Top Secrets for Having a Successful VBAC ( vaginal birth after cesarean)

The conventional wisdom used to be that "once a Cesearean, always a Cesearean," but no longer. The medical cultural climate, as well as the AMA advice on the subject ebbs and flows, sometimes encouraging, sometimes discouraging attempting a VBAC (vaginal birth after Cesearean). But with the current style of uterine cutting, a VBAC can be attempted in most cases. But it is up to you to make the circumstances the best they can be for success.

The "classical" c-section cut was a long vertical cut into the uterus, making for a relatively unstable healing process. Because cutting through this large portion of upper uterine muscle does not heal as well, and has a larger instance of scaring problems, women with a classical incision are urged not to try a VBAC. No doctor in the U.S. will do a VBAC after a classical cut, and no midwife with the proper credentials will either. Weighing the rate of c-section complications versus the rate of uterine rupture, it is simply not worth it to have a VBAC in this case. As anyone who has looked into VBACs knows, the risks to the baby include fetal distress, brain damage and death. The risks to the mother include hemmoraging, loss of the uterus, and death.

Fortunately, if you have had a c-section in the past 10 years or so, you most likely have the low transverse incision, or "bikini cut." This portion of the uterus is much more likely to heal well and have less problems with scarring. One of my low transverse sections did have a lot of scar tissue, but that is not the norm. For a doctor to attempt a VBAC with you, you must have documentation that your previous c-section was not a classical cut.

Most midwives will no longer do VBACs, no matter what their incision, due to a spate of lawsuits in the past five years. There are some midwives who will, but they are few and far between. If you are able to find a midwif who will do a VBAC at home, I still would not recommend it due to the slight risk of rupture ( 1/2 of 1 percent). If there were to be an unlikely rupture, it is best to be in a hospital where help is close by. If there were a complication at home, you would likely not be able to make it to the hospital in time for help.