Vaginal birth after Cesarean Delivery (VBAC)
Thanks to recent advents and availability of emergency and elective caesarean section,most of the difficult deliveries which could have been traumatic and detrimental to both mother and baby are averted reducing the morbidity and mortality in both.
But many women still want to have the natural birth experience and also want to avoid surgery for obvious reasons.
BUT, CAN EVERYONE DELIVER VAGINALLY AFTER CESAREAN?
According to recent studies, among women who take TOLAC (trial of labour after caesarean) 60-80% have chances of normal vaginal delivery.
Firstly, what is TOLAC?
See, women who are willing to under go VBAC have to pass a few criteria, after that a trial of labour is given with a backup of emergency caesarean, so that if either the mother or the baby are in jeopardy, the process can be stopped right away and surgery done.
Criteria for VBAC
I want to explain you all in as simple terms as possible.
The doctor has a few selection criteria where both maternal and fetal factors are taken into consideration.
- the mother is motivated
- gap between the pregnancies is ideally 3 years
- preferably had one previous vaginal delivery
- has good pelvic dimensions
- previous surgery was uncomplicated, includes pre and postoperative periods were good.
- Low transverse caesarean section (it is a mode of surgery, you better have your operative details from previous surgery)
- No previous history of scar rupture.
- No other uterine surgeries (like done for fibroids etc)
- Spontaneous labour pains
- No anaemia or hypertension in the mother.
- Previous scar is thick
- The baby should be average size compared to the pelvis
- Should be in cephalic position
- No malposition like breech,transverse lie etc
- No cord prolapse or cord presentation(the cord comes out or eady to pop out before the baby repectively)
- No associated complications like placenta previa,cervical fibroids,vulval and vaginal infections etc
Above all it also depends on the facilities available in the hospital for emergency surgery and also competence of the doctor.
The above are a few basic factors involved in selecting a candidate suitable for VBAC.
Every procedure has its set of pros and cons, so does VBAC.
- Rupture uterus-even if the gap has been 3 years or more,sometimes rupture can occur during delivery.
- In case of a rupture, the placenta separates leading to fall in heart rate of the baby and the baby may land in jeopardy.
- The mother can also go into shock due to massive haemorrhage of rupture.
- The mother may need blood transfusion.
What can you do from your side?
It is important that you can mentally prepared for all consequences. You can’t half-heartedly give a trial. Motivation plays a huge factor.
Have a detailed discussion with your Doctor.
Talk about pros and cons and especially what complications you can face in your condition.
Start taking iron and folic acid medications atleast 3 months before getting pregnant.
Take high protein diet and prepare your body for the situation.
Have blood reserved in blood bank near term for any unforeseen circumstances.
Know before hand how labour pains will feel and if you are willing to bear them or take epidural anaesthesia.How and when you should bear down.
Get regular scans as advised by your doctor especially to know baby anomalies, fetal weight ,placental position and most importantly scar thickness.
I know every mother cherishes the dream of a vaginal delivery no matter what hassles she has to face.
It is important that rather than flowing in the emotion of vaginal birth, take your health into consideration as well as baby’s.
Planning ahead helps you and prepares you!
And yes,VBAC is a big deal, talk about it,be proud of it and thank your super baby for getting you a successful one!!!