Vaginal birth after cesarean (VBAC)
Maybe some mothers asked, could they not give birth normally if they had previously given birth by cesarean section? Is it possible to give birth normally if you had a cesarean section? Certainly not as easy as imagined. Many factors must be considered.
Normal labor after a previous cesarean section may have been delivered. In the medication, this is called vaginal delivery after Cesarean (VBAC). Although currently, the success rate of normal labor after cesarean is quite large, it is not a simple and riskless action. The decision to give birth normally after a cesarean section requires careful consideration and complete preparation.
If you plan to do so, you should choose a doctor who supports the decision. Because not all hospitals meet the criteria for offering a Vaginal birth After C-section (VBAC) or normal delivery after a cesarean section. Usually, some hospitals also avoid controversy and potential legal problems.
What is VBAC?
VBAC or Vaginal Birth After C-section is an attempt to give birth through the vagina or normal labor, after delivery in a previous cesarean section. This action is usually carried out in the hospital with close examination and supervision of the medical team, including obstetricians and pediatricians.
What are the VBAC criteria?
Before deciding to do VBAC, mothers should know the following criteria:
- The previous cesarean incision is a low transverse (horizontal) uterine incision. If the vertical incision in the upper uterus (classic incision) or ‘T’ has a greater risk of uterine rupture.
- The mother’s pelvis is large enough to allow the baby to pass safely. Even though there is no certain way to find out, the doctor will examine your pelvis and confirm it.
- It is recommended for mothers who have never had major surgery in the uterus, such as myomectomy to remove fibroids (myoma).
- The mother also has never experienced a uterine rupture.
- There are no obstetric problems such as placenta previa or large myoma, which will make normal labor riskier.
- Make sure there is a doctor who oversees the delivery of the Mother and can do emergency cesarean section if needed.
- Likewise with anesthesiologists, other medical personnel, and equipment available at all times, to anticipate emergencies that can occur to mothers and prospective babies. Also, the mother must also pay attention to health conditions. The safest is done with the previous operating distance of about 18-24 months, less than 18 months the risk of spontaneous uterine tears increases. Although, it does not mean that it is not allowed. Another factor is the estimated fetal weight of no more than 4 kg.
What is the risk of normal labor for mothers who have had a cesarean section?
The birth of VBAC is quite a lot and successful. However, of course, there are several advantages and risks of VBAC.
- Benefits of VBAC
Successful VBAC can avoid major abdominal surgery and the risks associated with. This includes a higher risk of excessive bleeding, which can cause blood transfusions or even hysterectomy in rare cases. A higher risk of developing certain infections and other organ damage during the procedure. All potential complications of large abdominal surgery increase with each cesarean delivery because scarring can make each procedure technically more difficult.
The cesarean section requires hospital care that is longer than a normal birth. Recovery of the mother is generally slower and more uncomfortable. If the mother plans to have more children, she should know that each undertaken c-section will increase the risk of pregnancy in placenta previa and placenta accreta in the future. This condition causes the placenta to be implanted too deeply and does not separate properly during childbirth. This condition can cause life-threatening bleeding and removal of the uterus (hysterectomy).
Risk of VBAC
- Even if the mother meets good requirements for VBAC, there is a very small risk (less than 1%) that the mother’s uterus will rupture at the site of the previous maternal fault. Mothers can experience severe bleeding due to tearing of the uterine wall and maybe lack of oxygen for the baby. Uterine rupture is very dangerous for both mother and baby since the baby’s head can be injured.
- If the mother finally cannot give birth normally, the mother can last several hours for unplanned cesarean deliveries. Although successful VBAC is less risky than the repeated scheduled cesarean section, unsuccessful VBAC requires a c-section after the onset of labor carries more risk than the scheduled c-section.
- With unplanned c-section after delivery, mothers are more likely to have surgical complications, such as bleeding and infection of the uterus and incisions. The risk of complications is even higher if the mother finally needs an emergency cesarean section. If the maternal bleeding condition is more severe and difficult to deal with, the doctor must immediately take the removal of the uterus (hysterectomy). If your uterus is removed, you will not be able to conceive it later.
- Finally, there is a risk of the baby experiencing serious complications that can cause long-term nerve damage or even death. Although this risk is very small overall, it may be higher in prospective mothers who undergo failed VBAC (meaning c-section after labor failure) than for prospective mothers who have successful normal labor or scheduled c-section.
- For some women, pelvic floor problems are also potential. The weight and pressure of pregnancy can weaken the pelvic floor muscles that support the uterus. Vaginal delivery can stretch the pelvic floor muscles longer. This can cause temporary incontinence.
How do you prepare for VBAC?
If the mother chooses VBAC, here are some lists the mother should be done before:
- Learn about VBAC.
Take a birthing preparation class specifically for VBAC. Involving a spouse or other person/companion, if possible. Convey your concerns and expectations with health care providers. Make sure he has a complete history of health about you, including previous SC records and other procedures or interventions.
- Let the process of labor done as natural as possible. Avoid induction because this will increase the risk of uterine rupture
- Make your physical effort during pregnancy: Yoga, pregnancy exercise. Even swimming can be an option to prepare your body for the VBAC process
- Learning and discipline in practicing breathing techniques and hypnobirthing relaxation can be a solution so that you stay calm and in control during labor. Besides, this can also help shorten the length of labor
- Keep preparing plan A, plan B and even plan C. This means that you have to prepare physically and mentally if it turns out that doctors recommend sudden SC (for example it turns out to experience preeclampsia, failure to progress labor, or fetal distress)
- It is important to provide self nutrition. Eating healthy foods, including physical activity in daily routines, with good health and adequate rest, will help prepare vaginal delivery.