What is Vaginal Birth After Caesarean Section?

Vaginal birth after cesarean sectionIt is when a woman who has previously given birth by cesarean section gives birth to her baby vaginally in her next pregnancy. This type of birth in briefSSVDIt is called.

When VBAC is planned, the expectant mother goes into labor and vaginal birth is targeted. If TOLAC is successful, birth occurs vaginally and this condition is called VBAC.

Vaginal birth after cesarean section is not suitable for every expectant mother. The type of incision made on the uterus in the previous cesarean section, previous birth history, course of the current pregnancy, position of the baby, general health condition of the mother and emergency response capacity of the center where the birth will take place should be evaluated together.

In suitable candidates, VBAC may provide advantages such as shorter recovery time, fewer surgical complications, and reduced risks associated with repeat cesarean section in future pregnancies compared to repeat cesarean section. However, due to rare but serious risks such as uterine rupture, the decision must be made together with a gynecologist and obstetrician.

Benefits of Vaginal Birth After Caesarean Section

Vaginal birth after cesarean section may offer some significant advantages in suitable candidates. A successful VBAC may be associated with lower maternal morbidity and fewer complications than repeat cesarean section in suitable candidates. Recovery after vaginal birth can often be faster and the hospital stay may be shorter.

Follow-up plan during pregnancy and birth; It should be created by evaluating the medical history of the expectant mother, the week of pregnancy, findings about the baby, and the conditions of the center where the birth will take place [1][2].

Possible benefits of VBAC include:

• Abdominal surgery will not be performed again.
• Recovery time may be shorter than cesarean section.
• Hospital stay may be reduced.
• The risk of blood loss, infection, and surgical wound complications may be lower.
• The mother can return to daily life in a shorter time.
• Placenta problems and surgical difficulties due to repeated cesarean sections may decrease in future pregnancies.
• It may be an option under suitable conditions for expectant mothers who want to experience vaginal birth.

However, these benefits are only valid when appropriate patient selection is made and the birth is followed by an experienced team. If VBAC fails, an emergency caesarean section may be necessary, in which case some risks may be increased compared to a planned caesarean section.

Vaginal Birth After Caesarean Section (VBAC)

Vaginal Birth After Caesarean Section (VBAC)It is when a woman who has given birth by cesarean section in the past gives birth vaginally in her next pregnancy. This method is wondered by expectant mothers who do not want to have a cesarean section again or who want to have a normal birth experience under suitable conditions.

The decision on the method of birth is not based on a single criterion; It should be given taking into account the safety of the mother and baby, previous birth history and current examination findings [2][3].

The most important point for VBAC is that the physician who monitors the pregnancy evaluates whether the expectant mother is suitable for this type of birth. Especially if the uterine incision in the previous cesarean section was in the form of a lower segment horizontal incision and there are no other risk factors, the VBAC option can be evaluated more easily.

According to NCBI/StatPearls data, the success rate in VBAC trials is generally reported to be around 60-80%. However, this rate; It may vary depending on whether the mother has given birth vaginally before, whether the birth started spontaneously, the baby's weight, the mother's body mass index, and the reason for the previous cesarean section.

Advantages of SSVD

The advantages of VBAC become more evident once a successful vaginal birth occurs. Since repeat cesarean section is a surgical procedure, it may carry risks such as bleeding, infection, adhesions, bladder or bowel injury. As the number of recurrent cesarean sections increases, future pregnancy risks such as placenta adhesion disorders may also increase.

Symptoms that occur during pregnancy do not always have the same meaning; In cases such as bleeding, severe pain, regular contractions or decreased baby movements, evaluation is required without delay [1][3].

1. Natural Birth Experience

VBAC allows the mother to experience the vaginal birth process in suitable candidates. The expectant mother can actively participate in the birth process, feel the birth process of the baby, and the postpartum recovery period may be shorter than a cesarean section.

