possible.
“I am a bit confused about why such a huge deal is made about the risk of uterine rupture during VBAC. Why are these women subjected to serious (and often biased) discussions with fearful practitioners about the dangers of attempting birth? Why are they categorised as ‘high risk’, limiting their care options and imposing additional monitoring and intervention during their labour? If we agree that this is the right approach, then we also need to treat all women like this because the risk of placental abruption or a cord prolapse is greater than the risk of a uterine rupture during a VBAC.
To be honest, as a midwife uterine rupture is the least of my worries when caring for a woman having a VBAC. I actually think the mountain that has been built out of the risk-molehill requires more energy and attention. These women do need special treatment, but not in the form of disempowering fear-based counselling or practice. They have often had a previous traumatic birth experience and are dealing with fear from family, friends, and the medical system, in addition to their own worries. They have been labelled ‘high risk’ and are constantly reminded of the potential disaster waiting to occur. They also risk ‘failing’ if they encounter any complications or end up having a repeat c-section. This impacts on their ability to trust their body, follow their intuition and allow the physiology of birth to unfold. Often these women need more nurturing, reassurance and support from those involved in their birth.”
- Dr Rachel Reed
This positive VBAC story takes place on a labour ward and is worth a watch! Some notes:
She talks about the mobile epidural option, and how this enabled her to stay active in labour, and feel what was happening with her body - fantastic! This likely contributed to her successful VBAC; she talks about not being able to move or feel anything with her first birth with the full epidural.
She talks about how the bearing-down urge feels, and fear of "“shitting herself”! Sooo relatable and helpful for first-time mums in particular to hear - it’s normal and a good sign!
She mentions her midwife picking up on signs that she had transitioned and was approaching the pushing stage, and saying “I need to check you”. This was not needed and she could have declined this check. The midwife could already tell what was happening by the woman’s body langue, noises etc; a vaginal check is not needed to confirm this if you don’t want it!
Discussion of: Delayed Cord Clamping & Physiological Third Stage (Placenta Delivery), Post-partum Bleeding (Lochia), first poo & wee post-birth, recovery.
HBAC (Home Birth After Caesarean)
Choosing a home birth after a previous abdominal birth is a safe choice for the majority of women.
The usual reason for choosing this is to avoid unecessary interventions and excessive monitoring common in some hospital settings.
In fact, a 2021 study found that “Planned HBAC was associated with a significant 39% decrease in the odds of having a [further] cesarean birth” (Bayrampour et al).
“So women who gave birth at home were more likely to give birth vaginally than to end up having another caesarean. That’s compared to women who gave birth in hospital. […]the researchers took into account the factors which might have made some women more or less likely to have a vaginal birth. They showed that, even when you considered those factors, the setting (or being at home) appeared to make a positive difference.”
- Dr Sara Wickham