What You Should Know about VBAC Risks

While a vaginal birth after cesarean delivery (VBAC) is often an empowering experience for women who are told they should have another C-section, this type of labor is not without risk.  A scar on the uterus from a previous cesarean delivery raises the possibility of uterine rupture – a potentially life-threatening complication that occurs when the C-section scar spontaneously breaks open during labor, causing massive blood loss.

Other VBAC risks include the need for an emergency or unplanned C-section, infection, and neurological damage to the baby in the event of oxygen deprivation.

But despite these frightening prospects, data shows that risk of uterine rupture and other complications with VBAC is less than 1 percent. If vaginal delivery after a cesarean section is actually safer than a C-section itself, why are doctors hesitating to perform them? OB-GYN Dr. Lizellen La Follette explains what expecting mothers should know about VBAC labor.

Facts about VBAC labor

Having performed more than 300 VBACs in her professional career, La Follette offers advice and information based on her experience.

• Induction with Pitocin is fine – while an induced labor may be longer than one that occurs spontaneously, this does not preclude women from having a successful VBAC.
• Conditions should be optimal – Prior to delivery, your OBGYN should assess fetal heart rate, size, position and level of amniotic fluid to make sure conditions are safe for a VBAC.
• Don’t go to the hospital into you’re in labor – If your cervix has not begun to dilate, the hospital could send you home. Once you’ve been admitted, the hospital must reserve an operating room until the baby has been safely delivered.
• Be prepared for a long labor – in order to reach “active labor,” the cervix must be dilated 6 mm. For some women, this change can take up to 20 hours.
• High rate of success – Data from The American Congress of Obstetricians and Gynecologist (ACOG) reports that 60-80 percent of vaginal births after cesarean delivery are successful. However, there are times when the baby’s presentation, size or other unforeseen complications render a VBAC too risky. A safe outcome for you and your child are top priority, and a C-section may be the better option.

VBAC labor risks

Rapid heart decelerations of the fetus are normally the first signs of a problem when attempting a VBAC delivery. Attending physicians must perform continuous electronic monitoring to ensure there are no signs of fetal distress, which may indicate a lack of oxygen.

A failed VBAC after a prolonged and difficult labor will lead to an unplanned C-section, which carries a higher risk of surgical problems such as excessive bleeding, infection, and in rare cases, the need for a hysterectomy.

An experienced and competent healthcare team is essential to the successful outcome of any childbirth. Doctors who fail to monitor fetal heart rate, or proceed with a VBAC despite a high estimated birth weight may put mothers and their unborn children at unnecessary risk for injury, giving rise to claims of medical negligence.

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