“I didn’t want another caesarean, because I knew how long it took to recover. I had seen so many women give birth naturally and they were able to get up and do what they wanted almost straight after.”
A previous c-section doesn't necessarily mean you'll have another for future pregnancies. A vaginal birth after c-section (VBAC) is often the safest choice for women, especially if you have a low uterine scar and no medical complications.
The American College of Obstetricians and Gynecologists (ACOG) recommends women are supported to choose a VBAC whenever possible, and says restrictive policies around VBAC should not be used to force women to have repeat c-sections.
A large meta-analysis of literature on VBAC, undertaken by the Agency for Healthcare Research and Quality, concluded that 74% of women who try for a VBAC will successfully achieve a vaginal birth.
The biggest fear surrounding VBAC is the possibility of uterine rupture, which is extremely rare. A study from 2012 shows that uterine rupture during VBAC occurs about 0.2% of the time. A birthing woman is more likely to experience other medical complications such as maternal hemorrhage or cord prolapse than uterine rupture.
Planning For A VBAC Birth
If you are considering a VBAC there are a few things to consider:
- A low-transverse uterine scar (a horizontal scar just above your bikini line) increases the chance of a successful VBAC. If you have a vertical scar it is more likely rupture than a low scar.
- If you've had a previous vaginal birth, your chances of VBAC increase threefold.
- If your previous c-section was due to breech positioning (baby not head down) and not fetal distress or a long labour, you are more likely to achieve a VBAC
- If labour starts spontaneously (on it's own with no help) you are more likely to succeed in a VBAC.
- Having a healthy weight range can increase the likelihood of a VBAC.
- If you want more children, a VBAC makes it more likely you will achieve future vaginal births as well.
- You can VBAC even if you have more than one previous c-section.
In low risk, healthy pregnancies, VBAC has advantages for the baby too. Contractions massage and stimulate your baby, preparing them for birth. During labour, your baby produces high levels of catecholamines (stress hormones), which mammals produce in the ‘fight or flight’ response to a stressful situation. This stress response during labour actually helps your baby get ready for life outside the uterus. Waiting until labour begins means your baby is ready to enter the world. Being born before labour begins has the potential that your baby is immature, with lungs that may not be able to cope with life outside your protective womb.
What To Expect During A VBAC Labour
“I could feel and see my baby moving down through my birth canal, and soon I felt his head crowning. What an amazing thing to feel! It was soft and hairy and squishy. I guided his head out, by massaging my perineum over and around it, and after about half an hour of pushing, James was born into his daddy’s hands.”
A VBAC labour progresses the same way as any other woman’s labour. Having a previous c-section will not affect your body’s ability to labour and birth naturally. If you’ve experienced labour previously, even if it ended in a c-section, you may find that your VBAC labour progresses more quickly than your previous one.
Being well informed about the normal process of labour is very important. Be as informed as you can. An independent birth educator can be a great resource to access as you can work through your previous birth experience and plan for an empowering VBAC. Hiring a doula as birth support may be worth considering, especially if you have any concerns about coping during labour.
Some women experience a ‘stall’ in their VBAC labour, at the point they had reached during an earlier labour; usually at the stage where the decision to perform a caesarean was decided (e.g. at 5 cms). It is not known if this has a physical cause, but it is more likely to be a response to the emotions surrounding the memories of the previous experience, triggered by reaching the same stage in this labour. Fear is a powerful emotion. If this does happen, it doesn’t mean you will not birth vaginally. Nearly all women are able to work past this point, especially with the right support, and have a wonderfully empowering birth experience.
Preparing yourself emotionally and working through your previous birth experience before your VBAC can help decrease the chances of your body stalling. Being informed of your body’s ability to birth naturally and choosing a VBAC friendly caregiver increases your chances of being supported through this stage if it does occur.
After Your VBAC
“Once the feeling came back into my feet (they were pretty numb from kneeling) I got up and showered then put on my silky nightie and hopped on the bed for some photos. Dom had a nice cuddle with Sabrina while I showered.”
A vaginal birth is different for all women. Nearly all women who birth this way do report feeling a mixture of emotions:
Physical feelings vary depending on the individual experience. Some common physical feelings are:
- Abdominal soreness (like bruising)
- Perineal soreness (more so if you’ve had stitches, though the amount of bruising involved is a big factor)
- Sore tailbone
- Sore (bruised feeling) anus
- Sore arms/shoulders (from hanging on to things i.e. your partner, bed, etc)
- Tired legs (from standing, kneeling or squatting)
- Sore throat (if you have been vocal in labour!)
- Exhausted (but not at all tired!)
For perineal soreness you can use cold packs, which will help reduce swelling and pain. A warm shallow bath is also excellent for relieving bruising and ensuring stitches stay clean and uninfected; it is also very soothing. Over the counter pain relief will usually alleviate any soreness. Discuss this with your doctor or midwife and make sure you feel comfortable. Find out more ways to care for a sore perineum here.
Your body has worked hard and does need looking after. Rest as much as you can and try to keep pressure off your perineum by lying on your side. Keep well hydrated too avoid constipation, especially if you are worried about the pain of bowel movements after birth. Nurturing yourself after birth is key to a good recovery.
“I cannot describe what I felt – it was relief, joy, tears and laughter, it was pride and satisfaction, and so, so right. It was tenderness, and surprise and love, and a tinge of sadness for my firstborn to no longer have me all to himself – and the most satisfying part of all the tears and the laughter on Todd’s face as he looked at our new son, and said “you did it – all by yourself. You’re so clever, look what you did!”