Birth Education

VBAC: Myths vs Reality

It has become pretty standard for birthing people to believe that once you have had one caesarean section (herein referred to as ‘c-section’ for ease!) for the birth of your baby that there is no longer any other option for subsequent births but to have another c-section.

This idea has been perpetuated by obstetricians and other medical professionals, where they believe this to be the safest option for mother and baby. It’s my personal opinion that it is also because of the control that it gives medical professionals over the birthing situation – if you don’t allow space for what *could* go wrong, regardless of the chances of the possible ‘mishaps’, then you have full control and have a better idea of what will happen next.

Unfortunately, c-section isn’t always the safest option, and most second or subsequent babies can safely be born by VBAC.

Wait, what is VBAC?

VBAC stands for ‘Vaginal Birth After Caesarean‘, which is self-explanatory – the event of a natural birth taking place after a previous baby has been born by c-section.

Sometimes there’s a number or an extra letter thrown in – for example, a baby born vaginally after two c-sections would be VBA2C, or a homebirth after c-section would be HBAC.

There is a growing number of women recognising their options around birthing and turning to VBAC for their second or subsequent babies.

Myth – C-Sections are Safer

C-sections are major abdominal surgery, and they certainly have their place in the birthing world. The number of lives saved – both mother and baby – over the years thanks to c-section is very high.

Unfortunately the surgery, like any other surgery, brings along its own risks, both immediately and in the future.  

Immediate risks to the birthing person include:

  • haemorrhaging;
  • blood clots;
  • adverse reaction to anaesthesia;
  • infection;
  • surgical injury to the bladder or intestines;
  • amniotic fluid embolism (where the amniotic fluid from the uterus enters the maternal bloodstream);
  • inflammation of the uterus.

Immediate risks to the baby include:

  • breathing issues;
  • surgical injury;
  • adverse reaction to anaesthesia.

Future risks to the birthing person include:

  • possible tearing along the c-section scar (uterine rupture) when pregnant or labouring with a second or subsequent baby;
  • placenta placement or movement (placenta praevia, placenta accreta, placenta increta, or placental abruption). 1

We’ll go more into some of the above at a later date, but this is to demonstrate that c-section is not always the safest option. 

Intervention should only be considered when the risks to the mother and baby are higher if no intervention were to take place.

In the majority of cases, VBAC is a perfectly safe and reasonable option for second or subsequent babies.

Myth – The Chance of Uterine Rupture after C-Section is too high

Some sources quote that the chance of uterine rupture – that is, the uterus tearing – is anywhere between 50-70%. This just isn’t true.

The chances of uterine rupture are:

  • of all women who go into labour – 0.017 – 0.07%
  • of all women with a previous c-section – 0.68 – 1% (about 1 in 200 births) 2

Uterine ruptures are a small risk to any pregnant person, not just those having VBAC.  Risk factors include 5+ previous pregnancies, abdomen trauma (such as motor vehicle accidents), previous first trimester abortion, and other uterine surgery (such as fibroid removal).

Research has even shown that the risk of uterine rupture due to previous c-section is often lower with each subsequent successful VBAC. 3

No prior vaginal birthsWith 1 prior VBACWith 2 prior VBACWith 3 prior VBACWith 4 prior VBAC
0.87%0.45%0.38%0.54%0.52%

Myth – VBAC patients cannot have epidurals

The context behind is this that VBAC patients, if utilising epidural, will not be able to feel the pain of a uterine rupture.

Notwithstanding the above statistics, only 26% of women who experience uterine rupture actually report any abdominal pain, so pain itself in this instance is an unreliable and inconsistent symptom.

Myth – Mother and Baby could die

The chances of death of either mother or baby are higher during c-section than VBAC.  The risk either way is very low – with VBAC it stands at 0.0038% and elective c-section is 0.0134%. 

There is limited evidence suggesting a 2.8 – 6.2% risk of infant mortality after an already-rare uterine rupture.

Myth – If your hospital refuses VBAC, you have to have a c-section

Absolutely not correct. You, like any other person, have the right to refuse surgery (or any other procedure).  You are entitled to your autonomy.  The policy of your hospital should not be used to force you to undergo a repeat c-section against your will.


There is much, much more to this topic that I could go on about for a long time, but essentially it comes down to this: you are in control.  You have the right to choose what you want for your birth.  Informed decision making is the best way to choose what is right for you and your baby.

Notes:

  1. https://www.webmd.com/baby/risks-of-a-c-section
  2. https://www.vbac.com/what-is-a-uterine-rupture-and-how-often-does-it-occur/
  3. Data from Mercer, BM, Gilbert, S, Mark B. Landon, MB, et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology 2008;111:285-291.
    www.greenjournal.org/cgi/content/abstract/111/2/285

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