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Vaginal Birth After Cesarean

By Peggy DeZinno

Have you had a Cesarean Section for the birth of your baby? Do you know someone who has? Have you heard the phrase, "Once a Cesarean, always a Cesarean"? Do you think it's true?

If the answer to any of these questions is "yes," you will want to know more about Vaginal Birth After Cesarean, or "VBAC" (pronounced "VEE-Back").

Here are a few facts about Cesarean Section that you might not be aware of:

  • Cesarean Section is a major surgical procedure.
  • In many cases it can be lifesaving if there is a good medical indication.
  • The rate of Cesarean has increased from 5% in 1970 to 24.7% in 1988, and has dropped slightly to 20.5% in 1995.
  • In the U.S., Cesarean Section has become the most frequently performed major operative procedure for childbearing women.
  • Cesarean Sections cost more than vaginal births in terms of higher hospital and doctor costs and fees, and longer hospital stays.
  • The World Health Organization (WHO) tells us that the Cesarean Section rate should not be more than 10-15%. On the other hand, women who have a VBAC have a quicker recovery. Having a proven successful VBAC sets the path for further vaginal deliveries.
Across the country, there is an initiative to lower the Cesarean Section rate and raise the VBAC rate. "Cycles for Change" is the catchword that describes efforts to reach the goal of a 15% Cesarean rate and a 65% VBAC rate in the next year. "Once a Cesarean, always a Cesarean" no longer holds true. In fact, women with two previous Cesarean Sections can now labor. The only absolute contraindication specific to a VBAC trial of labor is a previous vertical incision on your uterus.

What can you do to increase the chances of having a VBAC?

  • First, expect a vaginal birth;
  • Discuss with your caregiver the circumstances surrounding your previous pregnancy and delivery. Try to determine what could be changed to improve your chances of having a VBAC;
  • Find a supportive doctor/nurse-midwife. Ask what the C/Section rate is in the practice;
  • Know that a VBAC is possible;
  • Seek prenatal care early;
    Have an uncomplicated pregnancy;
  • Eat a well-balanced diet;
  • Find a safe prenatal fitness program, i.e. Dancing Thru Pregnancy®; Attend a VBAC Class early in your pregnancy to learn more about your options for a successful VBAC;
  • When you are in labor, use all the comfort measures that you learned about in your classes, including coming to the hospital in active labor, staying upright and out of bed, using all comfort measures at your disposal, including a Birth Ball, aromatherapy acupressure, showers, slow dancing, frequent position changes, and more;
  • Learn as much about birth as a normal process as you can;
  • Believe in yourself. When laboring, surround yourself with people who believe the same as you do.
  • Read about VBAC, especially if you are thinking about having a repeat Cesarean Section. Birth After Cesarean, by Dr. Bruce Flamm, is the best book on the subject.

To join the initiative "Cycles For Change" and be part of a growing team that is working very hard to make birth more of a process and less of a medical event, contact the hospital or birthing center at which you will give birth.

Peggy DeZinno is the coordinator of Women's Education, Life Learning at Yale New-Haven Hospital. She and her husband live in Prospect with their three daughters.

NOTE: This information should not be used as a substitute for the medical care and advice of your personal healthcare provider.

 

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