VBAC 101: Vaginal Birth After Caesarean Section

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VBAC 101: Vaginal Birth After Caesarean Section


Many of the women who are lucky enough to experience Vaginal Birth After C-section (VBAC) say it is the single greatest experience of their lives. They feel empowered, in tune with their bodies and more bonded to their babies and partners. If successful, it can be life changing.

Many doctors in South Africa are against VBAC births, but times are slowly changing. With more and more women interested in having a VBAC, more doctors are coming around to the idea and supporting their patients’ decisions. Statistics indicate that between 60 – 80% of VBAC births are successful. Provided the woman is a good candidate and gives birth in a facility equipped for emergencies.

Is VBAC a possibility for you? What do you need to do to make it a reality for you and your baby? Let’s look at some of the facts…

VBAC: Who is eligible?

The American College of Obstetricians and Gynaecologists states that 90% of women are candidates for a VBAC birth. If you are in good health, have an uncomplicated pregnancy and have a doctor who is willing to support you, you will be able to attempt a Trial of Labour after Caesarean (TOLAC). You are a good candidate for VBAC if the reason for your previous C-section is not present in this pregnancy (breech baby, multiples or umbilical cord compression).

Who isn’t eligible?

Anyone with:

–        multiple previous C-sections (more than two)

–        high blood pressure

–        diabetes

–        scarring from other abdominal surgeries

–      twin pregnancies (although the American College of Obstetricians and Gynaecologists recently updated their guidelines to allow trial of labour for women carrying twins – it will be difficult to find a South African Doctor to allow this)

–        less than 18 months since last C-section

Women who are obese are also poor candidates for VBAC, but it is still possible.

The Risks

The most often cited reason for opposing VBAC is the risk of uterine rupture. Uterine rupture is when the uterus tears along the weakened area around the previous C-section scar. Statistics don’t seem to support this as a major risk; with most studies quoting risks between 0.5% and 0.9%. Uterine rupture is a serious complication and can have serious repercussions for both mother and child. If your VBAC is unsuccessful and you end up needing an emergency Caesar, your risk of operative injury is greater, as well as an increased risk of hysterectomy and other complications. Risks to the baby include foetal distress, brain damage and even death. In addition to this, VBAC risks also include the risks associated with vaginal birth.

It is all of these risks, however small, that lead most conservative gynaecologists to dissuade women from VBACs. As one Cape Town obstetrician explained, “if something goes wrong we open ourselves up for expensive legal action, and very few doctors are willing to risk it.” The risks are small, but real and worth considering and researching fully.

You can find many VBAC risk calculators online that will tally up your risk factors, age, height etc. and provide you with a percentage probability of a successful VBAC. These calculators take all kinds of factors into account and are well worth trying out. Do an internet search for “VBAC risk calculator”.

The benefits

There are numerous benefits of vaginal birth, for both mother and child. Your baby enjoys all kinds of benefits from its trip down the birth canal. A lower risk for respiratory problems, an immune system boost and easier breastfeeding initiation to name but a few. Avoiding a major surgery and the resulting quicker recovery time is a big plus for mom too, especially if there are other children to be looked after and time out after a C-section is difficult.

A successful VBAC means avoiding the C-section risks and paving the way for less risky future pregnancies too. C-section risks increase with each procedure. A VBAC is also cheaper than an elective C-section.

Preparing for VBAC

If you have decided on a VBAC, you are going to need to do research. Surrounding yourself with supportive professionals is one of the best things you can do. Your doctor, midwife and a doula should all form part of your VBAC team. Spend some time reading VBAC books and success stories (see the resources below for a good starting point). Mentally preparing yourself for the birth is important process. Physical preparation is also important, getting your body in prime condition for the gruelling challenge of labour. Yoga, Pilates and generally remaining fit and healthy will all help improve your chances of a successful VBAC.

Some resources:

–        ICAN: The International Caesarean Awareness Network – has a strong online presence including a very active Facebook community. A first stop for mums wanting a VBAC who are looking for resources, information and support.

–         “Silent Knife: Caesarean Prevention & Vaginal Birth after Caesarean”, Nancy Wainer Cohen, Lois J. Ester. The Wall Street Journal calls it the “Bible of caesarean prevention”.

–        “Don’t Cut Me Again!: True Stories about Vaginal Birth after Caesarean Section”, Angela Hoy. Fantastic, uplifting resource filled with success stories. Just what you need to mentally prepare for a VBAC.

–        Facebook groups: VBAC SA, VBAC and the Unnecesarean

–        Look into Hypnobirthing: The odds of a successful VBAC experience are improved when hypnobirthing techniques are used. There are practitioners in all major South African cities.


The saying “Once a Caesar, always a Caesar” is no longer true. Weigh up the pros and cons carefully and consult with your doctor. If your doctor is very uncomfortable with the idea, it is his or her duty to refer to you someone else. Very few South African doctors will suggest or encourage VBAC, so the onus is on you to find someone who is supportive of a Trial of Labour. The main thing to consider when deciding is what is most likely to end with a healthy baby and mother.


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