What you need to know about VBAC and birth after caesarean.

Did you know that the biggest reason for having a baby via caesarean, is having had a previous caesarean? And did you know after having had a caesarean, only about 15% of women will go on to have a vaginal birth for their next baby?

Because of these high rates of surgical birth, it can be easy to assume that repeat caesareans must be necessary and safe. And for some women, this will be the case. Some – but not all.

Attention is being drawn to rising caesarean rates. While the World Health Organization recently stated that caesarean rates over 10% are not associated with reductions in maternal and newborn mortality rates, countries such as Australia and the United States have some of the highest rates of surgical birth in the world. In Australia, more than one in three births now happen via caesarean, at 33% of all deliveries.

But what does this mean for an individual woman?

​Sometimes, women find it isn’t as simple as a choice between a repeat caesarean, or a vaginal birth. If it was, we wouldn’t have a vaginal birth after caesarean (VBAC) rate of only 15%.

​I spoke to Ana, who gave birth to her third baby after two prior caesareans. Of her second caesarean, Ana explained, “After being disappointed when my first birth ended in a caesarean, in my second pregnancy I sought a care-provider who would support my plan to have a VBAC. Although this care-provider offered one-to-one care, they didn’t listen to my needs or wants, and spent the entire time convincing me that my only option was a scheduled repeat caesarean.”

Pregnancy and birth is a time of personally nuanced and complex feelings and needs. Yet planning for a birth after caesarean, however, can also often feel like an exercise in statistics. Risks of this, chances of that, a certain-times increase or decrease in something else. It can be confusing to make sense of the presented statistics and to work out how they can inform your decision making.

Often, women might feel talked at, rather than listened to. She might feel differently to her partner, or her friends or family. She might have one care-provider tell her one thing, only to have a different care-provider tell her something else. She may also find that her feelings change as her pregnancy goes on, and she may wish to make different decisions or change her plans. It can be of enormous benefit to a women to learn to communicate her own desires and needs to those who will be supporting her – for instance her partner, and her maternity care-providers.

When planning a birth after a caesarean, it can be helpful for women to remember that their choices are individual, and that risk analysis is subjective. What feels like a risk for one may not feel so for another. What is important to one woman, may not be for someone else. Consider, for instance, a woman who may have previous birth trauma centred around not being given enough time during labour, and feeling coerced into interventions. It may be vitally important to her that this does not happen again, that for her next birth, she feels supported to labour uninterrupted and without pressure. Yet another woman may have felt alone or out of control in her previous birth, and for her next birth she needs strong, consistent support and explanation from care-providers at all times.

As Ana went on to tell me, “It wasn’t until I found myself unexpectedly pregnant with my third child that feelings from the previous experiences surfaced … this time I would not settle for a care-provider or any model of care that did not put my needs as the highest priority. So I went on a mission to find support for my plan for a physiological and natural birth after two caesareans. This was not readily available. I quickly concluded that I would need to develop my own team, made up of personal support for myself and my husband … My doula offered us unbiased information when exploring our needs for this birth. I also sought a care-provider who respected our decisions, as well as independent birth education to provide us with useful information and tools that raised our confidence in preparation for the labour and birth. Finally we worked on restoring our belief that women’s bodies are designed to birth, that my body could birth this baby physiologically and naturally. Anyone in our social network who offered a different opinion was reminded to keep that to themselves.”

Even though a wealth of evidence demonstrates that birthing after caesarean carries minimal extra risk, women may choose not to consider a VBAC for many reasons: fear (of pain, of complications, of birth itself), care-provider preference or policy, lack of support from family, or feelings about risk.

A planned repeat caesarean will be right for some women, and a planned VBAC a must for others. Each woman’s needs, choices and situations are different and unique. The important point is that every woman deserves to make birth choices with all the information, and with the full support of those around her.
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Ana’s story demonstrates this importance, as she finishes, “I am proud to say that this preparation and determination is what made the difference in our third birth. I birthed my third baby – my biggest baby, and my longest labour – naturally as planned.”