“VBAC” is an acronym for vaginal birth after cesarean. There are reasons why a vaginal birth may be desirable for women who have previously delivered by cesarean. For example, some want to participate more fully in the birthing process. Some say a vaginal birth will allow them to feel closer to their newborns. Some simply want to deliver naturally rather than by cesarean. And many simply do not want to undergo the invasive cesarean surgical procedure again.
Preferences aside, the safety and health of mother and baby must come first. Apparently, however, that has not always been the case.
Review Patient’s Surgical History
Prior to approving a vaginal delivery, it is essential to review the patient’s medical and surgical history. The medical professional must determine the type of uterine incision that was made for the previous cesarean. If a low transverse incision was made, this may indicate that the patient will be a candidate for vaginal delivery. If, however, it was a vertical incision, the risk of a uterine rupture increases and vaginal delivery should not be recommended.
Primary VBAC Risk: Uterine Rupture
There are potential risks associated with VBAC. The primary risk is a uterine rupture during delivery. This occurs when the uterine scar from a previous c-section or other uterine surgery reopens. This is not only extremely dangerous but in some instances life threatening for both the mother and the baby. It should be noted that while rare, a uterine rupture can occur even in the absence of a previous cesarean scar.
If there is a rupture, immediate emergency treatment will be necessary. A surgical procedure known as an exploratory laparotomy will be required. An incision is made through the abdomen to deliver the baby by cesarean. If the uterus is healthy enough it will be surgically repaired. If it is not, it will be removed. This is known as a cesarean hysterectomy.
Severe birth injuries may occur to the fetus.
If Vaginal Birth is Selected
If vaginal birth is selected, precautions should be made, which may include the following:
- Fetal ultrasound
- External monitoring during pregnancy
- External monitoring during delivery
- Monitoring of baby’s heart rate
- Measurement of mother’s amniotic fluid
- Internal monitoring through vagina, cervix, uterus, to baby’s head
Delivery Should Take Place in a Hospital
There are numerous precautions that should be taken before a VBAC procedure. The following are essential:
- The vaginal delivery should take place in a hospital
- Both the gynecologist and anesthesiologist should be present and immediately available
- Access to surgery is crucial
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