Vaginal Birth after cesarean (VBAC)

Have you had a prior cesarean? Let’s look at some critical criteria in identifying if homebirth might be a good choice for you.

  • Have you already had a VBAC? If so, you have a much higher success rate of a successful VBAC at home at 95.6%

  • Have you already had a term vaginal birth? If so, you also have a higher success rate of a successful HBAC at 90.2%.

  • Will it have been more than 18 months from your cesarean to this baby’s due date? That is an important lapse of time when planning a VBAC, because at least 18 months between births lowers your risk of a uterine rupture.

  • Was your surgical incision low and transverse? If so, homebirth might still be an option for you.

  • Do you know where your placenta is? Knowing this will be a critical piece of information when planning a VBAC.

  • What was the reasoning for the cesarean? Did you dilate? If so, how far? Were you induced? If so, why? How many hours were you in labor? Did baby ever get low and engaged? Did you push? If you have never had a term vaginal birth, the midwife will need to know much more… These are important clues when considering a planned VBAC at home.

  • Are you willing to receive co-care with an OB/GYN? This is a good idea when planning a HBAC. Complete records are also required.

  • Not everyone is a good candidate for a HBAC. Even with tailored, skilled, and loving care, planned primary HBAC’s have the highest rate of intrapartum transfer due to lack of fetal descent combined with maternal exhaustion (even though this is still infrequent and far more often successful). Planned home VBAC’s have a much higher hospital transfer rate than non-VBAC’s (at 18% vs 7% - MANA stats, not my practice stats)

RESOURCES

HBAC STATS

More mothers with a prior cesarean needed to be transferred to a hospital compared with women without a prior cesarean (18% vs 7% MANA stats). The most common indication for transfer was failure to progress. *Sometimes low dose pitocin in a hospital setting can save a VBAC.

Homebirth stats

VBAC’s at home with a trained midwife have an 87% success rate. Mothers with a prior cesarean who also had a previous vaginal birth had a success rate of 90.2%. Mothers who had a previous VBAC had the highest rate of success- 95.6%.

VBAC Calculator

This is a calculator that OB’s use to predict success rate of hospital VBAC’s.

Primary VBAC BOoking LIMITATIONS

Because Primary VBAC births tend to last so much longer than non-VBAC births, and Covid has midwives booked to the brim, Emily is limited to accepting no more than one Primary VBAC client per month. This is one more reason to book with a midwife early in pregnancy.