Expert / 3 April, 2017 / Etienne Horner

Caesarean Awareness Month 2017: Should You Have A VBAC OR Caesarean?

The question:

My wife and I have been discussing VBAC vs Caesarean over the last couple of days.  The nurses and doctors seem to be pushing for VBAC but it’s difficult to know which is the safest option.

Our fear has been heightened by the fact that one of our friends has just had a horrendous VBAC (vaginal birth after caesarean section) which resulted in the little one losing oxygen and having the threat of brain damage which thankfully after some time in an incubator seems to have subsided, but her advice – understandably – was to have a planned C Section at all costs as the birth was terrible.  I know all pregnancies are different and unique so this was probably just an isolated case but she isn’t the only person we know who has struggled with natural birth in recent months / years and that obviously clouds one’s judgment somewhat. What to do?

Etienne’s response:

Generally we counsel all women who have previously had a caesarean section for a possible VBAC but clearly some women are in a better position to try a VBAC than others.

Someone who has previously gone through labour is the better candidate for a VBAC. but it also depends on dilatation. Dilation exceeding 5cm is the best scenario for a successful vaginal delivery. Women who have had a planned caesarean section do not make particularly good candidates, but if they’re keen to try they are still fine to give it a try.

It’s worth noting that it is not safer to have a caesarean section as opposed to a VBAC. VBACs should also be safe, given the constant monitoring of the mother and child during labour.

Those who opt for a VBAC must also be “up for it” as it could be that if the labour advances with no progress after a long time an emergency caesarean section would then need to be done. Because of this, some women might therefore say they should have had a caesarean section in the first place, but of course, one never knows beforehand.

I would advise this couple to discuss the pro and cons with their team in detail, and then decide which suits best, bearing mind that medically everything needs to be perfect, i.e. size of baby/ placenta location/ BP etc). If all of those things are in order, I would agree a VBAC.

It is strongly advised against having a VBAC after two caesarean sections, especially if recovery was uncomplicated following the first caesarean section. In these instances it is more reassuring for the woman to have another planned caesarean section rather than to go through a VBAC, as her cervix would have never been laboured.

Etienne Horner, Obstetrician & Gynaecologist