Am I a Candidate for a VBAC?

February 12 2019

Dr. Delisa Skeete Henry answers the popular question…

Am I a candidate for a VBAC?

So for whatever reason you have just delivered via a cesarean section! Few women truly anticipate having a cesarean section especially if they have prepared for a vaginal delivery. A cesarean delivery is potentially always a possibility even to the most adequately prepared patient!

So time has passed. You’ve experienced the incision pain and gas pains. You are walking upright again. You can lift the baby and other heavy objects. You can starting driving again. The doctor has cleared you for exercise and intercourse. You’ve recovered from your surgery.

As you ponder growing your family, the question arises … can I have a vaginal delivery after a cesarean section?

The answer is perhaps.

An attempt can be made if you have had 1 or 2 low transverse C/S (LTCS). So the cut was made low on the uterus. An uncomplicated Low transverse cesarean section has less of a risk of uterine rupture than a high transverse incision or a vertical incision. This information is detailed on your operative report dictated by the surgeon.
The best thing to do is to obtain your operative report after delivery and keep it in your records. Hospitals and doctors are not obligated to keep these reports after several years and honestly reports can be lost or difficult to obtain after some time.

Can I VBAC if I have a single closure mod the uterus? Perhaps…

Once the uterus is open and the baby is delivered the uterine incision is inspected for any extensions then closed in a single layer. A second imbricating layer can be done in hopes of thickening and strengthening the incision site. There has not been significant studies to determine if double closure is better than single closure in relation to complications associated to VBAC. Because some doctors decline VBACs to women that here had single closure, it is imperative that you inform your provider that you prefer a double closure if a cesarean is needed. Put in on your birth plan .

Can I have a VBAC if my kids will be less than 24 months apart? Perhaps…There seems to be an unspoken rule that 18-24 months should be the minimum time from cesarean to attempted VBAC. The rationale is the give the uterine muscle time to heal and strengthen. Again there are not many definitive studies to support this rule. A few studies show that VBAC risk increase if inter pregnancy intervals were less than 6 months. Regardless, some doctors use this time frame to exclude women from attempting a VBAC. So if possible try to space your deliveries.

So if it is you desire to experience a vaginal delivery then obtain your operative report and consult with your healthcare provider.

-Delisa Skeete Henry, MD

Original article posted here.