VBAC – Is it really worth the risk?

Author: Dr Sri Harika Bonam Consultant Obstetrician & Gyneacologist & Lap Surgeon, Apollo Cradle & Children’s Hospital, Jubilee Hills

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New Delhi, October 24, 2023:

As per the statistics the caesarean section rate in India is around 20-30%, with rates as high as 50% in certain states. The main causes of increased rates are primarily because of increase in fetal monitoring leading to increased anxiety in the mother as well as the obstetrician & repeat caesarean section in those who had a caesarean before.

Women who have a vaginal(normal) delivery have quick recovery, early establishment of breast feeding & better birth satisfaction. On contrary those who undergo caesarean section will have longer time for recovery, can have difficulty in feeding, more pain & other surgery related complications like excess blood loss, wound infection & blood clots in the legs etc… in short term & risk of adherent placenta in long term a less known entity which can be dangerous to the mother during the subsequent pregnancy which may necessitate uterus removal.

Can something be done to reduce the caesarean rates?

VBAC means vaginal birth after caesarean section. It is trying for vaginal delivery in women who had prior 1 caesarean section. Chosen rightly It has all the advantages of normal delivery & the success rate is about 60-70%. But, in nearing 1% women there can be a risk of the previous scar on the uterus to open up during the labour process & it can be life threatening to mother as well as baby.

How do we decide who can have that risk?

It’s not always possible to tell who can have the risk of scar opening up. But can be predicted to some extent based on certain factors. Women who have previous caesarean done preterm (before 37wks), previous caesarean after a long trial, short inter pregnancy interval, currently having twins or a big baby, obese mothers, advanced age, associated other medical problems like high BP, diabetes etc… are few in whom VBAC may not be offered.

On other hand women who have had at least one previous successful vaginal birth, no other risk factors, coming in labour spontaneously without need of any medicines have higher chance of successful VBAC.

Where can a VBAC be tried? A well-motivated mother, fully informed about the pros & cons can try VBAC under the supervision of expertise Obstetrician & supporting staff at well-equipped medical establishment with 24 x 7 caesarean section, neonatal ICU facilities available.

To conclude ‘Yes it’s going to be hard, but totally worth it’.

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