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Myths and Facts About Vaginal Birth After Cesarean (VBAC)

You may have heard the phrase, "once a cesarean, always a cesarean." But that's not necessarily true. Although some women who have delivered by cesarean can't give birth vaginally, many can.

If you gave birth via cesarean section in the past and would like to deliver your next baby vaginally, you may be eligible for a vaginal birth after cesarean, or VBAC.

There are many myths surrounding VBAC. Here, board-certified obstetrician and gynecologist Houmam Al-Hakeem, MD, of Westover Hills Women’s Health in San Antonio, Texas, would like to separate the myths from the facts.

Myth: VBACs are dangerous

Fact: VBACs are safe for many women.

It's true that having a VBAC can increase the risk of uterine rupture, a condition in which a tear develops in the uterine wall. But uterine ruptures occur in fewer than 1% of women who attempt a VBAC.

To protect you from complications such as uterine rupture, we carefully evaluate your uterine health, your delivery history, and your overall health before recommending a VBAC. For healthy, low-risk women, VBAC can offer a safe delivery option.

Myth: Once you start to deliver by VBAC, you can't change your mind

Fact: You can always fall back on a cesarean.

If you'd like to try delivering by VBAC, you can do what's known as a TOLAC, or a trial of labor after cesarean delivery. If you succeed with your TOLAC, you can give birth vaginally. If not, you can choose to have a cesarean. Your health and your baby’s safety determine your delivery choices.

Myth: Having a repeat cesarean is much safer than having a VBAC

Fact: Depending on the situation, a VBAC may be safer than a cesarean.

Although VBAC does carry some potential risk, so does a cesarean. For example, cesareans can injure your bladder or bowels. And compared with a cesarean, VBAC may cause less blood loss and a reduced risk of infection, as well as a faster recuperation.

When deciding which option is best for you, we take many different factors into account, including the pros and cons of various delivery options. 

Myth: Anyone can have a VBAC

Fact: VBACs are not recommended for some women.

Women with certain health histories or surgical histories are advised not to have a VBAC. For example, if you had an up-and-down cut in your belly during your previous cesarean, you may have an elevated risk of uterine rupture. 

Side-to-side cuts tend to be the safest for VBAC, according to the American College of Obstetricians and Gynecologists.

Similarly, having a history of uterine surgery for other reasons besides childbirth may make a VBAC too risky for you. 

Myth: You can't have a VBAC after multiple cesareans

Fact: Some women who have had more than one cesarean can have a VBAC.

Depending on the type of incision you had for your previous cesareans, a VBAC may be as safe as another cesarean section. 

Should you have a VBAC?

The type of delivery that is best for you depends on many factors. We make delivery recommendations based on your health, your pregnancy, and your preferences. Dr. Al-Hakeem and his colleague, Dr. Edward B. Blackmon Jr., have extensive experience with all delivery techniques, including VBAC.

To schedule an appointment at one of our two San Antonio, Texas, offices, call us today or use our online tool.

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