2. Shorter Healing Process

Recovery after vaginal birth is usually faster than after cesarean section. Since there is no abdominal incision, wound care, limited movement, and surgical pain may be less. This may support the mother to take care of her baby earlier and return to daily life more easily.

3. Less Risk of Surgical Complications

Since repeat abdominal surgery is not performed in successful VBAC, surgical complications related to cesarean section can be avoided. Successful VBAC may be associated with less blood loss, lower risk of infection, and shorter recovery time.

4. May Provide Advantages for Future Pregnancies

As the number of recurrent cesarean sections increases, risks such as placenta previa, placenta accreta spectrum, intra-abdominal adhesions and surgical injury may increase. Therefore, VBAC may be an important option for long-term birth planning in suitable patients planning more than one pregnancy in the future.

Factors Affecting Failure in Vaginal Birth After Caesarean Section

VBAC may not always be successful. Emergency cesarean section may be performed for reasons such as labor not progressing, deterioration in the baby's heartbeat, suspicion of uterine rupture, or risk of development in the mother's or baby's condition.

In the postpartum period, physical recovery, mental status, breastfeeding and infection findings should be monitored together [1].

Factors that may reduce VBAC success include:

• Having never had a vaginal birth before
• Previous cesarean section was performed due to labor not progressing
• Older maternal age
• Having a high body mass index
• The estimated weight of the baby is high
• 40-41 weeks of pregnancy. continue after a week
• Labor does not start spontaneously and induction is required
• Cervical opening does not progress properly

The presence of these factors does not mean that VBAC will definitely fail. However, it may reduce the likelihood of success and should be taken into account when making a birth plan.

In Which Circumstances Can Vaginal Birth Be Performed After Caesarean Section?

VBAC is not recommended or considered high risk in some cases. A planned repeat caesarean section may be safer, especially in cases that increase the risk of uterine rupture.

Situations where VBAC may not be appropriate include:

• A vertical or classical incision was made in the uterus in the previous cesarean section
• Having a previous history of uterine rupture
• Having had some uterine surgeries that deeply affected the uterine wall
• Placental placement problems that prevent vaginal birth, such as placenta previa
• The baby is in a position that is not suitable for vaginal birth
• Development of a medical condition in the mother or baby that requires an emergency cesarean section
• Lack of possibility for emergency cesarean section and blood transfusion at the center where the birth will take place
• Uncontrolled serious maternal illnesses or severe pregnancy-related complications

Diseases such as diabetes or hypertension alone are not always a definite obstacle. However, the severity of the disease, the condition of the baby, the course of the pregnancy and the conditions of the birth center should be evaluated together.

Is VBAC Risky?

VBAC may be a safe option in suitable candidates; but it is not completely risk-free. The most important risk is on the uterine wall where the previous cesarean scar is located.uterine rupturethat is, uterine rupture.

Uterine rupture is rare; However, since VBAC can lead to serious consequences for the mother and baby, close follow-up is required in births planned for VBAC. It is important to have a team and facilities to perform emergency caesarean sections in centers where VBAC is planned. Birth should be planned in a hospital with appropriate equipment.

Possible risks to watch for during VBAC include:

• uterine rupture
• Need for urgent caesarean section
• Bleeding
• Infection
• Disturbance in the baby's heartbeat
• Labour's failure to progress
• Need for intensive follow-up for mother or baby

On the other hand, planned repeat cesarean section also has surgical risks. Therefore, when choosing between VBAC and repeat cesarean section, the benefits and risks of both options should be discussed individually.

What are the Requirements for VAT?

The most important condition for VBAC is that the expectant mother is medically suitable for this type of birth. In VBAC planning, previous cesarean section, week of pregnancy, position of the baby, mother's birth history and hospital conditions should be taken into consideration.

