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Balancing the risks and benefits of VBAC

Childbirth is a momentous life event. But it can also be a life-threatening one. Complications at any point during labor or delivery can have a big impact on both mother and baby for a long time to come.

Recognizing these risks, many hospitals and OB-GYNs are reluctant to allow VBAC (vaginal birth after cesarean) - or, more accurately, trial of labor after cesarean (TOLAC). Women who have previously had a cesarean delivery are often slated to have scheduled cesareans for all future births.

However, that may be changing.

This fall, the American College of Obstetricians and Gynecologists (ACOG) issued new guidance on VBAC, urging that it be made an option for low-risk women with no underlying complications. The practice bulletin notes that VBACs have an overall success rate of 60 to 80 percent. It discourages hospitals from instituting outright bans, provided they have the ability to handle emergency C-sections.

What can go wrong

The hesitation surrounding VBACs is rooted in legitimate concerns. Women who have had a previous C-section are at greater risk of uterine rupture - a serious and often deadly complication that threatens the lives of mother and baby. While the risk of uterine rupture is low (less than 1 percent for those who undergo TOLAC), the catastrophic consequences make it a risk worth taking seriously.

Why it may still be worth considering

On the flipside, there are benefits to avoiding a second cesarean section (which amounts to major abdominal surgery each time it happens). A successful VBAC lowers your risk of complications such as:

  • Blood clots
  • Hemorrhage
  • Infection
  • Adhesions
  • Surgical errors
  • Fetal respiratory problems

Vaginal deliveries also typically result in a smoother recovery.

Making the right choice for your situation

Of course, not all women are candidates for TOLAC. It might not be a safe choice if you have risk factors such as:

  • More than one previous C-section
  • Advanced maternal age (35 and older)
  • Maternal obesity
  • History of high birth weight
  • Failure of cervix to dilate in prior delivery
  • Previous delivery complications
  • Current pregnancy complications
  • An unfavorable incision (generally anything other than low transverse)

Every woman is different. If you're considering VBAC, take the time to discuss the risks with your OB-GYN, and be open to changing course if the need arises. Whether or not you attempt VBAC, you can feel more confident knowing you made a careful and informed decision.

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