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Can You Deliver VBAC Successfully?

April C. Sanchez, M.D.


I am currently pregnant with my second baby. When I delivered my first, everything started out fairly normal. By the 12th hour of labor, I was given a Pitocin drip, had my water broke, and my membranes stripped. Still no baby. After 37 hours of labor, I had only progressed to 5 cm. and my son was in position, only he was on his back. I ended up with a c-section. My question is this: what are the odds of this happening again? Can I successfully deliver Vaginal Birth After Ceserean (VBAC)? Thank you for any information you can give.

A The decision on whether or not to attempt VBAC (Vaginal Birth After Cesarean) can be a very difficult one. In a most situations, including yours, the odds of a successful VBAC are approximately 60-70%. The only situation where the success rate is lower is when the primary C-section was done after complete dilatation and the baby just does not come down with pushing. The chance of a successful VBAC in this situation is closer to 12-15%.

Now that you have an idea of your chance for success, you must weigh the risks and benefits of VBAC versus repeat C-section. The overall complication rate of any vaginal delivery, including VBAC, is lower that with a C-section. This includes complications of bleeding and infection. Although C-section is quite routine, it is still a major surgery, with all the risks of a major surgery. The recovery time, in general, is quicker for a vaginal delivery. The main drawback of a VBAC is the risk of uterine rupture. The Obstetric literature reports this risk to be about 1 in 1000. This is when the uterus, which has previously been weakened by an incision, ruptures during labor. Although the rate of this complication is lower than the complication rate of C-section, uterine rupture can result in some very serious consequences to the mother and the fetus. You alluded that your previous incision allows for VBAC. The American College of Ob/Gyn takes the position that attempted VBAC is OK if the previous incision is made transversely in the lower part of the uterus. A vertical uterine incision carries a higher rate of rupture in subsequent labor. Remember that the skin incision does not always correlate to the actual uterine incision.

The best approach when faced with this question is for you to make an informed decision with the help of your doctor. If you decide to VBAC, you should report to the hospital in early labor so that you can be closely monitored for the first signs of uterine rupture, which is often heralded by fetal distress. If you should decide to just schedule a repeat C-section near your due date, you should not let anyone make you feel like a failure for not attempting VBAC. Keep in mind that the goal is a healthy mother and baby and it's how you raise the child that's more important than how you deliver the child.

I wish you the best of luck with your pregnancy and delivery.

April C. Sanchez, M.D.

Dr Sanchez lives with her husband and two boys ages 6 and 2 in Mandeville, Louisinana. She is a Board Certified OBGYN with a dregree from Louisiana State University Medical School. She completed her residency through the Tulane University Medical School Residency Program. She also received a Surgical Excellence Award. She is now practicing Obstetrics and Gynecology at Total Woman Care, in Manderville, Louisiana. The Total Woman Care website, is an "Advanced" Obstetrics and Gynecology Practice that cares and provides for the needs of women with total Compassion, Empathy, and Understanding. Dedicated to Provide Obstetrics and Gynecology Related Information for the Women of West St Tammany Parish.

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