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Will I be able to have a VBAC?

Here are some questions to ask yourself before you try

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Originally published in Today's Parent August 2011

Let’s say you’d like to at least consider trying for a VBAC. What are some of the factors that influence your risk and likelihood of success?

Type of scar

The first thing you need to know is what kind of cut was made into your uterus during your earlier C-section: a classical (up-and-down) or transverse (side-to-side) incision. This is something you can only tell from your medical records. “It has nothing to do with the cut in the skin,” stresses Jon Barrett, chief of maternal-fetal medicine at Sunnybrook Health Sciences Centre in Toronto. Classical incisions, which are very uncommon, substantially increase the odds of rupture, so if you have this type of scar, most caregivers will recommend against a VBAC.

Number of previous Caesareans

While Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines state that women with two previous operations should be able to opt for a VBAC, this doesn’t always happen in the real world; some centres have a policy of not offering VBAC after two previous Caesareans.

How labour begins

IV medication (oxytocin) used to kick-start contractions, and hormonal gels and suppositories (prostaglandins) that are used to soften the cervix approximately double the chance the scar will separate. (By contrast, using a device called a Foley catheter to ripen the cervix has no such effect.) That’s why some centres rule out induction entirely if a woman is attempting a VBAC. Induction also decreases the chance that a trial of labour will end in a successful VBAC.

By contrast, going into labour spontaneously increases your odds of success. In fact, if your contractions start before a scheduled section, and you’re in advanced active labour by the time you get to hospital, not only are your chances of success increased, part of your risk of rupture has already passed, says Andrew Kotaska, clinical director of obstetrics and gynaecology at Stanton Territorial Hospital in Yellowknife.

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