Caesarean section is when a woman gives birth with the help of a surgeon who makes an incision on her belly and uterus and the baby is born through this cut. If you delivered your previous baby via caesarean section (also known as c-section), and you are currently pregnant, it is possible for you to have your next baby naturally via the vagina. This type of birth is called vaginal birth after caesarean section (VBAC).

Usually the success rate of women who try a trial of labour after caesarean (TOLAC) ranges between 60 and 80 percent.

Reasons for a VBAC

There are various reasons as to why a woman would consider VBAC, and these include:

• Having an individualized birth plan: With VBAC you get an opportunity to plan and experience the birth of your baby.
• The recovery time is shorter: After VBAC your hospital stay will be shorter than if you had a repeat c-section. You will also be able to resume your normal activities sooner; and the cost of childbirth will be reduced as well.
• Lower complication risks: Vaginal births have lower rates of infection, bleeding, deep vein thrombosis and injury to the abdominal organs such as the bowel or bladder.
• Help future pregnancies: VBAC can help if you are planning on having a larger family by avoiding risks associated with repeated caesarean section, such as scarring. Scarring can result in higher risk of placental problems in future pregnancies and can also make surgery difficult.

Ideal Candidate for VBAC

Having a successful VBAC depends on a number of reasons such as:

• If you’ve previously had a vaginal birth
• You and your yet-to-be-born baby are in good health
• If your labour starts on time, that is just before or on the due date
• You are pregnant with one baby, and you’ve had prior low transverse caesarean sections in addition to not having issues that would prevent VBAC.
• You are pregnant with one baby; had one prior caesarean section whose uterine incision is unknown, and you do not have issues that can prevent VBAC. But if it is suspected that you had a prior high classical (vertical) uterine incision, a VBAC would be deemed to be risky.
• You are pregnant with twins; you had a prior low transverse caesarean and you are a good candidate for a twin vaginal birth.

However, the chance of having a successful VBAC decreases if:

• Your labour is induced, or your due date has passed
• You have a similar condition with your current pregnancy which made you have a c-section in a past pregnancy such as if your baby is lying sideways in the womb, or there is a problem with the baby’s heart rate
• You are obese
• Your baby is very large
• You have preeclampsia which is when a pregnant woman has high blood pressure as well as the symptoms of some of her organs not working properly such as her liver and kidneys. Signs and symptoms of preeclampsia include changes in vision, having protein in urine and severe headache
• Your previous delivery was within the last 18 months
• You have a history of two or more c-sections and no vaginal deliveries

You are not a good candidate for VBAC if:

• The incision of your past c-section was not low transverse
• Your uterine ruptured during your previous pregnancy. This is when the womb tears during pregnancy
• Your uterus has undergone extensive surgery
• You have certain health conditions during the pregnancy that can make a c-section necessary such as heart disease, diabetes, genital herpes or placenta previa

Risks of Having a VBAC

VBAC, just like any other type of surgery carries some degree of risk even though during your pregnancy you and your baby are healthy. These risks include:

• Your labour failing to go well, and you end up needing a c-section
• Injury, infection or blood loss
• Tearing of the uterus

Preparing for a VBAC

Discussing about opting for a VBAC with your obstetrician is essential as they will help you every step of the way and also let you know if it is possible. Make sure to provide all your medical history including records of your previous c-sections during your visit as this helps in calculating the likelihood of you having a successful VBAC.

Your healthcare provider will take you through the benefits and risks of a VBAC. You should also learn as much about the procedure as possible, you can even take a childbirth class on VBAC. The facility that you choose to deliver in, should be a well-equipped hospital like King’s College Hospital, Duba, which can handle an emergency c-section if need be. Finally, it is important that you let labour to begin naturally and you should be flexible in case complications needing a c-section occur.

Next Step

At King’s College Hospital in Dubai our obstetrics team offers a complete package of care for the expectant mother throughout their pregnancy, during the birth and after the delivery of their baby. Our antenatal care package, run by our Obstetrics team from our Dubai Hospital and Medical Centres, includes regular check-ups for the mother-to-be, as well as detailed ultrasound scans to monitor the growth of the baby.

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