The benefits of a vaginal delivery are many. A vaginal delivery is the most natural process for childbirth. It is associated with the least amount of risk to the mother. The post-partum recuperation period is usually shorter and less painful than a vaginal delivery.
The risks of attempting a vaginal birth after cesarean (VBAC) must be carefully considered before making a final decision. Studies performed on many women attempting a VBAC have shown it to be a safe procedure. Fifty to eighty percent of women attempting to deliver vaginally will be successful. This also means that 20-50% of patients will not be successful.
It must be understood that while any obstetrical complications (bleeding, fetal distress, etc.) may occur during a VBAC process, there is one unique complication with VBAC. The risk of uterine scar rupture is 10%. If this were to happen, fetal distress and fetal and/or maternal bleeding could occur. Scar rupture could lead to immediate repeat cesarean section. Continuous monitoring during the labor process usually allows this complication to be appreciated early in the process; however, severe maternal and fetal complications can result from scar rupture including fetal compromise, anemia, and fetal death.
The risks of elective repeat cesarean section involve general surgical risks of increase incidence of wound or pelvic infection and increase risk of blood loss. Recuperation is also substantially longer after a C-section. Lastly, there may be slightly more neonatal breathing issues with cesarean babies as compared to babies born vaginally. Anesthetic issues are also more complicated in cesarean deliveries and will be discussed by the anesthesiologist before the procedure.
Generally, we offer women the opportunity to attempt at VBAC if they spontaneously go into labor prior to their scheduled C-Section. Otherwise, we generally recommend you have a repeat C-Section at 39 weeks, as any attempt to put you into labor or increase your contractions markedly increases the risks to you and your baby.
Answered by Susan K. Mueller, M.D.
