To V, or Not To V: Vaginal Birth After Cesarean

Craig Ruetzel, MD, Women's Health, ob/gyn, Hampton Roads OB/GYN Center, Bon Secours Hampton Roads Health System, Bon Secours DePaul Medical Center, pregnancy, childbirth, urinary incontinence, gynecology, gynecologist, vaginal health, Obstetrics & Gynecology

Craig Ruetzel, MD, of Hampton Roads OB/GYN Center

To V, or not to V,that is the question: that is , to VBAC or not to VBAC.

VBAC stands for “Vaginal Birth After Cesarean” and is the term used when a woman has, or tries for, a vaginal birth after previously having had a cesarean delivery.  There was a time not too long ago when the maxim “Once a C-section, always a C-section” was the rule in obstetrics. However, starting around 1980 it was learned that many women could safely have a vaginal birth even if they had had a cesarean in the past.  After this discovery, the pendulum swung and VBACs became so routine in the 1990’s that there was a time when many insurance companies required women to try for a VBAC, even if they wanted a repeat cesarean.

Recently, as more reports of complications of VBACs emerge, the pendulum has began to swing back in the other direction.  At this time, many obstetricians do not do elective VBAC deliveries, and there are many hospitals, even in metropolitan areas, where they are not offered at all.

What is a woman to do who is considering a VBAC and who wants to do the right thing?

There is no one ‘right thing’ in this matter, and each patient must learn the facts and decide what is right for her.  The prime concern with a VBAC is the uterine scar stretching or tearing open. This does not happen often. If a woman has had only one prior cesarean involving an across, or transverse, incision in the uterus and she is in spontaneous labor, this tearing happens less than 1% of the time.  More importantly, this uterine scar stretching or tearing usually isn’t catastrophic even when it does happen. In rare cases, this delivery can be extra-risky, either for the mother or the baby, leading many women to choose an elective repeat cesarean.

There are of course other factors that should go into the decision as to whether to try for a VBAC or not.  These include: the reasons for the initial cesarean, the facility with which an emergency cesarean can be done at the hospital, and a woman’s future pregnancy plans.  With each additional cesarean, the risks of complications do increase.

This is truly one of those areas in medicine where there is not one right answer. Talk about it with your obstetrician to see what is right for you.

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Dr. Craig H. Ruetzel has practiced in Hampton Roads since 1992. In addition to his comprehensive knowledge of women’s health topics, Dr. Ruetzel performs several highly-specialized and minimally-invasive procedures including laparoscopic hysterectomy and urinary incontinence surgery. Dr. Ruetzel is board certified by the American Board of Obstetrics and Gynecology and is a member of both the Medical Society of Virginia and the American Congress of Obstetricians and Gynecologists.

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