Earthen Vessels Nurse-Midwifery is happy to care for women desiring a VBAC at home who meet appropriate risk criteria and who take the precautions discussed below to make homebirth VBAC as safe as possible!
It was once thought that if a woman had one cesarean delivery, all of her babies should be born that way. Today, we know that many women can plan a vaginal birth after a cesarean delivery (VBAC) – and many who do will be able to give birth vaginally. But what are the risks? What are the benefits? What makes a mother a good candidate for VBAC? What are some reasons not to have a VBAC? What can a mother do to increase her chances of having a normal birth?
WHAT ARE THE BENEFITS AND RISKS OF VBAC?
Benefits of VBAC to the mother include:
- No abdominal surgery
- Shorter hospital stay
- Less expense
- Shorter recovery period
- Lower risk of infection
- Less blood loss
If you want to have more children, VBAC may help you avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.
Benefits of VBAC to the baby include:
- Less incidence of respiratory complications
- Population with normal body flora which has been linked to long-term health benefits
- Less asthma and allergies
- Decreased risk of certain immune system disorders
- No risk of injury from surgical scalpel
- Improved immediate bonding and breastfeeding
- Increased hospitalization rates in first year for gastrointestinal and respiratory infection
The risk of most concern for mother and baby is the possible rupture of the cesarean scar on the uterus or the uterus itself. Although a rupture of the uterus is rare, it is very serious and may harm both mother and baby. Fortunately, a uterine rupture from a prior cesarean with a low-transverse scar is a rare event and occurs in less than 1% of women laboring for a VBAC. With appropriate screening, less than 5 out of 1,000 women laboring for a VBAC will be at risk for a uterine rupture. Learn more about uterine rupture by clicking here.
Risks of VBAC to mother and baby include:
- Complete uterine rupture may result in disability or death of baby (1.9 in every 10,000 VBAC labors)
- Uterine rupture can cause hemorrhage in mother
- A hysterectomy may be needed after uterine rupture
- Emergency cesarean by be needed which can be frightening
- Labor may end in repeat cesarean
- Delay in emergency care if VBAC planned out of hospital
WHAT MAKES SOMEONE A GOOD CANDIDATE FOR VBAC?
Some women will be ‘ideal’ candidates for a safe, successful VBAC while some mothers will have absolute contraindications to vaginal. Most women, however, will fall somewhere between. In the hospital setting, approximately 60-80% of appropriate candidates who attempt VBAC will be successful. So, what are some criteria that increase or decrease success and safety?
Factors that improve VBAC outcomes include:
- At least one prior vaginal birth
- Cesarean performed for reason such as breech position
- One low transverse incision
- Spontaneous labor onset with one head down baby
- At least 9 months between cesarean and next conception
Factors that are less ideal but still acceptable for VBAC include:
- More than one previous low transverse incision (VBAC candidate but not appropriate for homebirth)
- Cesarean performed for reason with increased chance of recurring, like failure to progress
- Unknown cesarean scar type
- Twin pregnancy (VBAC candidate but not appropriate for homebirth)
- Pitocin induction or augmentation of labor
- Pregnancy spaced closer than 9 months
Factors that are contraindicated for VBAC include:
- Classical incision in upper uterus
- Inverted T or L incision in lower uterus
- Induction with prostaglandins like cytotec
- Uterine rupture in previous pregnancy
- Any factor that prevents vaginal birth in any situation, such as complete placenta previa
- Any health condition requiring emergency cesarean such as placental abruption
WHAT IF YOU WANT A VBAC?
What can a mother do to increase her chances of having a normal birth?
If your birth plan is for VBAC, there are no guarantees that you will avoid another cesarean. However, you can take steps to increase your chances for having a safe and satisfying vaginal birth. Advance preparation in pregnancy can make all the difference. Careful choice of a doctor or midwife and birth setting that support and encourage VBAC and a trained or experienced companion who will be available to provide continuous labor support may be the most important things you can do. Once you’ve done your research and talked to your partner, discuss the specifics of your situation with potential healthcare providers to see if VBAC is right for you.
CNMs can offer VBACs at home, birth centers and in hospitals if the facility itself allows. Many homebirth midwives welcome VBAC clients yet not all women with prior cesareans have factors that make them good candidates for birth outside the hospital. Women with one prior low transverse incision and spontaneous onset of labor with one head down baby whose cesarean was at least 9 months before the conception of this pregnancy can be considered for homebirth. Proximetry to a hospital with 24/7 surgical and anesthesia services, collaborative arrangements with an obstetrician, satisfactory emergency transport plan, and qualified home birth attendants who are well-trained in emergency procedures an adequately equipped with necessary equipment and medications are factors to consider when deciding on a homebirth VBAC. Earthen Vessels Nurse-Midwifery is happy to care for women desiring a VBAC at home who meet appropriate risk criteria and takes the above precautions to make homebirth VBAC as safe as possible.