Labor and Delivery: VBAC & Cesarean Section
Types of Deliveries
Most mothers are aware that there are two ways the baby comes out, either through the vagina (vaginal delivery) or through your abdomen with a man-made incision (a cesarean section or C-section). So, when you hear that there is a third way, known as VBAC, you’re probably wondering how there is even a third possibility. Not to worry, we have all the ins and outs of delivery types coming right up.
What is a VBAC?
A VBAC is an acronym for Vaginal Birth After Cesarean section. For example, a woman may have had a cesarean section on her first pregnancy. Then for her second pregnancy, she decides to have and her situation allows for a vaginal birth. Even though she had a vaginal birth for her second child, it would technically be considered a VBAC because her first child was a C-section. However, a VBAC isn’t always the best option for a pregnancy. As you know, vaginal deliveries and C-sections are very different. One takes a lot of muscle contracting and pushing while the other is a major surgery. Often delivery medical personnel follow the “rule” that once you have a C-section, C-sections for any future pregnancies are highly recommended. This is because a vaginal birth puts a lot of strain (as you may know) on your uterus and abdominal muscles. However, sometimes they can be weakened after having a C-section, and the strain of a vaginal delivery could be too much for them to handle in some cases. Let me repeat that, only SOME cases are advised against having a VBAC. Keep in mind that if you are one of those ladies advised against it, don’t be hard on yourself, your doctor just wants to keep you and your baby as safe and healthy as possible. And for those of you that have the option for VBAC, there is a 60-80% success rate, just always be sure to confirm with your OBGYN that it’s a possibility for you. Remember, the birth of your baby is going to be beautiful, no matter which delivery type you end up using.
Am I a good candidate for a VBAC?
- Previous vaginal delivery
- <35 years old. A 2007 study found that younger women had a better success rate and fewer complications.
- If your C-section was performed through a transverse(medical word for horizontal)incision, low on your abdomen(below your belly button). This can also be called a Pfannenstiel incision or Kerr incision. Your c-section scar may look like the mouth of a smiley face. A study showed women with one prior C-section with this incision have less than a 1% chance of uterine rupture.
- The reason why you had a c-section was a non-repetitive indication. This means the C-section was performed for the baby’s health for a reason likely unique to this pregnancy. Examples of these indications are a breech baby or difficulty tracing the fetal heart rate.
- They have some great VBAC Calculators out there now, click here for my favorite. If you’re still curious that if you’re a good candidate check this out, and don’t forget to talk to your doctor.
When are VBACs not recommended or are considered high-risk?
- If your C-section was performed through a Vertical T-shape incision. Your c section scar may look like a straight line from below your belly button to your pubic area. This is typically favored in emergency situations where they need more room to get the baby out or they need more visibility. Unfortunately, this type of incision puts you at a greater risk of uterine rupture.
- Labor dystocia or abnormally slow or difficult labor.
- Multiple C-sections. After 3-4 C-sections, most doctors will not recommend VBAC.
- Health complications: heart or lung defects
- Large babies(> 10 pounds), or if you had macrosomia (high birth weight of previous children)
- Going past your due date >40 weeks. More time in the womb means more growth, which means heavier baby, which means a more potential strain on your muscles.
- Home birth. The ACOG committee on obstetric practice considers fetal malpresentation (any position not head down), multiple gestation, or prior cesarean delivery and absolute contraindication to planned home birth. This is because these types of pregnancies sometimes require advanced medical intervention for the safety of your beautiful growing family.
Increase your chances of having a successful VBAC by:
- Talk with your doctor early in the pregnancy about having one. Discuss whether you are a good candidate or not. Keep in mind, the best delivery method is the one that is the safest for you are your baby.
- Manage your weight by staying active. A study in 2013 showed that overweight women who lost 1 body mass index increased their chance of a successful VBAC by 12%. But if you’re already at a healthy weight, just keep doing you, my dear. Go listen to Episode 12
- “Let it Go!” Wow, Frozen teaches us so much! Let mother nature run its course. Your chances for success increases if you go into labor on your own with an average uterine rupture at 0.7% vs 1% if you're induced with Pitocin or 1.8% with prostaglandins.
