Young Baby Holding Parents Hand

Women and Newborn Health Service

Health A – Z

 

King Edward Memorial Hospital

Vaginal Birth After Caesarean (VBAC)

Resources and links

  • Most women who have had one previous CS in the lower part of the uterus can attempt a VBAC
  • If you are planning more than two children it is important to consider a VBAC if you are suitable because of the risks associated with multiple caesarean section CS
  • With the right support and care most women can expect to have a successful VBAC (72 - 76%)
  • High chance of success:
    • Vaginal birth in the past (89%)
    • Previous CS was for breech (86%)
    • Previous CS was for placenta covering the internal opening of the cervix (86%).

Please discuss your individual situation with your Obstetrician, doctor or midwife.

To Top

Benefits of VBAC

  • Less blood loss.
  • No complications associated with major abdominal surgery.
  • Less infection.
  • A quicker recovery after birth.
  • A shorter stay in hospital.
  • A sense of achievement at having gone through labour and birth.
  • Reduces the risk of the baby experiencing breathing difficulties after birth that require admission to the neonatal intensive care unit.
  • Knowing that the baby has come when ready
  • Fewer complications in future pregnancies.
  • Even if a caesarean section is required you know that you have experienced some labour and have done your best and been part of the decision making.

To Top

Considerations for VBAC

  • The scar is potentially a weakened area on the uterus that can come apart. If this happens it can be potentially life threatening to the mother and the unborn baby.
  • When the CS scar is on the lower part of the uterus, the non contracting part, the risk of it coming apart during labour is less than 1% (0.5-0.7%).
  • The risk of uterine rupture is less than all the other risks for women in labour i.e. Baby not coping with contractions during labour (fetal distress), shoulder dystocia (where the shoulders get stuck after the head is born), postpartum haemorrhage (excessive bleeding after the baby is born) or cord prolapse (where the umbilical cord comes before the head of the baby).
  • Signs of the uterus opening or tearing include:
    • A sudden drop in the baby’s heart rate that takes a long time to recover after a contraction. It is normal for the baby’s heart rate to fall slightly during a contraction or during the pushing stage, but a drop of 60 beats or more from the baseline (normal heart rate) or where the heart rate is taking a while to recover after a contraction is taken seriously and an emergency CS may be required.
    • Excessive vaginal bleeding (a small amount is normal in labour as the cervix opens up, but continuous bright bleeding is not normal).
    • Shoulder tip pain or pain across the old scar line that continues throughout the rest period in between contractions.
    • Blood in the mother’s urine.
    • A change in the contractions i.e. they were coming regularly and now they are coming at different times and with different strengths.
    • The mother feels something is wrong (her intuition)
  • If the staff suspect that the old scar is opening you will be taken straight to theatre for a caesarean section.
  • The evidence tells us that in most cases, when an emergency CS is performed, no serious harm comes to the mother or baby.
    • Sometimes the mother may lose a lot of blood and may need some extra blood to be given to her (blood transfusion).
    • In very rare circumstances the baby may suffer serious complications or die. This is usually the result of the blood and oxygen supply being stopped for too long.

To Top

What improves your chances of successful VBAC

  • Wait at least 12 months after the CS before getting pregnant again.
  • Have no complicated medical problems
  • Have a healthy weight (BMI less than 30)
  • Go into labour before 41 completed weeks of pregnancy
  • Baby weighs less that 4000g
  • Baby in an anterior position for birth ie, back is facing mother's bellybutton. Visit the optimal fetal positioning website
  • Go into labour naturally. Some suggestions for encouraging natural labour:
    • Deep squatting when you know the baby is in a good position for birth (ask your midwife to show you how the baby is lying). The pressure of the baby’s head on the cervix helps to release prostaglandins which are good hormones for labour.
    • Evening primrose oil
    • Raspberry leaf tea
    • Sexual orgasm. The hormone Oxytocin is released during orgasm and causes the uterus to contract. It is also the hormone responsible for contractions during labour and birth. Sperm has prostaglandins in it which can help to soften the cervix and get it ready for opening up.
    • Stretch and sweep – you can ask the midwife to do a vaginal examination and gently stretch the cervix open and sweep around the cervix with her finger. This helps to release prostaglandins to prepare the cervix for opening up. A stretch and sweep can be done from 38 completed weeks of pregnancy.
    • Reflexology
    • Nipple stimulation – gently rolling the nipples between your fingers can cause the release of oxytocin which is the hormone responsible for contractions.
    • Discuss these further with your midwife and/or doctor, who may have some other suggestions for getting into labour naturally.
To Top

