Ioannis Raptis
MIC II, DEGUM I, AGUB I
Obstetrician – Gynecologist
Ioannis Raptis has clinical experience from his position as Senior Consultant at the German perinatal center AKH Hagen. There, he received comprehensive training in Special Obstetrics and Perinatal Medicine (Spezielle Geburtshilfe und Perinatal Medizin) and specialized in high-risk pregnancies and complicated deliveries.
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Vaginal Birth After Cesarean (VBAC)
What does VBAC mean?
VBAC stands for Vaginal Birth After Cesarean.
How does a VBAC differ from a regular vaginal birth?
The main difference lies in the closer monitoring of both the mother and the baby during labor.
Most women achieve a successful VBAC without any complications. However, there is a small risk that the previous uterine scar may open during labor (uterine rupture). This can become dangerous for both the mother and the baby.
What is uterine rupture and what are its possible consequences?
Uterine rupture may occur when the scar on the uterus from a previous cesarean section opens during labor due to the pressure created by contractions. This very rare complication can become life-threatening for both the mother and the baby because of severe bleeding.
If this complication occurs, an emergency cesarean section is performed. It should also be noted that, in very rare cases, uterine rupture can occur at any time during pregnancy, even in women without a prior history of uterine surgery.
What are the chances of uterine rupture in a woman attempting a vaginal birth after cesarean?
The chances are very low. Only about 1 in 200 women who attempt a VBAC — approximately 0.5% — will experience a uterine rupture.
What are the chances of having a vaginal birth after a cesarean section?
The likelihood is very high and depends on several factors.
For example, the reason for the previous cesarean section, the time interval between the surgery and the new pregnancy, whether there has been a prior vaginal birth, and the mother’s body weight are just some of the factors that influence the probability of a successful VBAC.
In general, approximately 75% of women with a previous cesarean section achieve a successful VBAC.
What are the advantages of a VBAC?
The main advantage is the avoidance of another cesarean section and all the disadvantages associated with it.
The risks of major abdominal surgery are avoided, post-delivery pain is significantly reduced, the mother’s mobilization and return to normal activities are faster, hospital stay is shorter, and the newborn is less likely to experience breathing difficulties in the first moments after birth, among other benefits.
Additionally, it fulfills many women’s desire to experience a vaginal birth.
In which cases is VBAC not recommended?
An interval of less than 6 months between the cesarean section and the subsequent pregnancy, a vertical (classical) uterine incision, and a history of uterine rupture are the main reasons to avoid a VBAC. In these cases, the risk of uterine rupture increases significantly.
I recently delivered by cesarean section. What should I do to increase my chances of having a vaginal birth in my next pregnancy?
The time interval before the next pregnancy plays a crucial role. The best VBAC outcomes are observed when at least two years have passed between the cesarean section and the subsequent pregnancy. This period ensures proper healing of the uterus.
Avoiding excessive weight gain before pregnancy, close monitoring during pregnancy, and strict adherence to your doctor’s instructions can all contribute to achieving a successful VBAC.
Finally, the choice of physician is of decisive importance. In modern obstetrics, the concept of “Once a cesarean, always a cesarean” is considered outdated.
At the same time, it is not enough for the obstetrician to be simply informed about the specifics of VBAC. Experience in high-risk pregnancies and complicated deliveries is essential. Only in this way can safe guidance of the pregnant woman and effective management of potential complications be ensured.
According to the scientific standards
of the German Society of Obstetrics and Gynecology
