When I found out I was pregnant with DS2, I knew I wanted to try and have a normal vaginal delivery so I started to look into my options, I read into both VBAC and HBAC. This post covers planned VBAC in hospital, why I chose to attempt one and the benefits and risks. I’ll cover HBAC and Caesarean in my next two posts.
I had already had one caesarean and knew the recovery time would be much longer if I opted for an elective. However I must stress my last section was an emergency and elective sections are typically much easier to recover from as your body hasn’t been through the stress of labour prior to the operation.
For me the main reasons for wanting a successful VBAC were as follows:
- I wanted to experience giving birth ‘normally’
- Vaginal births are much better and less stressful for baby
- Vaginal Births are much better and less stressful for mum
- Recovery time is much faster
- No limit on when you can drive (6 week driving ban after a section)
There are risks involved in trying for a VBAC, but to me the benefits outweighed the risks and considering that the risks involved in a vaginal delivery are lower than that of a section I came to the conclusion that as long as I laboured in hospital it would be a safe option.
I wouldn’t advocate trying for a VBAC in any facility that isn’t equipped to handle a Caesarean just in case there is an emergency, especially as there is a 1 in 200 chance of Uterine Rupture! If you have been following my blog you will already know that I was that 1 in 200 and had I not have been in hospital or a facility equipped to cope with such an event then I would have lost my baby and potentially my own life too.
VBAC is also a preferred option for women who are planning more children. Whilst the risk between VBAC and a second Caesarean is minimal, the risks in a third or fourth Caesarean start to rise dramatically. So VBAC is a much better option for those wanting more children. For me it wasn’t one of my reasons behind opting for VBAC as I don’t plan on having more children, but if you are it is something to consider.
There are two main risks involved with a VBAC. The first is you may need to end up with another Caesarean, this is most likely if the reason for your first was failure to progress. For me this wasn’t an issue as my first was due to malpositioning and I had managed to fully dilate and start pushing prior to my first section when DS1 decided to move and then get himself into distress. 25% of VBACs will end in a repeat section, the chance of a repeat section lowers to 10% if you like me did manage to progress to full dilation prior to the section.
The other risk involved with a VBAC is far more serious and is the Uterine Rupture. 1 in 200 VBACs will end up this way (0.5%) This is when the previous scar breaks open internally and baby breaks through the wall of the uterus into the abdominal cavity. This unfortunately is what happened to me.
If this does happen to you then like me you will need an immediate emergency Caesarean to prevent complications such as haemorrhage, brain damage to the baby or infant death. You may also need a hysterectomy if they can’t fix your uterus after the rupture. Thankfully for me they managed to save my baby and my uterus and thus save me a life of hormone replacement.
Whilst the prospect of a Uterine Rupture is extremely scary, as long as you are in a facility that is ready to deal with it then the chances of perinatal death are greatly reduced. You will have staff on hand to immediately deal with the situation.
It is worth considering that 6.2% of uterine ruptures are associated with perinatal death and that 33% of women with uterine rupture will require an emergency caesarean. Whilst these statistics seem scary, bear in mind that rupture only occurs in 0.5% of VBAC’s so the risk of perinatal death from attempting a VBAC stands at less than 0.005% (I can’t vouch for the accuracy of this figure, but it is low)
It is also worth considering that for VBACs in a hospital environment or a facility equipped for an emergency section that the maternal mortality rate due to uterine rupture is 0%.
So whilst there are risks associated with a VBAC they are minimal, especially if you ensure that you labour in an environment equipped for an emergency.
I feel blessed that I was in a great hospital with fantastic staff on hand when mine ruptured, my outcome could have been so different had I laboured at home.
Overall I am pleased I tried, and I don’t regret it at all. Yes I got unlucky, but as with anything you never know unless you try, and I felt secure in the knowledge that I was safe if/when the worst happened. It’s always good to remember that 75 – 90% of VBACs are successful, so the odds are in your favour 🙂