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Vaginal Birth After Cesarean (VBAC)

A cesarean section is an operation where a baby is born through a surgical cut made into the mother’s abdomen and the uterus. Cesareans are performed for a number of reasons and can be potentially life saving for both mother and baby.

Unfortunately, although the World Health Organisation considers the ideal rate for cesarean sections to be between 10% and 15%, cesarean sections have become increasingly common.

In Australia, the rate of women giving birth by cesarean section has continued to rise, to 35% in 2018 and, in private hospitals, where obstetricians manage care, the rate is much higher than the rate in the public hospital system.

The NSW Mothers and Babies report from 2016 found that operative (cesarean) births are more common among privately than publicly insured mothers. For privately insured mothers, the cesarean section rate was 42.1% but for publicly insured mothers the cesarean section rate was 27.8%.

Quite a difference in numbers.

With increasing numbers of mothers who have previously had a cesarean, there is a corresponding increase in interest in the option of Vaginal Birth After Cesarean, or VBAC.

Some of the benefits of having a VBAC, rather than another cesarean include a faster recovery time, a shorter stay in hospital, a decreased risk of infection and less pain after birthing.

As with anything, there are risks that come with having a VBAC. The most commonly quoted is the risk of uterine rupture, although the risk of this is only a .5% risk, meaning that 95.5% of women who are aiming for a VBAC will not have a ruptured uterus.

And while the U.K. has recently published guidelines about VBAC, which include explaining to women that there is little difference in outcomes for the baby between a repeat cesarean or a VBAC, supporting full range of choice for pain relief (including water birth) and continuous CTG monitoring only in certain circumstances, Australian hospitals often continue to implement monitoring and inform women that a water birth is not an option for a woman who is aiming for a VBAC.

As with any aspect of your pregnancy, labour and birth, the only way to have real options is to understand what those options are. This is especially true with a VBAC.

If you are considering having a VBAC, there are a number of ways you can inform yourself, but it is also important to seek information from a variety of sources. Good sources of information include speaking to your midwife, reading research based information online (www.sarawickham.com is a midwife researcher who translates research into easy to understand language) and asking questions about anything you don’t understand, or that doesn’t seem to fit with what you want to achieve.

There are also a number of ways in which you can increase your chances of having a VBAC, including choosing midwifery led care, hiring a doula and remembering that this is your body, your baby and your birth. You do not have to do anything, regardless of what well meaning people may tell you.

If you would like more information about VBAC or birthing, speak to your midwife or contact Dauntless Birth.



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