VBAC, natural birth after a cesarean: when it can be done

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Catherine Le Nevez
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VBAC natural delivery after a cesarean

Is it possible to give birth naturally after a previous birth by caesarean section? The answer is yes, it can be done. We speak technically of VBAC, from the English acronym for Vaginal Birth After Cesarean ('vaginal delivery after caesarean ').





In this regard, the guidelines on caesarean section of the Higher Institute of Health are very clear and say that, in the absence of specific contraindications, the possibility of a VBAC must be offered to all women.

VBAC is an English acronym for Vaginal Birth After Cesarean, that is vaginal delivery after a cesarean.

In this article

  • When can a VBAC be done?
  • Risks and Benefits of a VBAC
  • When can't it be done?
  • Where can a VBAC be done?

When can a VBAC be done?

It does not mean that all women with a caesarean behind who want a natural birth will actually be able to have it. All, however, must be given the possibility of the so-called trial labor (TOL, English acronym for trial of labor).



According to available studies, the 60-80% (about 3-4 out of 5 women) of pregnant women who have already undergone a caesarean section, give birth successfully in a natural way.

According to the experts about a year should pass after the caesarean section before another birth.

VBAC is always an attempt

It cannot be known a priori that a trial labor will end in vaginal delivery. According to available data, this is possible for about 3/4 of 5 women. For the others, trial labor will end with a new caesarean section.



Risks and Benefits of a VBAC


La most feared complication in the case of a natural birth after a cesarean it is the rupture of the uterus at the level of the scar. In this area, if the tissue does not resist the efforts of the contractions, it can give way: in this case an emergency situation arises, which can lead to haemorrhage and which may require transfusions and, in very extreme cases, the removal of the uterus.

In fact the risk of uterine rupture is slightly higher in the case of a trial labor compared to what happens in the case of repeated caesareans, but it remains a rare possibility.

On the other hand, Caesarean section is associated with other risks and, if repeated, could lead to complications even in subsequent pregnancies. The fact that there have been caesareans, for example, increases the risk of placenta previa in a new pregnancy, with all the problems that this condition can bring.

When can't it be done?

As with all pregnancies, labor and natural birth are not recommended in case of placenta previa or breech or transverse presentation. In addition to these general contraindications, however, there are some specific for VBAC, not recommended if in the past there have been three or more caesarean sections, if any uterine ruptures and there were surgeries on the uterus that they left longitudinal or T-shaped scars.

In any case, the choice to carry out a vaginal birth after cesarean must be made after discussing with your reference gynecologist (who will take into account the patient's medical history) and after having documented yourself in detail. Also according to the ISS Guidelines, the information to be collected does not only concern the possible risks of the two options, but also the characteristics and organization of the structure in which you intend to give birth and the type of assistance you will receive during and after the birth.

Where can a VBAC be done?

Again, the ISS Guidelines speak for themselves: women who wish to attempt trial labor must be guaranteed adequate clinical surveillance and fetal monitoring must be continuous throughout labor.

As we have said, the rupture of the uterus is a rare event, but it is good that the chosen structure has everything in order to intervene promptly. In other words, they must be guaranteed immediate access to the operating room and resuscitation - with a surgical team and an anesthetist available 24 hours a day - e the immediate availability of blood for any transfusions. Therefore, it is better to contact a high-level hospital.

References

  • Guidelines on Caesarean section of the Higher Institute of Health.

TAG:
  • Natural childbirth
  • natural childbirth after a cesarean
  • Caesarean section
  • give birth
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