6 important truths about VBACs

Had a C-section and keen to deliver baby #2 naturally? You may not always meet the requirements. Here’s why…

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If you delivered your first baby via a C-section, you may feel a little shortchanged, as if you’ve missed the experience of giving birth naturally. You’re also keen to experience the benefits that come with delivering your baby vaginally.

Dr Peter Chew, senior consultant obstetrician-gynaecologist at Peter Chew Clinic for Women, lists the advantages both mother and baby can enjoy with a vaginal delivery:

* The blood loss during labour is less.
* Fewer post-delivery complications, such as wound infection and pain.
* Less time needed for recuperating.
* Reduced risk of placental issues in future pregnancies.
* Feelings of joy if the vaginal delivery is a success.

And unlike the past, even if your firstborn was delivered by C-section, you can still opt for a Vaginal Birth after C-section (VBAC) for your second and subsequent pregnancies. The success rate of women who attempt VBAC is between 60 and 80 per cent, says the National University Hospital’s Women’s Centre.

Dr Chong explains that as your pelvis has never been subjected to the rigours of natural birth, your doctor can’t be sure that you will have a successful VBAC.

That said, you need to be mindful that this process involves serious risks. In fact, some ob-gyns are known to discourage VBACs precisely because it may pose life-threatening dangers. Here are vital facts you need to consider before deciding to get a VBAC:

1. You’ll need to meet these conditions to be considered suitable for VBAC So as to avoid potentially fatal health risks, both Dr Chew and SmartParents expert Dr Christopher Chong, a consultant ob-gyn at Gleneagles Hospital, stresses you will need to meet the following conditions:

* The previous C-section was carried out smoothly. Dr Chong explains that if there are tears at the C-section wound site or a previous infection, the uterus might not be strong enough for a successful VBAC.
* Your baby is assessed to be of the “right” size — that is, not too big — for natural delivery.
* No uterine growths that can cause problems when you deliver vaginally.
* Your previous C-section was a bikini-cut (also known as a low transverse C-section) ― this is a horizontal incision, made right above the pubic area.
* The reasons that resulted in the C-section have already been resolved.

These strict requirements are also the reason why a VBAC is often referred to as a “trial of labour”. Dr Chong explains that as your pelvis has never been subjected to the rigours of natural birth, your doctor can’t be sure that you will have a successful VBAC.

2. After having two C-sections, you can still opt to go for a VBAC Dr Chong cautions that if you opt for a VBAC for your third pregnancy, this will carry an even heavier risk ― four times more than usual ― of uterine rupture. However, in cases where mothers have previously delivered two babies via C-section, Dr Chew would recommend that their third child also be a C-section delivery.

Four more facts coming right up…

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3. Baby has to be in a “head-first” position Both ob-gyns agree that they will make it a point to check your foetus’ position in the womb. Dr Chew notes that if the baby is in a breech position (appearing with folded legs first) or transverse position (lying horizontally from right to left or vice-versa), a VBAC may not be feasible, since it’ll mean a higher risk of uterine rupture. Dr Chong stresses that a “cephalic” position — where the foetus’s head comes out first — is necessary to achieve a successful VBAC.

4. You may still end up getting a risky, unplanned C-section If for any reason unforeseen issues derails your vaginal delivery, you may still have to undergo a complicated C-section. Dr Chong explains, “The womb tissue that the gynae will cut into is often soggy and marshy [following a long labour]. Hence, the surgery will be more difficult.” You may even inhale vomit into your lungs — a result of not fasting for the surgery. As you may not be mentally prepared for the surgical procedure, Dr Chong cautions that you may have an increased chance of suffering the postnatal blues. Not to mention, more pain and endure a longer period of recovery.

“In the case of a uterine rupture, the foetus will die almost instantaneously. An immediate C-section may not save the foetus in time.”

5. Having a VBAC can be potentially fatal for you Giving birth vaginally after a C-section puts you at greater risk of suffering a uterine rupture. As the name suggests, there will be a tear at the site of the previous C-section, which will cause massive bleeding. Dr Chew notes that your doctor may even advise you to get a hysterectomy to stop the bleeding. However, Dr Chew points out that studies show that the likelihood of uterine rupture is low ― occurring in 0.5 per cent of spontaneous labour. Besides the uterine rupture, a VBAC may also injure the surrounding organs such as the bladder.

6. It may also threaten baby’s life, too Dr Chew explains, “In the case of a uterine rupture, the foetus will die almost instantaneously. An immediate C-section may not save the foetus in time.” To lessen the chances that your uterus ruptures during the birthing process, your doctor may even have to use forceps to help you deliver your baby. This will heighten your little one’s risk of sustaining traumatic injuries like fractures. Babies delivered via VBAC are also more susceptible to foetal distress syndrome — their oxygen supply is reduced drastically during labour.

Photos: iStock

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