VBAC is an acronym for Vaginal Birth After Cesarean and is pronounced "vee-back".

In the 1980's when medical interference with birth was at it's very highest and c-sections were being overwhelmingly common, there was no real research on the safety of having vaginal birth after the uterus had a scar on it. It was then that the saying "once a cesarean, always a cesarean" became known.

Today things are a little different. During the 1990's began the start of a movement where women started re-exploring natural childbirth options and many who had had previous c-sections went on to give birth naturally. These days we now have the information available showing that having a vaginal birth after 1 or more previous c-sections is a safe choice, although it is not without risk.

So what is it that people are worried about with a VBAC

The big concern is something called "Uterine Rupture" which can have devastating results if it is not detected and dealt with quickly. Due to the previous surgery there is now scar tissue left on the uterus from where it was cut into. In some cases the scar can be weaker than the rest of the uterus and a powerful contraction can cause the muscle tissue to separate.

While this sounds scary and unnerving for mothers wanting to achieve a VBAC it is important to consider the following:

  • The chances of it happening are less than 1% and have been reported to be as low as 0.09%. To put this further into perspective, the chance of have non-VBAC related complications (for any pregnancy) such as placental abruptia and umbilical prolapse are actually higher than the chance of uterine rupture
  • The risks and complications associated with a repeat c-section are higher than that of VBAC. A repeat c-section will also influence future pregnancies as they can cause placental malformations, increase risk of miscarriage and even reduce fertility
  • Induction of Labour should never ever be done with a mother who is having a VBAC. The medication used to induce labour can bring on very strong contractions and has been shown to increase the chances of a rupture occurring by a significant amount
FAQ's about VBAC

My doctor won't support a VBAC. What can I do?

Change your doctor. The safety of VBAC has been proven and even the notoriously conservative American Congress of Obstetricians and Gynecologists (ACOG) is in support of it. There is no reason for your doctor not to support VBAC other than it is not something they have knowledge of and are therefore not capable of caring for women having a VBAC. It is more than possible for find a more fully qualified doctor who will support your choices for your body, your baby and your family.

Can I have a VBAC at home?

Otherwise known as a HBAC (pronounced "H-back"), and yes, it is possible to have an HBAC in South Africa. The problem is though, that for those wanting it, it is a very difficult thing to find support for. While this option is more readily supported in places like the UK it is very difficult to find a midwife who feels comfortable supporting a HBAC as in most cases it needs to be carefully arranged. Midwives need to practice with the backing of an Obstetrician but there are virutally no Obstetricians who will be willing to back a midwife who takes on such cases. However, there are a small number of midwives who will support women in their choices, it's just a matter of finding them. Your best way to locate an HBAC midwife is to contact local Doulas, especially those who support homebirths and to ask them if they know someone you could speak to about your plans.

Who can't have a VBAC?

This is a difficult thing to answer as it really just depends on your own circumstances. Women who have been diagnosed with TRUE CPD (a proven small pelvis) may be advised against VBAC, especially if the reasons for the CPD diagnosis were to do with damage to the pelvis (eg. fractures, breaks, malformations). That being said, unless it is completely obvious as to why your pelvic outlet (the space between the pelvic bones) is particularly small, it may be worth your time visiting a chiropractor or cranio-sacral therapist to help you with your alignment.

VBAC Resources for South Africa

The South African VBAC Website has discussion forums, information on doctors, midwives, doulas who all support VBAC