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Can You Really VBAC It?

Pursuing a Vaginal Birth After Cesarean

By Shel Franco

"[The greatest risk of vaginal birth after Cesarean is] uterine rupture, or the incision coming apart," says Cathy Hartt, a certified nurse-midwife in Galveston, Texas. "Sometimes this happens and we never know it because Mom and Baby do fine. But it is potentially life-threatening to both Mom and Baby and can occur rapidly."

Statistically speaking, rupture is rare. "Most of the large studies show this risk to be less than 1 percent," says Kathleen Gray Farthing, public relations professional for ICAN. "The risk of rupture is around the same risk or less than any birthing woman has for cord prolapse, placenta previa, placenta abruption, fetal distress and some other complications of birth."

These rates vary, particularly when certain factors are present. One of those factors is the type of surgical opening. The Cesarean can be accomplished using classical incisions or transverse incisions. Today, the classical incision, sometimes called a vertical incision, is mostly reserved for emergency situations. "[The] vertical incision scar is more likely to rupture, because it ascends into the upper segment of the uterus that is more active," says Lorrie Peck, a midwife in Edmonds, Wash.

A transverse, or horizontal, incision is most common. This cut is made in a lower, less active part of the uterus, making the scar better able to withstand rupture. "[The] risk with one prior low transverse incision [is] quoted as 0.5 to 1 percent," says Geffrey H. Klein, MD, an obstetrician and gynecologist in Webster, Texas.

Want to see more?

• Should Women Having Large Babies Expect to Deliver by Cesarean?
• Why Hire a Doula?
• Could I have a VBAC?
• What are the risks of a VBAC?

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