Vaginal Birth After Caesarean (VBAC)
Not necessarily; under the right conditions, and with appropriate care and management, a vaginal birth after a caesarean section (commonly called a VBAC) is a safe and frequently successful option.
Much like having another caesarean birth (often called an elective repeat caesarean section, ERCS), there are risks and benefits which need to be carefully considered and discussed with your maternity care provider.
An additional purported benefit is a sense of achievement and active participation in your child's birth. While this is certainly the case, it is important to be aware and acknowledge that many women will end up requiring another caesarean section, despite the best efforts of themselves and their obstetrician. Many factors in labour can be managed, but not necessarily controlled - such as concerns with baby, a small pelvis, or emergencies such as a uterine rupture. I therefore feel it is important to focus on the goal of a healthy mother and baby, rather than necessarily achieving the planned method of birth; otherwise we risk engendering feelings of guilt and failure at a time when a woman should be feeling the absolute opposite: she has achieved the birth of a healthy baby after caring for her baby for nine months of pregnancy - and this is an amazing accomplishment, whichever way baby makes an entrance!
* Although this sounds alarming, this needs to be put into context: the risk of a baby dying is about 1 in 2000-3000; this is similar to the risk of infant death among low risk women in labour with their first child.
Factors in your history may influence your chance of a successful VBAC, or may increase the risks. Although these factors are not absolute, they may help you have a frank discussion about your particular situation, and this may help guide your decision-making. I am always keen to look carefully at previous labour and delivery medical records to help you understand why a caesarean was required previously, and how things may be different this time.
Intended family size is quite important, as some of the risks of caesarean section tend to increase with increasing number of caesarean sections; if you are planning a family of six children, the cumulative risk to you of six caesarean sections starts to become very high. Conversely, if you are planning a relatively small family, the benefit of VBAC in avoiding repeat caesarean sections is more modest. Obviously, your beliefs and value around childbirth are very important in your decision making, and I would always seek to discuss these with you during a consultation.
It is also worth considering or discussing your feelings around attempting labour - do you feel you should give it go? Or would you be more concerned about attempting labour but then ending up with a caesarean section again? In the end, it is a personal and individual decision, and open communication between you and your obstetrician is essential.
David is a strong advocate of women's informed choice in their health care, and supports safely attempted VBAC.
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Vaginal Birth After Caesarean (VBAC)
David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland. He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery. David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments. He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.
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