What Moms Need to Know Vaginal Birth After Cesarean (VBAC)

Many mothers assume if they’ve had a Cesarean (C-section) delivery for their first or second baby, then a Cesarean is written in stone for their next child. But this isn’t always the case, says South Shore Health's Certified Nurse Midwife (CNM) Judy Berk.

In fact, Judy says helping women who have had a C-Section labor and deliver their babies is one of the many highlights of her practice.

“I have delivered more than 2,000 babies,” she says. “My greatest joy is to enable a woman to have a baby come out of her body from her own power.”

Nanette Landry, RN, CNM and co-director of the Midwife Practice at South Shore Hospital, says she’s seen an uptick of mothers interested in Vaginal Birth After Cesarean, also known as VBAC.

“These mothers are well-supported at South Shore Hospital,” she says. Eighty-three percent of mothers seen by South Shore Hospital's midwifery group between January and May of 2018 who attempted a vaginal birth after a C-section delivered their babies vaginally.

If a woman is interested in a Trial Of Labor After Cesarean (TOLAC), her nurse midwife or obstetrician will counsel her about the risks and benefits. But first, her healthcare team will review the eligibility criteria for a VBAC and ask the following questions:

What type of C-Section did you have previously?

To be eligible for a VBAC, a mother needs to have had a low transverse C-section. This refers to the type of scar on the uterus, says Berk. If a mother had a classical or vertical C-section, she would not be able to deliver vaginally.

How many C-sections have you had previously?

Typically a mother would not be able to deliver vaginally if she’s had more than two previous C-sections.

What happened in your previous deliveries?

“When we counsel a mother, we take a look at what happened before,” says Berk. “The reasons for the previous C-section are reviewed by the provider so the option of a TOLAC can be explored. If a mother had a C-section because the baby was in the breech position or had a non-reassuring fetal heart rate, these situations will not impact her current pregnancy or labor.”

Some women are concerned about trying to have a vaginal birth if they had a C-section because their baby was too big the first time. Judy says size shouldn’t be a deterrent to considering a TOLAC. “I’ve delivered babies that were bigger than the mother’s first baby,” says Berk. “It’s not always the baby’s size, it could be the fetal position during that specific labor.”

Before planning on a TOLAC, a midwife or obstetrician will go over the risks, including dehiscence, which is when the C-section incision opens during pregnancy or labor. This occurrence can be catastrophic to both the baby and mother, says Landry and Berk. If the scar is from a transverse C-section, the risk of dehiscence is less than one percent, but Berk says, “We take this risk very seriously.”

With a C-section comes all the risk associated with a surgical procedure, including increased risk of infection, laceration of a vessel, loss of blood, and increased risk of respiratory issues for the newborn.

All of the risks and benefits can be scary and overwhelming. A nurse midwife will address all of the information for both options and help the mother decide what is best for her and her baby.

As mothers already know, the baby can have different plans as the pregnancy unfolds. If the baby suddenly changes position or the mother’s health status changes, a C-section may need to be considered despite the mother’s initial intentions. But Berk aims to empower mothers to make an educated decision on how they would like to deliver their baby.

“We work hand in hand with the mother,” says Berk. “We are there to support the woman and family and how they would like to experience their pregnancy and their labor.”

Learn more about midwifery care at South Shore Health.