What reduces your chance of successful VBAC

  • Induction of labour
  • Being overweight (BMI over 30)
  • No previous vaginal birth
  • Previous CS for ‘no progress’ especially if you reached 10 cm dilation and the baby was in a good position i.e. head well flexed with chin tucked in and back facing towards belly button (anterior).
  • Baby weighs over 4000g

To Top

Pregnancy care

More information about pregnancy care

  • It is a good idea to attend antenatal classes so you and your partner can explore all your options for birth and help prepare for either a VBAC or a positive CS. Contact your local midwife or childbirth educator for information about classes.
  • Getting together with women who have had a previous CS and are planning the birth of their next baby is a great way to share ideas, talk through fears and prepare together for an empowered birth. It can be reassuring to meet other women in a similar situation as your own. Sessions that are facilitated by a midwife are a good opportunity to learn more and have your questions answered in a friendly environment. See these resources for more information.

To Top

What happens in labour

Please check with your midwife or doctor about any specific care in labour at the hospital you have chosen to attend.

  • Present to the hospital when in established labour (regular painful contractions that are coming about every 5 minutes and lasting 40 – 60sec) or when there is rupture of membranes (waters break), bleeding or constant pain.
  • On admission an IV cannula will be inserted in your arm and some blood taken for crossmatching (to ensure your blood type is in the hospital in case you need it).
  • You should be able to eat and drink as you wish until in active labour (i.e. 4cm dilated with regular painful contractions).
    • Once in active labour it is recommended that you don’t eat, but you can drink fluids such as isotonic energy drinks. Milk based drinks are not recommended.
  • Continuous fetal monitoring (CFM) is recommended once in established labour.
  • If the baby’s heart trace is good, then you may be able to negotiate time off the CFM to be able to sit in the bath or labour under the shower for a while. The midwife will listen to the baby’s heart rate using a hand held Doppler.
  • To be able to remain active during your labour, you can request the use of the telemetry CTG, which enables you to walk around unattached to a machine.

Special note: If you choose not to have CFM, and would prefer intermittent monitoring with the Doppler, then the staff will want to document this in your medical notes as it may deviate from the standard care offered at your chosen hospital. It is best to negotiate this well before the labour commences and have your preference documented in your medical notes as part of a birth plan.

  • To assess progress of labour, the midwife or doctor can make an assessment through:
    • Observing how you behave during a contraction
    • Feeling the strength and frequency of your contractions
    • Feeling the position of and the level of your baby’s head (using hands on your belly)
    • Performing a vaginal examination (VE) to assess how much your cervix has opened up. 

To Top

Pain management

When you are in labour, the same options for pain management are available to you whether you have had a previous CS or not.

Some excellent pain management strategies include:

  • Massage
  • Music
  • Aromatherapy
  • Hypnotherapy
  • Visualisation
  • Deep breathing
  • Water – shower or full immersion in a bath
  • Hot packs
  • Upright and active positions during labour
  • Being and staying mobile

Additional strategies include:

To Top

Planning a positive caesarean section

  • It is a good idea to have some idea of what you would like to happen during a CS if you should require one. Perhaps you have some negative memories from the last CS and you want to make sure those things don’t happen again, or there were some really pleasant memories that you would like to experience again if you should need to have another CS.
  • Many women report that when they feel supported in their choices the experience is enhanced. Take time to write down the things you feel are important to you as you prepare for the birth of your baby. This is a great opportunity to talk through your wishes with your partner and share the experience.

