VBACs: How to Have a Successful Vaginal Birth After a C-Section

vbacFor decades, pregnant women lived by the principle that once they gave birth via cesarean, that's how all subsequent deliveries had to be. This school of thought was due to the restrictions the American College of Obstetricians and Gynecologists (ACOG) put on the practice in the '90s, which caused many hospitals to refuse natural labors for women who already underwent C-sections. But, thankfully, in 2010, the ACOG became more lax with its restrictions, giving women more opportunities to attempt vaginal births after C-section, or VBACs.

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There are many reasons pregnant women find VBACs to be an attractive option. With vaginal births, there are shorter hospital stays, quicker recoveries, and less blood loss involved in the delivery process. And the good news? According to the American Pregnancy Association, about 90 percent of women who have undergone cesarean deliveries are candidates for VBACs, and in most studies, roughly 3 to 4 out of 5 women who have previously undergone cesarean birth can successfully give birth vaginally.

Thinking of attempting a VBAC? Here are 5 ways to put the odds in your favor.

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Monitor your weight. Many patients end up with a C-section because they gained more than the recommended amount of weight during pregnancy (between 25 to 35 pounds) and had bigger babies. The bigger the baby, the higher risk for a C-section. Exercising and being mindful of what you eat can allow for a smaller baby and a higher chance for a vaginal delivery. Daniel Roshan, MD, a maternal fetal medicine specialist in New York City with a high VBAC success rate, suggests running and swimming for his pregnant patients attempting VBACs. "This allows for a stronger body, better abdominal muscle tone, and pushing power," he notes. "It also decreases the risk of developing gestational diabetes, which leads to bigger babies."

Try evening primrose oil. It's important you talk to your doctor before taking any supplements, but Dr. Roshan gives his patients evening primrose oil starting at 34 weeks. "This makes the cervix much softer and more amenable to dilation when the labor starts," he says. "Many patients have C-sections because their cervix does not dilate."

Avoid inducing labor. "Using medication to induce labor (Pitocin) increases the risk of uterine rupture, and the best is to avoid it or use it very carefully," states Dr. Roshan. "Induction is not a natural process. The uterus, pelvis, and baby are not ready for labor, and this by itself increases the risk of cesarean. If there is no clear need to induce, it is best is to wait for spontaneous labor, which allows the baby to be in a better position, and the body is more ready for giving birth."

Wait between pregnancies. Many doctors will recommend you avoid getting pregnant for 18 months after a C-section to increase the odds of a successful VBAC. The reason? The interval between pregnancies can help the uterus to heal, and the scar of the C-section will be stronger, so the likelihood of it separating during pregnancy or labor is decreased. "Twelve to 18 months is recommended in between pregnancies for VBAC patients," suggests Dr. Roshan. "Unless the patient is of an age where she might not be able to get pregnant easily, then a shorter interval is allowed. However, the recommendation is to do a repeat C-section in such a case."

Choose your caregiver wisely. After you've made the decision to try to have a VBAC, you should do your homework. Typically, midwives have lower rates of cesarean sections (though you may want to seek out a midwife who delivers at a hospital in the case that you do need a C-section). If you're not comfortable giving birth with a midwife, look for a doctor/hospital with a low cesarean section/high VBAC rate, and be sure to discuss your intentions with your practitioner before you go into labor. You want someone who is up on the latest studies; preferably who doesn't view VBACs as "high risk"; and of course, who is on the same page as you.

What are you doing to prepare for your delivery?

 

Images via Fabrizio Morroia/Flickr/Corbis

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