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What is a VBAC?
VBAC (pronounced vee-back) stands for vaginal birth after a caesarean. It means having your baby vaginally when you’ve had at least one baby by caesarean section.

How does a VBAC differ from other vaginal births?
Many women are able to have a successful VBAC without any complications. But there’s a small risk that the scar from your previous C-section could tear. This is called uterine rupture.

Uterine rupture affects only one in 200 women trying for a VBAC. But your medical team will watch out for it, as it’s a serious complication that can put you and your baby at risk.

If you go into labour prematurely (before 37 weeks), VBAC may still be an option.

You’ll find that your labour will be checked more closely and more often if you’re aiming for a VBAC. During your labour you'll be offered continuous electronic foetal monitoring. This will measure your baby's heart rate and your contractions.

If your baby's heart rate doesn't sound right, it could be an early sign that there’s a problem with your scar. The team looking after you can then act quickly to keep you and your baby safe.

Because of the risks surrounding VBAC, your doctor is likely to recommend that you give birth at a unit that has an operating theatre and an on-site blood transfusion service. This may sound alarming, but it’s just a precaution to make sure you and your baby are in safe hands.

What pain relief can I have during a VBAC?
You should be able to have the same pain relief options during your VBAC as you would have for a first-time vaginal birth, including an epidural. An epidural may mean that you’re not as aware of the early symptoms of uterine rupture, though. These include severe abdominal pain that lasts between contractions and sudden tenderness of your scar.

Depending on your pregnancy history and your hospital, you may be able to use a shower or a birth pool to help you cope with your contractions, if your hospital has the appropriate monitoring equipment.

Because you’re at a greater risk than normal of needing a caesarean section under general anaesthetic, your doctor or midwife will recommend inserting an intravenous line into your arm and that you only drink clear fluids.

What's the alternative to a VBAC?
If you’re not sure about going for a VBAC, you could have a planned repeat caesarean. This is usually booked for one of the seven days leading up to your due date, unless your doctor thinks it’s better for your baby to be born sooner.

In some circumstances, your doctor may recommend a caesarean as the only safe option for you or your baby, because of your medical history. This includes:

• uterine rupture in a previous pregnancy
• a vertical, rather than a horizontal C-section scar
• a previous labour complication, such as placenta praevia

Your doctor may also recommend a caesarean if you’ve previously had an operation for fibroids or another uterine abnormality that’s left scarring, or if you’ve had two or more previous caesareans.

If VBAC or caesarean are both options for you, you'll have plenty of time to consider the risks and benefits of each, so talk to your obstetrician about your previous births. You'll be encouraged to decide by the time you're 36 weeks pregnant.

What are the advantages of a VBAC?
A successful VBAC carries the lowest risk of complications. If you have a VBAC, you’ll avoid the risks associated with repeat caesareans and have a quicker recovery time. Looking after an older child and a new baby without the discomfort of a c-section wound will also be easier.

If your baby arrives before 39 weeks, he’s less likely to have trouble breathing after he's born, compared with a baby born at the same time by planned caesarean. If you do have a repeat caesarean before 39 weeks, though, your doctor may offer you steroids beforehand to help prepare your baby's lungs and reduce his risk of breathing problems.

With a successful VBAC, you'll have a shorter stay in hospital and you should experience less pain and discomfort in the weeks and months after the birth.

If you’re planning more pregnancies, then trying for a VBAC may help you avoid future complications that are more likely after repeat caesareans, including placenta praevia, placenta accreta and hysterectomy.

Once you've had one successful VBAC, you're more likely to have another one in the future.

What are the disadvantages of a VBAC?
The disadvantages of a VBAC are similar to those of any vaginal birth. In the short term, these can include:

• pain from bruising and stitches in the area between your vagina and back passage (perineum)
• leaking wee while the area round your vagina recovers

Pregnancy itself can weaken your pelvic floor, so having a caesarean doesn’t necessarily protect you from pelvic floor problems in later life. It’s important to do your pelvic floor exercises, whichever way you give birth.

Giving birth vaginally, whether it’s your first time or if you’re trying for a VBAC, may slightly increase the risk of your uterus slipping into your vagina (prolapse)