Some ideas to think about are:

  • Who you would like to be there when the anaesthetic is being put in.
  • Who you would like to be in theatre with you when the baby is born.
  • Whether you would like some music of your choice playing during the surgery.
  • Whether you would like to see the baby lifted from your abdomen i.e. request the sterile curtain to be lowered as the baby is lifted up for you to see.
  • If you’d like to feel the baby all wet and warm. You could ask that the baby be passed to you directly after birth (as long as there are no medical issues with the baby) and hold the baby skin to skin.
  • You may like to discover the sex of the baby yourself, instead of being told by staff.
  • If there are some health issues with the baby or he/she does require some assistance from the pediatric doctors, then ask that the resuscitation cot be placed near the operating table and within your vision.
  • If you’d like to breastfeed the baby you may request that the baby remains with you after birth, while stitching is taking place and while in recovery room, until the first breastfeed has been completed.
  • You may like to have the baby stay with you in recovery. If there are staff available, this may be possible.

Discuss these with your midwife and/or doctor before your labour begins so that your requests are clearly stated in the medical notes. You may like to write your preferences down on a sheet of paper (birth plan), sign them and have them placed at the front of your chart.

To Top

Consumer brochures

To Top

Resources and links

  • Next Birth After Caesarean Clinic: Clinic at KEMH for women requiring support and advice after caesarian.

  • www.birthrites.org: This Perth-based consumer group website offers information and support to women who have had or need to have a CS. They also have information about VBAC and planning a positive CS. Services include: online discussion forum, telephone support, coffee groups South and North of the river in Perth, quarterly magazine which has some great birth stories and an information booklet “Caesarean Birth…Making Informed Choices”.

  • www.canaustralia.net: Australian website dedicated to information and support to women who have had a CS.

  • www.childbirthconnection.org: American consumer organisation (similar to the National childbirth Trust in the UK) which has put together evidence-based information to assist women and their families to make informed choices in childbirth. Excellent information to help decide whether to choose a VBAC or repeat CS.

  • www.vbac.com: American-based website dedicated to evidence-based information for women. Lots of links to VBAC guidelines around the world. Helpful information about how to make a truly informed decision about VBAC or CS.

  • The New Zealand Guidelines Group: Organisation made up of different health professionals who look at all the research around the world and then put together guidelines to help health carers to provide evidence-based care.

  • www.lamaze.org: American website that promotes normal birth. Good resources for birth preparation.

  • Royal College of Obstetricians and Gynaecologists: The UK recently published their VBAC guidelines (Feb 2007). These are very thorough guidelines although technical so you may need a health professional to help you understand some of the terms.

  • www.caesarean.org.uk: UK based website put together by two women who have been involved with the NCT for many years and have a passion for supporting women who have had a CS and/or planning a VBAC.

  • www.cares-sa.org.au: South Australian consumer group offering information and support to women about CS and VBAC.

  • www.birthtalk.org: Brisbane-based organisation run by midwives and women working together to provide information and support. Some good information about healing from a traumatic birth, planning a positive birth no matter how you give birth.

  • www.CSectionRecovery.com: American website dedicated to providing information to women to help them recover from a CS birth.

  • Health Pages: American website – lots of different health information including about VBAC and CS.

  • www.birthbeyondfear.com.au: A Local Perth midwife has put together a practical program to help women overcome fear associated with birth, whether CS or vaginal birth.

  • www.birthchoiceuk.com: UK website dedicated to empowering women to make an informed choice about how they give birth and who they choose to care for them. Some useful tools are provided.

  • www.nct.org.uk: The official National Childbirth Trust website has loads of information about all things related to pregnancy and birth.

To Top

 
All contents copyright © Government of Western Australia. All rights reserved