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.

Women who wish for and undergo Vaginal Birth After Cesarean (VBAC) share various experiences and opinions. In general, those who opt for VBAC (Vaginal Birth After Cesarean) and work with a skilled specialist are generally satisfied, even if some complications or risks arise. However, this does not mean that there are no negative outcomes. Therefore, it is not advisable to make decisions about the process without the doctor’s recommendation, expert advice, and assessment.

While the experiences and opinions of those who prefer vaginal birth after cesarean or cesarean birth may be useful, it is healthier to listen to the recommendations, comments, and preferences of the specialist doctor who monitors and evaluates your process, especially for health-related matters.

Conditions Required for Vaginal Birth After Cesarean (VBAC)

There are certain conditions for performing vaginal birth after cesarean. One of them is that no additional uterine surgery should have been performed. Women who have experienced pregnancy anomalies and uterine rupture in previous births cannot have vaginal births. The healthcare institution must be capable of monitoring, managing, and performing the birth, as well as immediately performing a cesarean if necessary. The hospital where the birth takes place must also have specialized staff available, especially during weekends and nights, to be ready for an emergency cesarean.

This is important to prevent risky situations. Women requesting vaginal birth after cesarean must be thoroughly evaluated, and the medical benefits and risks must be explained. The decision should be based not only on emotional reasons but also on medical facts. For example, a woman who had a cesarean for breech presentation in her first pregnancy, is not obese, and has a normal-sized baby at 38-39 weeks of pregnancy is a good candidate for VBAC, whereas a woman who had a cesarean due to lack of progress at 8 cm in her first birth, is obese or diabetic, has an estimated baby weight over 4000 grams, and is post-term, is at higher risk for complications.

If the factors or reasons that led to your first cesarean are not likely to recur in your current pregnancy, and there is no significant medical or health issue, as well as if your newborn is developing normally, within a normal weight range, with a head-down position, and if you are willing to go through the VBAC process and your doctor is also willing, experienced, and as invested in the process as you are, you will be a positive candidate for vaginal birth after cesarean. You can discuss these conditions with your specialist doctor, get the necessary evaluations for the birth, and make an informed decision.

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