Tearing with joy and looking slightly exhausted, she hugged her husband tightly and exclaimed happily, “I have done it finally!” M, 30, had just delivered her second child normally. Looking slightly dazed, her husband kissed her repeatedly and congratulated her for achieving a natural birth, which she had desperately wanted to.
Two years ago, M delivered her first child in another hospital by an emergency Cesarean section (C- section) because of fetal distress. Her baby had pooped inside the womb during the early stages of labour.
“Doc, would you let me try for a vaginal delivery?” she pleaded with me at her first consultation. M’s antenatal course was uncomplicated. She was of average height with a roomy pelvis. The fetus was assessed to be about 3 kg at term with a head-down position. After discussing the pros and cons of VBAC with the couple, I gave her the go-ahead for vaginal delivery which she believed would heal her emotional wounds from having undergone a C-section for her previous pregnancy.
Prevalence of VBAC According to the 2018 data from the Centers of Disease Control and Prevention (CDC) of USA, 13 % of pregnant mums had VBAC. There is no local statistics.
Advantages and Risks of VBAC Advantages
Relatively safe in selected cases
Avoidance of surgical and anaesthetic complications of C-section
Shorter recovery time
Option to have another vaginal delivery in subsequent pregnancies
Reduction of the risks of multiple Cesarean deliveries, the most serious of which is placenta accreta spectrum disorder (PAS)
Positive impact on the emotional wellbeing of the couple
Risks Uterine rupture
The most serious risk of VBAC is uterine rupture in which the scar from a previous C-section gives way under the pressure of contractions. The incidence of uterine rupture is about 0.5% -1% after one previous lower segment C-section, and 4–9% after a previous classical cesarean section. The resulting tear, if it rips through all layers of the uterus, can be life threatening for both the mother and the baby. Up to 30% of babies may die or suffer permanent brain damage.
What are the warning signs and symptoms of imminent uterine rupture? These include:
Severe abdominal pain
Rapid and rising maternal pulse
Sudden nausea and vomiting
A drop in the fetal heart rate by electronic monitoring
Assessing the suitability of VBAC VBAC is not for everyone. The following conditions may not be suitable for VBAC
Classical C-section where the scar is in the upper part of the uterus
Previous uterine surgery e.g., fibroid removal. This may result in weakening of the muscle wall of the uterus
History of prior uterine rupture
Obstetric complications: e.g., severe pre-eclampsia
Chance of a successful VBAC? If there are no contraindications, the chance of a successful VBAC resulting in a natural delivery may be up to 60–70%.
M had spontaneous labour at 39 weeks of gestation. Labour commenced with a “show” and regular contractions. Her labour progressed smoothly and she delivered a healthy baby boy 5 hours after admission with the help of a vacuum cup.