Dr Sherene Kalloo

Vagi­nal Birth Af­ter Cae­sare­an, com­mon­ly re­ferred to as VBAC, or tri­al of labour af­ter cae­sare­an, is the process of de­liv­er­ing a ba­by vagi­nal­ly af­ter hav­ing had a pre­vi­ous cae­sare­an sec­tion (C-sec­tion). For many years, the phrase “once a cae­sare­an, al­ways a cae­sare­an” dom­i­nat­ed ob­stet­ric care. To­day, how­ev­er, we know that many women can safe­ly at­tempt a vagi­nal de­liv­ery af­ter a pri­or C-sec­tion, pro­vid­ed cer­tain cri­te­ria are met.

What Is VBAC?

A VBAC oc­curs when a woman who has had a pre­vi­ous cae­sare­an de­liv­ery goes in­to labour and suc­cess­ful­ly de­liv­ers vagi­nal­ly. The at­tempt it­self is called a Tri­al of Labour Af­ter Cae­sare­an (TO­LAC). If suc­cess­ful, it re­sults in a VBAC; if not, a re­peat C-sec­tion may be re­quired.

VBAC has be­come an im­por­tant op­tion in mod­ern ob­stet­rics be­cause it can re­duce the num­ber of re­peat sur­gi­cal de­liv­er­ies and their as­so­ci­at­ed risks. How­ev­er, it is not suit­able for every­one, and care­ful eval­u­a­tion is es­sen­tial.

Who Qual­i­fies for VBAC?

Not every woman with a pre­vi­ous C-sec­tion is a can­di­date for VBAC. The de­ci­sion de­pends on sev­er­al med­ical and ob­stet­ric fac­tors:

• Type of pre­vi­ous uter­ine in­ci­sion: The most favourable sce­nario is a pri­or low trans­verse (hor­i­zon­tal) in­ci­sion on the uterus. Women with ver­ti­cal or “clas­si­cal” in­ci­sions on the uterus (not the ab­domen) are gen­er­al­ly not ad­vised to at­tempt VBAC due to a high­er risk of uter­ine rup­ture.

• Num­ber of pri­or C-sec­tions: Women with one pre­vi­ous cae­sare­an are typ­i­cal­ly bet­ter can­di­dates.

• Rea­son for the pre­vi­ous C-sec­tion: If the ini­tial cae­sare­an was due to a non-re­cur­ring is­sue, such as breech pre­sen­ta­tion, the chances of a suc­cess­ful VBAC are high­er. If it was due to fac­tors like­ly to re­cur (such as a very small pelvis or labour that did not progress), CPD, the like­li­hood of suc­cess may not be pos­si­ble.

• Over­all health and preg­nan­cy sta­tus: A healthy preg­nan­cy with­out com­pli­ca­tions such as pla­cen­ta pre­via or cer­tain med­ical con­di­tions im­proves el­i­gi­bil­i­ty.

• Fa­cil­i­ty readi­ness: VBAC should on­ly be at­tempt­ed in a fa­cil­i­ty equipped to per­form an emer­gency C-sec­tion if need­ed.

Ben­e­fits of VBAC

When suc­cess­ful, VBAC of­fers sev­er­al ad­van­tages:

• Short­er re­cov­ery time: Vagi­nal de­liv­ery typ­i­cal­ly al­lows for quick­er heal­ing and a short­er hos­pi­tal stay com­pared to surgery.

• Low­er risk of sur­gi­cal com­pli­ca­tions: Avoid­ing a re­peat C-sec­tion re­duces the risks of in­fec­tion, blood loss, and in­jury to sur­round­ing or­gans.

• Fu­ture preg­nan­cy ben­e­fits: Each ad­di­tion­al cae­sare­an in­creas­es the risk of com­pli­ca­tions such as pla­cen­ta acc­re­ta and re­peat cae­sare­an in fu­ture preg­nan­cies. VBAC can help re­duce these cu­mu­la­tive risks.

• More nat­ur­al birth ex­pe­ri­ence: Many women val­ue the op­por­tu­ni­ty to ex­pe­ri­ence vagi­nal child­birth.

Risks of VBAC

While VBAC can be safe, it is not with­out risks:

• Uter­ine rup­ture: This is the most se­ri­ous con­cern. It oc­curs when the pre­vi­ous ce­sare­an scar on the uterus opens dur­ing labour. Al­though rare, it can be life-threat­en­ing for both moth­er and ba­by and re­quires im­me­di­ate sur­gi­cal in­ter­ven­tion.

• Emer­gency C-sec­tion: Not all TO­LAC at­tempts are suc­cess­ful. If labour does not progress or com­pli­ca­tions arise, an ur­gent cae­sare­an may be need­ed, which car­ries more risk than a planned one.

• Un­pre­dictable out­comes: Labour can be dif­fi­cult to pre­dict, and even ide­al can­di­dates may not achieve a VBAC.

Fi­nal thoughts

VBAC rep­re­sents an im­por­tant shift to­ward more per­son­alised ma­ter­ni­ty care. It em­pow­ers women with choic­es while main­tain­ing a strong em­pha­sis on safe­ty. If you have had a pre­vi­ous cae­sare­an and are con­sid­er­ing your de­liv­ery op­tions, dis­cuss VBAC with your ob­ste­tri­cian ear­ly in your preg­nan­cy. With prop­er eval­u­a­tion and mon­i­tor­ing, many women can safe­ly and suc­cess­ful­ly achieve a vagi­nal birth af­ter cae­sare­an. Good luck with your de­liv­ery and con­grat­u­la­tions to all preg­nant women.

This con­cludes April C-sec­tion aware­ness month.

Dr Sherene Kalloo

MDW, MBBS, DGO, DM, FACOG

Spe­cial­ist Ob­ste­tri­cian & Gy­nae­col­o­gist