VBAC, or Vaginal Birth After Cesarean, refers to a woman’s attempt to have a vaginal birth after a previous cesarean section. In the past, the idea of “once a cesarean, always a cesarean” was widely accepted, but with advances in medical knowledge and technology, this notion has evolved into a new birth method. This method, known as Vaginal Birth After Cesarean, or VBAC, has become a viable option for many women who previously gave birth via cesarean and now prefer a vaginal birth.
VBAC is an important right granted to women who have had a cesarean experience but still wish to attempt a vaginal delivery. In modern times, cesarean birth rates have significantly increased. The World Health Organization (WHO) suggests that cesarean rates should be around 17%, but in our country, this rate is often much higher.
In our country, this rate varies between 20% and 90% depending on the hospital and specialists. Generally, the majority of cesarean births are women who have had a previous cesarean section. To reduce cesarean rates, efforts should primarily focus on lowering first-time cesarean rates. If requested by the family and medically appropriate, an attempt at vaginal birth after cesarean should be considered.
In general, to attempt vaginal birth after cesarean, at least 12 months must have passed since the first cesarean. If the woman has previously experienced a uterine rupture or underwent surgery for a fibroid that required incisions in all layers of the uterus, VBAC is not recommended. There should be no conditions during the pregnancy that would require a cesarean, such as gestational diabetes, a very large baby, placenta previa, or breech presentation.
The birth should ideally start naturally at the expected time. Inducing labor with medications or artificial methods during VBAC attempts may pose risks, but in cases where labor does not start on its own, supportive approaches can be used to encourage vaginal birth.
There are certain benefits to attempting a vaginal birth after cesarean. One of the primary advantages is a reduced hospital stay. Recovery after birth tends to be quicker, and mothers are able to establish communication with their baby more easily, which is important for initiating breastfeeding and stimulating milk production. Additionally, the risk of complications such as severe pain, heavy bleeding, blood clots, fever, blood transfusion, and uterine infections is lower. Vaginal birth also allows the baby to acquire beneficial bacteria during delivery, which can help reduce respiratory issues later on.
Some doctors may not support vaginal birth after cesarean, as they may not feel secure in handling emergencies that could arise during the process. Fully equipped hospitals may not always be sufficient for handling unexpected complications. A major concern for doctors is legal responsibility. Many doctors face legal challenges due to unavoidable complications during delivery, which may discourage them from performing vaginal birth after cesarean. To avoid such situations, doctors may choose to opt for a cesarean decision at the slightest indication of risk.
