VBACs Are Great… for Other People


There are a lot of reasons that we ought to try for a VBAC (vaginal birth after cesarean). Maybe if I was braver, or more determined, this would be an easy choice.

I wrote about some of the great reasons to delivery vaginally after a C-section, including a shorter recovery time and a better chance for vaginal deliveries of any future children we may conceive. Since then, I've been encouraged to give my child the gift of a vaginal birth and not be scared by the seemingly small odds of uterine rupture or the chance of a repeat emergency C-section.

"The literature says that VBAC is safer than most people think. I tell patients that if they come in [to the hospital] in labor, we should give it a try," says Ron Jaekle, MD, professor of Clinical OB/GYN, University of Cincinnati College of Medicine. "VBAC is a completely reasonable choice in the right situation."

But is mine the right situation?

I could wait to go into labor naturally and give it a whirl. The idea of giving birth without another eight-inch souvenir across my bikini line is appealing, as is nursing and carrying my baby directly after birth. Some theories speculate that women who give birth vaginally are better able to bond with their babies, due to the rush of hormones that occurs during the process.

But do I feel any less attached to my second daughter, who was born by C-section, versus my first daughter, who was born during a drug-free vaginal birth? Truthfully, not at all. And the first recovery process was more arduous than the second. I experienced extreme blood loss due to a partially separated placenta, and the subsequent anemia dogged me for months afterward.

Next Page: Am I at risk? [ pagebreak ]I went to Charles Lockwood, MD, the Chief of Obstetrics and Gynecology at Yale-New Haven Hospital, to ask his opinion about my risks.

"The likelihood of success varies with the indication for the prior C-section," Dr. Lockwood explains. According to him, the success rate—the chance of avoiding another emergency C-section—is close to 80% if your previous C-section was for a breech-presenting baby. But the success rate drops to 30% if the C-section occurred because the fetus was too big to fit and the labor was long, with advanced cervical dilation. He estimated my success rate to be between 50–60%, based on my prior labor.

Those odds aren't too bad, but I'm still nervous about the possibility of uterine rupture. After a prior C-section, the risk of rupture during labor is about 1%, and the chance of a "catastrophic fetal outcome" if rupture occurs is about 15%, according to Dr. Lockwood. He then suggested I do my own risk-benefit analysis.

I reported to my own doctor's office to conduct the analysis and learned I have some indications that my risk may be higher than 1%, at least according to one recent study.

If the original C-section is performed in the midst of maternal infection, my chances of rupture are slightly higher, according to my doctor. The study also states that women becoming pregnant within six months of having a C-section are four times more likely to experience a rupture, there are "significantly greater" risks for women who give birth to big babies, and women over the age of 30 were three times more likely to rupture than younger women.

All of those risk factors apply to me. Though none of the risks are huge on their own, taken cumulatively, I found it concerning. Then I tested positive for Group B Strep again.

That did it. I'm planning a C-section for the 40th week of this pregnancy. The risk of infection, an emergency procedure, and/or rupture has become too much for this pregnant lady. We're taking the "easy" way out.