Have you heard of a VBAC? Maybe you know someone who has had a VBAC, or you yourself have had one.
What is a VBAC?
VBAC stands for Vaginal Birth After Cesarean.
Why is this important?
Here in the United States, we have a high rate of cesarean births. In 2019, 31.7% of all births were by c-section. To put this into context, this is more than double the rate recommended (10-15%) by the World Health Organization (WHO). C-section rates under 10% indicate lack of access to this life-saving medical intervention, while rates above 15% indicate overuse of this medical intervention, which is linked to long-term risks for the birthing person. Additionally, each subsequent c-section comes with additional risks to the birthing person.
With so many cesarean births happening nationwide, we need to consider the reality for people who have had cesarean births but wish to have a future vaginal birth. Afterall, for most individuals, a vaginal birth (including VBAC) comes with more benefits and fewer risks than cesarean sections, especially repeat cesareans. Benefits include easier recovery and less long-term health risks, along with the typical benefits of vaginal birth.
While there has been controversy surrounding VBACs due to misunderstanding and misinformation surrounding the risks of VBACs, the American College of Obstetricians and Gynecologists (ACOG) states that VBAC can be appropriate for the majority of individuals desiring vaginal birth. In fact, studies show that up to 90% of people who have given birth previously by c-section are candidates for a subsequent vaginal birth.
What are the criteria for VBAC?
The typical criteria to be considered a good candidate for a VBAC include the following, although ultimately it will come down to a conversation between the birthing person and their care provider.
- Most importantly, you desire a VBAC.
- You have a low-risk pregnancy and are in good overall health.
- Your c-section uterine scar is low transverse.
- You understand the risks associated with repeat cesareans. Click this link to read more at The VBAC Link.
- The time between your c-section and your subsequent pregnancy is considered sufficient by your provider. Sufficient time between your c-section and your next pregnancy allows for the scar on your uterus to fully heal.
The success rate (about 74%) for pregnant people who prepare for and attempt a VBAC are very high.
Midwifery care and VBACs
Studies show that midwifery care is linked to higher VBAC rates. Midwives utilize a personal, individualized approach to prenatal care, taking more time with each patient and supporting them to achieve their personal childbirth goals. Midwives are trained to support physiologic (natural) childbirth, which means that they avoid unnecessary interventions and favor a patience-based approach. While each individual scenario is different, most prenatal care providers – including midwives – recommend that VBACs occur in hospitals due to the associated risks. Our birth center will support individuals desiring VBACs by providing education and prenatal care that prepares patients for their VBAC. Patients desiring VBACs will be able to have prenatal care at our center and give birth at a collaborating hospital.
VBAC rates and racial justice
Despite overall high VBAC success rates, institutional medical racism and biases are reflected in low VBAC rates for Black birthing people. These low rates are not due to any physiological or biological factors; rather, similar to the maternal mortality and morbidity rates, they are due to institutional racism/bias on the part of medical providers. Often, providers advise people of color against attempting a VBAC due to low VBAC rates for people of color; this situation becomes a self-fulfilling prophecy. We at FPCN believe that pregnant people of any race can be great candidates for a VBAC, and are committed to empowering all pregnant/birthing people – especially Black birthing people who are at higher risk of having poor outcomes – to prepare for and achieve the birth they envision.
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This post is not meant to be taken as medical advice. Please consult your healthcare provider if you are interested in having a VBAC.