Vaginal birth after cesarean (VBAC) is no longer an exception. It doesn’t raise questions either. Nowadays, VBAC is considered a viable and safe option (associated with a 60% to 80% success rate) for many women. I believe that VBAC is a birth option that needs to be offered more in Greece. It provides many advantages, such as no surgery on the belly and lower risk of serious blood loss and infections. Also, it is known that many women trying for a VBAC had positive experiences during pregnancy and childbirth.
What is VBAC, and when and how should it be performed?
VBAC, which stands for Vaginal Birth After Cesarean, is considered a completely safe option after a previous birth by cesarean section in England, where I studied. Critics of VBAC often refer back to 1916, when Edwin Cragin stated in a public speech, “Once a cesarean, always a cesarean.” Things have changed. In Canada and America, doctors and scientific personnel argue that it should be included in state medical care measures so that all women who have already had a cesarean section can choose whether they want to give birth to their next child by VBAC. Many medical studies support the idea that an additional cesarean section is much more dangerous than a VBAC for the mother and the newborn. I repeat, a C-section is still surgery, and as such, it should only be considered an emergency medical procedure, not an elective one.
Questions and inquiries about VBAC
Many women ask how long they should wait after a cesarean delivery before becoming pregnant again and giving birth via VBAC.
The recommended gap should be at least 18 to 24 months.
How should a VBAC be performed?
A necessary condition for ensuring a successful VBAC is the correct selection of an experienced doctor in the fields of fetal medicine and high-risk pregnancy, supported by a specialized medical team (providing obstetric, hematological, and neonatal support). Additionally, more intensive monitoring of both the mother and the fetus is required throughout the pregnancy to achieve this unprecedented experience of natural childbirth, which only nature and the female body could have foreseen. The strength and affirmation of a woman after all the effort she puts in, the bonding with her partner who is also present at the moment of birth and cuts the umbilical cord, and the skin-to-skin contact with her baby whom she immediately takes into her arms, is truly overwhelming.
What are the risks of attempting a VBAC?
The risk of uterine rupture, meaning the old incision opening due to a previous cesarean section, is actually minimal, and in any case, the likelihood of this happening is around 0.5%, something an experienced maternal-fetal medicine specialist with a team of trained colleagues can ensure. The doctor who will be overseeing your VBAC needs to review your medical records to ensure there is no history of uterine rupture in a previous delivery, that you have had no more than two previous cesarean sections, and to determine what type of incision you had from your previous cesarean. If the incision is not T-shaped but lower in the uterus, near the cervix, VBAC is safer. Besides, most women today have the incision low, in the lower segment of the uterus. VBAC has fewer chances of success when the baby’s birth weight is predicted to be large (over 4 kilograms) and the mother’s age is over 40 years.
VBAC, step by step
Choosing an MFM specialist and a trusted team to support them so that the couple, and especially the expectant mother, will faithfully follow their instructions (for example, undergoing all the ultrasound and other check-ups, not gaining unnecessary weight, exercising, etc.), will help her gradually build this feeling of security and safety that she so desperately needs, and with the guidance of her doctor and the support of her midwife, experience an unforgettable birth.
What are the advantages of VBAC compared to a C-section?
For the mother, it’s a deep satisfaction and an even deeper physical and emotional transformation through a completely natural process that spares her an unnecessary surgery. Skin-to-skin contact creates an intense bond between mother and newborn child. Another difference is that almost immediately after this traumatic event, they get out of bed, walk, and leave the hospital faster without any mandatory recovery period.
However, there are also advantages for the newborn. Passing through the mother’s birth canal strengthens the baby’s respiratory and immune systems, reduces the future likelihood of childhood asthma and obesity, strengthens the bond with the parents, and facilitates immediate breastfeeding.
Conversely, another cesarean section carries a higher risk of adhesions in the pregnant woman’s abdomen, potentially leading to bleeding during that or the next delivery, and an increase in neonatal morbidity with a high probability of respiratory distress in the infant.
How big is the fear of childbirth, and how justified is it?
I know from my patients who had VBAC after a C-section that even their close circle of friends and family were initially against their decision. Perhaps because when something is considered standard practice, another process surprises us, disrupts the status quo, awakens us to overprotectiveness, and sometimes causes fear of our loved ones. But I’ve never seen anyone, and especially no new mother, who regretted doing it. On the contrary, I would say that their reactions to giving birth naturally, with a VBAC, painlessly, and with such positive spirits are so intense and profound that they impress even me, even though I’ve been with them throughout the entire pregnancy and childbirth process from the beginning.
And how widespread is the practice of cesarean sections in our country?
As a professor of Obstetrics and Genetics at the University of West Attica and a collaborator with many public gynecology clinics throughout Greece, I know that a percentage of births are performed either by scheduled or emergency cesarean section. In our country, this percentage of cesarean sections exceeds 52%, while according to the World Health Organization (WHO), it should be around 15%.
Conclusion
Every woman has the right to bring her child into the world as she wishes, and every birth (regardless of the method used) is an achievement. Furthermore, in many cases, a C-section proves to be not only life-saving but also the only solution; let’s not forget that. A woman chooses the VBAC method, not just because she avoids surgery, but because she chooses what she wants and achieves it. And this moment is so special that it cannot be explained in words, nor can the feeling be conveyed.
Learn more about natural childbirth after cesarean section in the following video:
