Monday, August 29, 2011

VBAC-Are you a good candidate?

So I've had patients ask me about VBAC (vaginal birth after cesarean) and whether or not this is the best option for them. This is a one of those things that is very individual and may or may not be the right thing for you.

First of all, VBAC has risk whether you've had a vaginal delivery before or not. There is approximately 1-2% percent risk of uterine rupture (from the previous scar on the uterus) during labor and delivery. There is risk of hemorrhage and fetal death from this, as well as hysterectomy (removal of your uterus). If you choose to take this risk, it is necessary for an obstetrician to be immediately available during your labor in the event that emergency c/section and/or hysterectomy is necessary. Because of this, CNM's (in this area) do not do VBAC's. We can however see you for prenatal care and then if you are an appropriate candidate for VBAC and desire this, you can transfer to an OB willing to offer VBAC and go from there.

Secondly, are you someone that VBAC would be successful or more likely than not to be successful? If your reason for having a c/section with the first or 1 or 2 of your deliveries (no more than 2 or VBAC is not allowed due to risk) was because of a breech baby, placenta previa, non-reassurring heart tones in labor, severe pre-eclampsia or HELLP syndrome where you didn't get the chance to labor or some other reason besides failed trial of labor, then you may be a good candidate for VBAC. This is especially true if your cervix is softening, dilating, and effacing the last month of pregnancy.

If your reason for c/section was because you labored a long time ( like 24+ hours), and your cervix never dilated, or it dilated but the baby never dropped or you pushed for 2-3+ hours and the baby never descended into the pelvis enough to deliver or to place a vacuum or forceps to attempt vaginal delivery, you are NOT a great candidate for VBAC. This is a circumstance that is likely related to you having a small pelvis and trying for a vaginal delivery again will result in the same problem. Although this is not always true, (maybe your baby was larger last time or the head was not coming down straight, etc.) it tends to be more likely that you will need a c/section again anyway, and your better option is just to schedule the repeat cesarean.

The other thing you should be aware of with VBAC is that it is preferrable that you go into labor on your own, and have an epidural during labor (in case of emergency c/section). If you are dying to just be started and your cervix is not ready, you should probably be anticipating a repeat c/section.

Well, hope this helps with your understanding of VBAC. As usual, please ask if you have any other questions or concerns regarding this. I can't always remember every detail of every topic to put on this blog. This is just the general gist....