VBAC/VBA2C and ERCS
Our practice cares for women who choose a vaginal birth after caesarean (VBAC or VBA2C) and those who choose to have an elective repeat caesarean (ERCS). During your prenatal visits, we will discuss your options to ensure you are making a fully informed decision.
VBAC: The staff at Groves Memorial Community Hospital is supportive of low-risk women choosing a vaginal birth after one or two previous caesarean sections. Our clients have a prenatal consult with an obstetrician at Groves and are cared for by their midwives during labour. If you have a normal labour and birth, you will remain in midwifery care. We are not required to transfer care during labour to an obstetrician. However, if any complications develop, an obstetrician is available to assist or take over care if needed. The chances of a successful VBAC are up to about 75%, depending on your history.
ERCS: If you choose to have a repeat caesarean section, one of your midwives will accompany you into the operating room for the surgery. She will help you and your partner by advocating for your needs and explaining what is happening. If you and the baby are both well, then she will assist with moving the baby onto your chest for skin-to-skin contact within a few minutes of the birth. Your midwife will go with you, your partner and your baby to the recovery room to help you start breastfeeding if that is your plan.
VBAC Benefits vs Risks
Benefits of VBAC
- shorter hospital stay
- faster recovery
- reduced risk of problems from surgery including fever, infection, heavy bleeding, blood transfusion, removal of your uterus, complications during the surgery such as bowel and bladder damage, and serious illness leading to death
- reduced risk to future pregnancies from multiple caesarean scars (placenta previa, placenta accreta, ectopic pregnancy, and placental abruption)
- feeling more in-control of your birth
- baby is less likely to have breathing problems and less likely to be separated from you after birth
- baby is more likely to get early skin-to-skin and start breastfeeding sooner
Risks of VBAC
There is about a 0.5% risk of uterine rupture in labour. This is a very serious emergency where the uterus opens up at the site of the scar from your previous caesarean. It carries a risk of serious harm or death of the baby and/or mother.
If you do not progress in labour, or if you have a uterine rupture, you will need to have an emergency caesarean. An emergency caesarean carries more risks than a planned caesarean.
It is important to understand that both VBAC and ERCS carry risks. The risk of uterine rupture decreases with each successful VBAC. Also, if you are planning to have more than two children, it may be safer to plan VBACs as the risk of problems increases with each caesarean.
Choice of Birthplace
The College of Midwives of Ontario supports women’s choice to plan a home birth or hospital birth after one previous caesarean section. The Society of Obstetricians and Gynaecologists of Canada recommends that all VBAC births happen in hospital because of the need for quick access to emergency surgery in the event of uterine rupture.
It is important to know that in small hospitals such as Groves, the obstetricians, other physicians and operating room staff are not in the hospital 24/7. They are required to be present in the hospital within 30 minutes of being called, but it is sometimes possible for bad weather to delay their arrival. If you want to give birth at a hospital where these staff are always present in the hospital, you would need to plan to give birth at a larger facility.
If you are planning a hospital birth, we recommend going to hospital at the beginning of active labour because a uterine rupture can happen anytime during labour. If you are planning a home birth, we will need to transport to the nearest hospital with caesarean capability if there is a problem during labour.
For More Information
Vaginal Birth After Previous Low-Segment Caesarean Section – Clinical Practice Guideline (Association of Ontario Midwives)
Vaginal Birth After Cesarean Section: Outcomes of Women Receiving Midwifery Care in Ontario (Canadian Journal of Midwifery Research and Practice)
Guidelines for Vaginal Birth After Previous Caesarean Birth – Clinical Practice Guideline (Society of Obstetricians and Gynecologists of Canada)
MFMU Network VBAC Calculator – This calculator is based on the equation published in the article “Development of a nomogram for prediction of vaginal birth after cesarean”
International Cesarean Awareness Network (ICAN) – A nonprofit organization whose mission it is to improve maternal-child health by preventing unnecessary casareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Caesarean (VBAC)
Best Birth Clinic – Vaginal Birth After Cesarean and Planned Repeat Cesarean Birth – Booklet to help women choose type of birth
VBAC.com – A woman-centered, evidence-based resource about VBAC
Please note that Grand Valley Midwives does not endorse or promote any of the information, products or services contained in any of the links posted on our website. We do not receive any compensation, financial or otherwise, for including these links on our website. Accessing information, products or services through any of the links provided is entirely at the user’s own risk. Information on these websites is not meant to replace advice from your midwife.