General eligibility criteria for VBAC are:

• In the previous cesarean section, the uterine incision should be in the form of a lower segment horizontal incision.
• Mother and baby should be generally healthy
• The baby should be in head position
• There should be no placenta or baby position problems that would prevent vaginal birth.
• There should be no history of additional uterine surgery that increases the risk of uterine rupture
• There must be an emergency cesarean section at the center where the birth will take place.
• Mother and baby should be closely monitored throughout birth

The decision on suitability for each expectant mother must be made individually. A VBAC plan that is suitable for one person may not be safe for another.

When Can Vaginal Birth Be Planned After Caesarean Section?

VBAC is usually evaluated after the 37th week of birth in the current pregnancy. However, the decision is not made only based on the week of pregnancy. The time since the previous cesarean section, the type of uterine incision, the mother's birth history, the development of the baby and the risks that occur during pregnancy are considered together.

A very short interval between a previous cesarean section and a new pregnancy has been associated with an increased risk of uterine rupture in some studies. Therefore, birth interval is also taken into account in the evaluation of VBAC.

Spontaneous onset of labor may increase the success of VBAC. When labor induction or artificial pain is necessary, the risks and likelihood of success should be re-evaluated.

Differences Between VBAC and Repeat Caesarean Section

There are two basic options for pregnancy after previous cesarean section:VBAC trialor planned repeat cesarean section. Both options have advantages and risks.

If VBAC is successful, abdominal surgery is not required, recovery may be shorter, and the risks of repeat cesarean sections in future pregnancies may be reduced. However, there are risks such as uterine rupture or the need for an emergency cesarean section during the VBAC trial.

In a planned repeat cesarean section, the time of birth may be more predictable and the risk of uterine rupture is lower because labor is not attempted. However, cesarean section is a surgical procedure; It carries risks such as infection, bleeding, adhesion, organ injury and placenta problems in subsequent pregnancies.

Misconceptions About VBAC

There is a lot of misinformation in society about VBAC. This misinformation may negatively affect the decision-making process of expectant mothers.

"Anyone who has had a cesarean once must have a cesarean again."
No. In suitable patients, the option of vaginal birth after cesarean section can be considered.

"VBAC is completely risk-free."
No. VBAC may be safe in suitable candidates; However, it carries risks such as uterine rupture and emergency cesarean section.

"SSVD will definitely be successful."
No. VBAC success rate varies from person to person. Previous vaginal birth history, spontaneous onset of labor and the mother's general condition affect success.

"VBAC cannot be performed if there is diabetes or hypertension."
These situations alone are not always definitive obstacles. The control status of the disease, the course of pregnancy and the health of the mother and baby should be evaluated together.

"VBAC can only be done at home or in natural birth centers."
No. VBAC should be planned in appropriate health institutions with emergency cesarean section.

Comments of Those Who Had Vaginal Birth After Caesarean Section

The experiences of mothers with VBAC vary from person to person. Some mothers state that since they were able to give birth vaginally, they recovered faster, were able to take care of their babies earlier, and actively participate in the birth process. Some mothers may experience the process more stressfully because the birth attempt results in an emergency cesarean section.

"My first birth was a cesarean section. In my second pregnancy, after discussing all the risks with my doctor, we decided to try VBAC. The birth process was closely monitored and my recovery was easier because I was able to give birth vaginally."

“VBAC was a powerful experience for me, but the most important thing in the decision process was that my doctor clearly explained to me both the benefits and risks.”

"I started trying to give birth, but due to the baby's heartbeat, a cesarean section was made. Although I was sad at first, I later realized that the best decision was a safe birth."

Patient comments can provide insight into the decision process; However, the decision for VBAC should be made based on the medical evaluation of the mother and baby, not on personal experience.

Frequently Asked Questions

References

• [1] WHO - Recommendations on antenatal care for a positive pregnancy experience- International recommendations for pregnancy monitoring, counseling and safe follow-up.
• [2] WHO - Intrapartum care for a positive childbirth experience- Guide for the birth process, birth support and safe care principles.
• [3] ACOG - Clinical Guidance: Obstetrics- Clinical guide archive for pregnancy, birth and women's health practices.