Our nation's current cesarean section rate is 32.2 percent of births. This means a large group of women have an important choice to make if they get pregnant again: whether to try for a vaginal birth after cesarean (VBAC) or plan a repeat C-section.

For Milwaukee-area moms, several doctors, midwives and hospitals are supportive of VBAC, including Columbia St. Mary's, Wheaton Franciscan St. Joseph, Aurora Sinai, West Allis Memorial and Froedtert Hospital.

For women who aren't sure about attempting VBAC versus having a planned repeat C-section, here are a few things to consider:

Risks of attempting a VBAC

The most well known risk is called uterine rupture. This is when, usually during labor, the scar of the previous C-section breaks open. It is rare, happening in less than one percent of cases. However, when it does happen, it requires immediate C-section to save the lives of mother and baby. With uterine rupture, the mom is at risk of losing a lot of blood, and in some cases, her uterus must be removed, which means no future children. The baby likely will have less blood supply and thus oxygen disrupted, so a C-section must be performed quickly.

This is why not all hospitals feel equipped to support VBAC. It requires 24/7 availability of an obstetrician and anesthesiologist who can perform surgery immediately if needed. Attempting an out-of-hospital VBAC is not recommended.

Risks of a repeat C-section

Given the above scenario, why would anyone want to attempt a VBAC? Well, it's important to remember vaginal birth usually goes well, with VBAC success rates typically 60-70 percent, and that a C-section also carries risk. While it is generally a very safe procedure, there is risk of wound infection, heavy bleeding, and damage to surrounding organs during surgery. With each subsequent pregnancy, more scar tissue and adhesions form, making future pregnancies and C-sections more complicated. Furthermore, women report recovery from C-section is more painful and longer than recovery from vaginal birth.

Factors in VBAC success

When deciding whether or not to try for a VBAC, women should consider the reason for their previous C-section. A lot of C-sections are done for reasons that may not repeat themselves in future pregnancies. For example, if a C-section was done for concerning fetal heart tones, breech, or twins, these conditions may not repeat themselves. There is no reason to think that these women are not capable of giving birth vaginally.

Second, women should think about the circumstances surrounding their previous birth. Were they induced? Did their providers give them enough time in labor before deciding to do the C-section? Did they feel pressured or coerced into having a C-section?

Third, women should know that if they've had a vaginal birth at any point in the past, their chances of success are higher.

A tool that may be helpful in predicting the chances of a successful VBAC can be found at: https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html.

Increase chances of success

It is essential that women who want to have a VBAC chose a supportive doctor or midwife. A provider may have legitimate concerns about a woman's individual risk factors or chance of VBAC success. It is important to discuss these ahead of time. However, if a provider seems negative about VBAC and frequently pushes the idea of repeat C-section, it could be that he or she is not going to be supportive during labor either. Another option to increase the chances of VBAC is to hire a doula. Doulas help guide women through childbirth and support them in making good decisions that will encourage normal labor, such as walking and position change.

Choosing another C-section

For most women, VBAC is a safe choice, but so is repeat C-section. If a woman has discussed risks and benefits with her provider and decided that repeat C-section is the best choice for her, she should not second guess herself or listen to criticism from others! There is no 'one right way' to give birth, and it does not make a woman less of a mother to have had a C-section.■

Ann Ledbetter is a certified nurse midwife at Sixteenth Street Community Health Centers.

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