In most cases, it is better for mother and baby to go through the process of childbirth than a surgical delivery. For both of them, the possible complications of a caesarean section are more common and significant. After vaginal delivery, the recovery time for the mother is much shorter, giving her the chance to get to know and enjoy her new baby and her expanded family.
The concern in the past was over the risk to both mother and baby if the surgical scar on the uterus were to break open in labor. If the contractions are strong enough to dilate the cervix and deliver a baby, they could be strong enough to tear open a scar. This concern still exists, but we have learned that such a problem does not happen often in a well managed labor. If a problem does arise, close observation can allow a repeat caesarean to be done safely.
If you have once had a caesarean section, it is a good idea to visit an obstetrician during your routine prenatal care. Most often, however, your family doctor can continue to provide your obstetrical care. It is still debated whether women should have a VBAC when twins or a breech birth (coming bum first) are expected. These circumstances need to be discussed with an obstetrician and the method of delivery selected.
Your doctor will want to check your old delivery records to learn why you needed a caesarean and what type of procedure was done. Only those women with the surgical scar running along the lower segment of the uterus are eligible for VBAC. The scar on the outside of your abdomen does not indicate what happened on the inside.
Up to 80 per cent of women attempting VBAC who are carrying one baby in a head first position and whose scar on the uterus is appropriate will have successful vaginal deliveries.
You would think that if the previous caesarean section was done because the baby did not appear to fit through the birth canal, another caesarean would be necessary for a baby of equal or greater size. Often, this is not the case. Babies more than a pound larger than their older brothers and sisters have been born successfully by VBAC. Changes can occur in the birth canal, the position of the baby and the progress of the labor to allow this to happen. More than half the women who had caesareans for "failure to progress" will have successful VBACs.
Hospitals permitted to offer you VBAC must have certain facilities. There must be access to a blood bank on a 24-hour basis. Electronic fetal heart monitoring needs to be present, along with nurses and doctors trained to interpret the records.
Due to the small risk that the scar on the uterus may rupture, you need to be in a hospital where an emergency caesarean section can be done on short notice. Experienced obstetrical physicians capable of performing surgery, anesthetic personnel, pediatric staff and nursing staff need to be available. There must be an operating theatre for emergency use.
Although a doctor does not need to be present throughout labor, your progress will need to be monitored closely and assessed often. Failure of labor to progress at a predetermined rate is an indication for a repeat caesarean section.
You should plan to manage your labor the way you have learned from prenatal classes and reading materials. In early or pre-labor, rest and save your energy for the active phase. During active labor, try to get up and move about, changing your position frequently. Empty your bladder often to make more room for your baby to move down. Use the coping techniques you have learned such as relaxation, breathing patterns and massage.
Throughout a VBAC, your baby will be checked through fetal heart monitoring and most doctors will prefer you to have an intravenous line (IV). You may also be told to stop eating and drinking. Pain relief should be available as suits your needs. An epidural (spinal) anesthetic can be used quite safely in VBACs.
If there are no other reasons against it, doctors should encourage women to plan for VBAC. If your doctor does not suggest this, ask for the chance to experience a successful VBAC if caesarean was the previous method of delivery.