Dr. Max Izbicki Chicago, IL OB/GYN offers patient with a previous delivery by cesarian section the opportunity for a vaginal delivery. Vaginal birth after cesarean delivery, commonly referred to as VBAC, is a delivery option for patients who have had one prior c-section. Recently the technical terminology has changed a bit, referring to the labor process as TOLAC (trial of labor after cesarean), and successful completion of a vaginal delivery as VBAC. However, the term VBAC still tends to be the most widely used and understood abbreviation.
VBAC allows an option for experiencing a vaginal birth, and successful VBAC avoids additional abdominal surgery and provides a quicker post-partum recovery. For those planning large families, VBAC enables one to avoid multiple repeat c-sections and the associated surgical risks.
Who is a candidate for VBAC?
TOLAC is a reasonable option for many women who have undergone one previous low transverse cesarian. The term “low transverse” refers to how the incision was made on the uterus, not the skin. For patients interested in VBAC, your provider will request a copy of your prior operative report to confirm that the incision on your uterus is indeed, low transverse.
What are the risks of VBAC?
It is important to remember that both repeat cesarean delivery and VBAC have risks associated with them, and the highest risks are associated with a failed VBAC. Either of these may be associated with maternal hemorrhage, infection, and hysterectomy. However, the risk most commonly associated with VBAC is uterine rupture, meaning that during the labor process the uterus ruptures , or breaks open, on the prior uterine scar line. In rare instances uterine rupture may occur with a routine scheduled c-section. Uterine rupture is associated with both maternal and fetal complications. The risk of uterine rupture in a patient who has had one prior low transverse cesarean delivery undergoing TOLAC is 0.7-0.9%.
What is the success rate for VBAC?
For any woman considering VBAC, the indication for your prior c-section impacts the likelihood of successful VBAC. For example, a patient who had a prior c-section for arrested labor (ie the cervix stopped dilating or one reached 10 cm but pushed for a few hours without making progress), has the lowest likelihood of VBAC. On the other hand, someone who has had a prior successful vaginal delivery has the highest likelihood of success. The overall success rate for VBAC is 60-80%. There are a number of other factors that make a trial of labor after cesarian more or less likely to result in a successful VBAC. Women should only make the choice for a TOLAC after close consultation with a supportive obstetrician experienced with VBAC deliveries.