VBAC (After 2 Cesareans)

A VBAC is often referred to as a “vaginal birth after cesarean section”. While having a vaginal birth has an improved psychological and physical benefit for the pregnant women, some women must be wary about having a VBAC because of a risk of having the uterus rupture during the delivery. Some women worry about having it, especially if they had a hard time delivering their previous children. It is still an option for many women and those women who try to have a vaginal birth after cesarean will be successful about 60-80 percent of the time.

Can I Have a Virginal Birth After 2 Cesareans?

This can be a controversial answer and depends on a variety of situations. Many women are able to have a vaginal birth following a prior cesarean section. The primary risk factor is having a uterine rupture during the vaginal birth, which can be life-threatening.

Nowadays, doctors screen women more carefully before prescribing a VBAC to them. Fewer are being performed these days but those that are done are much more successful. About 60-80 percent of VBACs go on without a hitch. Statistics indicate that about 66 percent of women with a prior cesarean section are considered excellent candidate for a subsequent vaginal birth. Your doctor will be able to tell you if you are a good candidate or not.

The factors the doctor will consider in making the decision include the following:

  • What kind of cesarean section you had. If you had a side-to-side or transverse incision on the lower uterine segment, a VBAC is considered much safer than having had a classical vertical incision during your prior cesarean section. Classical cesarean sections are rare but mean you can’t have a VBAC.
  • The reasons behind your past cesarean section. If your prior surgery was done because of something that isn’t likely to repeat itself, you are likely to be able to have a VBAC. This includes cesareans for fetal distress or cesareans due to a breech delivery. If your cesarean section was done because the baby was too big and the cervix didn’t open properly, you have a decreased chance of having a successful VBAC.
  • The health of your baby and you. If you have health problems, such as high blood pressure or diabetes, it may be risky to have a VBAC. According to the American College of Obstetricians and Gynecologists (ACOG), you need to have a doctor that can do an emergency cesarean section available for the delivery if you are having a VBAC. You cannot have a home birth after a cesarean section.
  • The number of previous cesareans you have had. According to the most recent recommendations, you are relatively safe if you have had a single cesarean section in the past. If you want a VBAC (after 2 cesareans), you may find that the doctor will not allow it as the risk of rupture is too high. Before you go ahead with a VBAC, you need to understand the risks.

Things You Should Know Before Considering Virginal Birth After 2 Cesareans

There can be a rupture of the uterus in the same place as where the prior cesarean scar was located. This is a rare complication but it can be serious for both the baby and the mom. Most cesarean sections these days involve an incision along the lower uterine segment. A scar from this type of incision is not likely to rupture during a VBAC.

This is a rare event that occurs in less than 1 percent of women who choose to have a VBAC. This means that about 5 out of every 1,000 women choosing to have a VBAC are at an increased risk of having a rupture of the uterus.

Uterine ruptures aren’t limited to VBACs and can happen at any delivery. It is the result of weakness in the muscles of the uterus after having many other pregnancies. Using medications to induce labor, the use of forceps, and having a previous surgery in the affected area can increase the risk of a uterine rupture.

This is the overall risk of having a uterine rupture during a VBAC:

No previous vaginal births

1 previous VBAC

2 previous VBACs

3 previous VBACs

4 previous VBACs

87 percent

45 percent

38 percent

54 percent

52 percent

Other Moms’ Experiences

These are some experiences other moms have had regarding a VBAC and a previous cesarean section. Some have had a VBAC (after 2 Cesareans):

Natalie "I have nothing but praise for my doctor who talked me into a viginal birth after 2 cesareans. The first cesarean was due to having a baby that was born breech and the second didn’t need to have been done because the doctor simply wouldn’t allow it. I was on my third baby when I did some research indicating that it might be safe to have a VBAC. I saw a different doctor that took my insurance plan and who felt I was a good candidate for having a viginal birth. I had no problems with my VBAC and I am very pleased."

Mel2407 "There is little difference between having a VBAC after one cesarean versus a VBAC after having 2 cesareans. There is a slight percentage risk for either situation. I had an emergency cesarean with my first pregnancy because of fetal distress and 17 hours of labor. I had a second cesarean section because I didn’t know I had any other option. I then tried a VBAC but it failed because my cervix wouldn’t dilate. I would do a VBAC again because the risk is really low of having a rupture."

Colorful Mama "I recently had a baby from a VBAC (after 2 cesareans). My first surgery was in 1989 and it happened because my water broke and I didn’t contract. I was fully dilated after getting Pitocin but the cord was wrapped around her neck so I had to have another cesarean. I tried a VBAC after that but it led to another emergency C-section. I finally found a midwife for my third baby but I had to have the baby at a hospital instead of a birthing center. Finally, I had my vaginal delivery and there were no complications. It was a great natural birth."

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