Vaginal Birth After Caesarean Section

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What Is VBAC?

VBAC is the acronym for “Vaginal Birth After Caesarean section”.

If I Had One Previous Caesarean Section Birth, Can I Go Through A Subsequent Vaginal Birth?

Women who have had one previous uncomplicated lower segment caesarean section (LSCS) and no other adverse obstetric feature in the current pregnancy are suitable candidates for VBAC. Generally, the relevant factors to determine suitability for VBAC are as follows :

  1. The type of previous caesarean section
    • Type of incision: This refers to the manner in which the uterus was incised during the delivery in the last pregnancy.
    • “Classical section” refers to a vertical incision on the upper part of the uterus. Women who a previous classical caesarean section should not opt for VBAC as there is a higher risk of uterine rupture or tear.
    • “Lower segment caesarean section” refers to a horizontal incision on the lower part of the uterus. This method is associated with a lower risk of uterine rupture and women with this type of incision may opt for VBAC.
  2. Reason for previous caesarean section: If the reason for the previous caesarean section is a recurring one such as contracted pelvis (i.e. where the pelvis is too small to allow the passage of baby due to some form of obstruction), then VBAC is unsuitable.
  3. Complications during the previous caesarean section: If the previous caesarean section was complicated by unexpected tears in the uterus, the obstetrician may advise the need for repeat caesarean section in the subsequent pregnancy. VBAC should not be considered in such a case.
  4. Current pregnancy: Certain conditions such as low-lying placenta or abnormal presentation of the baby in the present pregnancy may prevent a safe vaginal delivery.
  5. Other medical / surgical problems: Certain medical conditions such as certain heart diseases or severe hypertension would prevent a woman from enduring the physical stress of a vaginal delivery. Previous operation on the uterus to remove fibroids may result in weakening of the muscle wall of the uterus and increase the likelihood of uterus rupture during labour. In such cases, the risk and benefits of VBAC may have to be considered carefully.

What Is The Chance Of A Successful VBAC?

The chance of a successful VBAC is between 60% and 70%. It is generally higher for women who have had previous successful vaginal deliveries. The chance of success may be lower if the reason for the previous caesarean section was due to cephalopelvic disproportion (i.e. where the baby is relatively too big to pass through the maternal pelvis).

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