Vaginal Birth After Cesarean (VBAC)

Many women who had previously given birth by cesarean subsequently give vaginal birth.   This is referred to as vaginal birth after cesarean (VBAC).

Certain circumstances may increase or decrease the risk of vaginal birth after cesarean. Women who had previously given vaginal birth will have a greater chance for using VBAC. If the first birth was vaginal and the second one was by cesarean, the chance of success for giving vaginal birth is higher for the third child. Normally, a 2 to 2.5 years waiting time is considered necessary for vaginal birth after cesarean. A key reason for this waiting time is to give the tissues sufficient time to heal and the risk of uterine rupture in fetuses if delivered earlier.

After the 36^th week of gestation, the fetus slowly begins moving into the uterus. Particular care must be taken when performing gynecological examination of pregnant women at weeks 38 and 39.  Uterine dilation, fetus weight, birth canal and the fetus’ position should be weighed carefully. For a problem-free delivery, waiting until week 40 or 41 – if the fetus or mother’s condition allows – may be possible. In vaginal birth after cesarean, it is best to let the patient go through birth pain, and let the fetus establish itself in the birth canal. The fetus’ head position changes in millimeters every week, and the fetus enters the uterus. In this case, inducing labor may prevent the fetus from assuming the correct posture. Induced labor is also not recommended as it may increase the risk of a uterine rupture during vaginal birth after cesarean. It is important that the infant is settled in the uterus and prepares the mother for labor.

An active lifestyle will strengthen pelvic muscles and help them form a hammock between the uterus and bladder. A sedentary lifestyle, on the other hand, prevents development of pelvic muscles in women.  Therefore, pregnant women are advised to exercise after week 28 of gestation to strengthen their muscles in the birth canal. Kegel exercises, performed 15 to 20 days every day and involving contraction of pelvic floor muscles not only promote labor, they also reduces the risk of urinary incontinence and uterine prolapse in the future. Also, perineal massaging may augment blood circulation, flexibility and relaxation of pelvic floor muscles and generally benefit vaginal birth.