Keys to Having a Successful Delivery
Plan to the best of your ability
Try to ask off work for at least the last week of your delivery date. Only 5% of women actually deliver on their due date. Some are early and some are late, but you’ve been growing a human for about nine months, you deserve some time off! At 36 weeks, your baby is considered full-term. If your baby is in a breech position, most OB’s will schedule a “flip” of your baby at 37 weeks to prevent being rushed into a C-section. At 39 weeks, most elective C-sections are scheduled. During your last month of pregnancy, you will see your doctor every week. Sometimes it’s helpful to schedule it for the same day every week and ask work for the same day every week off to keep it consistent. If you are approaching 40 weeks, you may have doctor’s visits every other day depending on your situation. Also, PRO TIP: keep puppy training pads or incontinence pads in your car and on your bed just in case your water breaks. Trust me, it’s much easier to throw that away than attempting to clean it. And another PRO TIP: actually drive to the hospital with your spouse, because in the heat of the moment you will not want to get lost.
Hospital bag should be packed and ready to go
You need the following:
- Comfortable socks with traction. It’s good to start walking ASAP on the floor. Many hospitals will use being able to walk and use the restroom as an indication you’re ready to move out of the labor & delivery rooms into a nicer room.
- Comfortable PJ’swith easy boob access if you’re breastfeeding.
- Nipple cream/nipple shield. A friend highly recommended this Earth Mama’s Organic Nipple Butter to me.
- Breastfeeding pillow
- Tennis ball to rub out backaches.
- Change of clothes for you and baby to go home in (remember to get pregnancy clothes, the weight doesn’t just go away after the baby is born you will be swollen).
- NoMo Nausea Band to stop nausea and vomiting during delivery.
Be Prepared, for anything (especially puke)
Over 80% of women have nausea and vomiting during delivery. Women having a C-section may experience it after anesthesia or receiving the spinal anesthesia (“spinal block”) due to a drop in blood pressure (medical word: hypotensive event) or due to pain medication, inadequate hydration, tugging, or after anesthesia. During vaginal or VBAC procedure nausea and vomiting can occur because of the vaso-vagal puke response when your baring down and pushing. The epidural also can cause a drop in blood pressure. Remember, anti-nausea medication usually doesn’t provide instantaneous relief but after a certain period of time it will. But, if you don’t want to deal with that nauseous discomfort, try the NoMo Nausea Band. The NoMo Nausea Band is a wristband that combines essential oil and acupressure. Since these give immediate relief and just slid on your wrist, you don’t have to worry about calling a nurse to give you medicine or waiting for the anti-emetic medication to take effect. NoMo Nausea Bands are perfect for the OR (operating room), delivery room, in your car on your way to the hospital and postpartum rooms after all this band is used by hospitals. But grab one just in case your hospital doesn’t carry it and so you can slip it on whenever you’re feeling queasy.
Meet Your Team
Try to meet everyone who could possibly deliver your baby BEFORE you show up to the hospital. This can help with your comfort level and theirs. By meeting them in advance, they know you, they know your “style” and you have established trust with one another. Even if you have a favorite OB, he/she may not be available when your baby is ready, so try to also get a feel for the other doctors or OBs who could deliver your child.
Don’t be so close-minded and ask all questions about anesthesia during pre-op when you have a level head
Anesthesia is not the enemy. It’s actually one of the world’s most important medical advancements. Even if you’re on the fence or don’t want an epidural, have a conversation with your OB.
Should I ask for an epidural? Consider:
- Length of the procedure
- How the epidural is performed
- How many anesthesia providers are on the floor
- Medication that can be added for pain relief without numbness
It is quite common when women begin having contractions that parallel to the most painful experience they have ever had, or if the baby causes a tear “down under” (often from the vagina towards the butthole), a local anesthetic or an epidural will be administered for the pain.
Can an epidural be used for a C-section?
Yes, an epidural can be used for a C-section. However, epidurals for C-sections are given in higher concentrations so if needed, the baby can be delivered without putting the beautiful mama asleep (under a general anesthetic).
Should I get an epidural for a VBAC?
If you’re having a VBAC please consider an epidural for your safety and the safety of the baby. Having an epidural does not affect the chance of uterine rupture, which is one of the biggest concerns during a VBAC.
Spinal Vs. Epidural
A spinal block is what is used to go directly in the CSF and they use a smaller volume of medication than an epidural usually to numb you from the top of your tummy to your feet. On the other hand, an epidural places a catheter in your lower spine to allow continuous medication. You will still feel touch and pressure but no pain. Make sure to know your options about anesthesia because your anesthesiologists can make your delivery so much more comfortable.
Finally, keep in mind that most deliveries are a marathon and not a sprint. Bring plenty of things to keep you occupied whether that’s movies or board games or your great support system. Get excited to meet your beautiful baby! Want to hear this information again? Check out the podcast version below!Listen to "What Is VBAC? VBAC vs Cesarean Pregnancy Pukeology Podcast Episode 21" on Spreaker.