Want to have a successful VBAC (Vaginal Birth After Cesarean) if you must have a C-section the first time around? Read on!
When it comes to giving birth, a vaginal birth is certainly preferable to a C-section. Recovery from vaginal birth is much more rapid and involves less danger to the life of the Mother and child. After all, a C-section is considered major abdominal surgery with all the inherent risks.
In addition, there is evidence that children born vaginally are healthier than those born by C-section. Vaginal birth allows the child’s sterile gut to have first exposure to beneficial flora from the Mother during delivery. This exposure helps to properly seed the intestinal tract with immune system boosting bacteria.
Birth by C-section initially seeds the child’s gut with whatever bacteria are floating around the hospital environment. This leads to a higher risk for development of auto-immune problems. These chronic issues include allergies, leukemia, type 1 diabetes, asthma and others.
Intravenous (IV) antibiotics during labor can also negatively affect the normal seeding of baby’s gut during vaginal birth. As a result, skipping the Strep B test is a good idea since women who test positive are frequently forced to have IV antibiotics. Unfortunately, this happens even though research has failed to demonstrate any benefit to antibiotic treatment during labor.
Another benefit of vaginal birth is that it involves a gradual and more tolerable increase in stress for the baby. This as opposed to a cold cut Cesarean which shocks and stresses the newborn in a very short period of time. The shock stress of a C-section potentially causes unfavorable DNA changes to the baby’s white blood cells (July 2009 Acta Pediatrica).
For these reasons, it is best to take steps to avoid C-section if at all possible. Having a natural birth at home or at a birth center and avoiding an epidural is one way to reduce C-section risk. Another is to know how to induce labor naturally if baby is late.
In addition, planning for future pregnancies to be VBAC is wise too. Planning for a natural birth with a midwife in attendance with avoidance of all drugs definitely helps skew the odds in Mom’s favor. One intervention typically leads to another, and then another. A domino effect to C-section is thus avoided by refusing all interventions unless deemed a medical emergency.
Sometimes, despite everyone’s best efforts, a C-section needs to be performed. In these situations, C-sections are indeed a life saving operation.
The fact is that life is unpredictable and a C-section is the end possibility for every pregnant woman. This is true no matter how much planning is done to prevent one! As a result, every pregnant woman needs to have a conversation with her OB about the approach to stitching up the uterus in the event an emergency C-section is necessary.
Successful VBAC and Uterine Sutures
Many parents do not realize that the doctor performing the C-section has a choice about how to stitch up the uterus following surgical birth.
Double Layer Suture
The double layer uterine closure was primarily used throughout the United States prior to the early 1990’s. The first layer of sutures pulls all the cut edges of tissue together. The second suture layer, called the “imbricating pattern”, pulls uncut tissue together on top of the first suture layer.
Single Layer Suture
The single layer uterine closure has been used since the early 1990’s in the United States. Europe also uses this technique extensively. It involves suturing the cut edges together. Then, smaller sutures are used to stop any continued bleeding or to pull together areas of tissue that aren’t well counterbalanced.
Which Type of Uterine Suture is Best for a future VBAC?
Overwhelming evidence has shown that the single layer closure involves fewer complications in the immediate post operative period.
Research has also indicated that the double layer closure involves less risk of uterine rupture and successful VBAC with future pregnancy.
In other words, each suture method has benefit as well as a downside.
In 2002, a large study was published comparing single to double layer Cesarean sutures. A significantly higher risk of uterine rupture with the single versus the double closure (3.1% vs. .5%) was identified. The study analyzed 489 women who had C-sections with the single closure and 1491 women with the double closure. Results were controlled for use of pitocin, epidurals, age, and other factors.
The study authors concluded that the single closure method involves significantly higher risk of uterine rupture if the woman attempts a VBAC with a later pregnancy.
Since this study, prominent midwives in the US community have advocated use of the double layer closure to improve the odds of women attempting VBACs. Some even believe that women who have had a single layer closure should not be allowed to plan out of hospital births or VBACS at all.
I heard a prominent US midwife interviewed on National Public Radio advocating the double layer closure. Her reason? This type of suture is a very good idea for women who desire a successful VBAC with future pregnancy.
Smaller studies have shown no difference in risk of uterine rupture between the two suture methods. But, the overwhelming results of the large study by Bujold remains a concern for many in the midwifery community. Hence the continued push for use of the double layer technique.
VBAC Conclusions
If a Mom is only going to have one child or her current pregnancy is her last, then the single layer closure is probably the best choice. This type of suture in the event of a Cesarean gives the best chances for optimal post operative recovery.
However, if Mom wants more children and wants to birth them vaginally, insisting on the double uterine closure in the event a C-section is best. This type of suture greatly improves her odds for a successful VBAC in the future. In fact, some OBs and midwives won’t even attempt a VBAC without it.
Sarah, The Healthy Home Economist
Source: The Suture Debate
Had an HBAC almost a year ago with my 2nd son… AMAZING!! I didn’t skip the strep B though b/c my midwife said that IF I were to be transferred, that hospitals tend to bully you a lot into getting antibiotics b/c they don’t know if you are positive or not. I ended up being positive, but my water didn’t break until I was pushing… plus my midwife knows that antibiotics haven’t really changed the stats on babies getting sick from strep B since dr’s started that regimen. You can always decline antibiotics even if you find out you are positive. I guess my point is, sometimes hospitals will treat you better if you don’t skip the test b/c they probably judge you as being more responsible for at least getting the test and declining the IV antibiotics, rather than skipping it altogether… just another p.o.v on strep b. Also, doing something like hypnonbabies or hypnobirth is tremendously helpful to create a positive mindset for your vbac… also read Ina May’s guide to childbirth. First half of the book is all positive birth stories which does amazing things for your psyche as well 🙂
I had a c-section with my first child, and almost 7 years later, I had a normal, natural birth.
There is nothing wrong at all with c-sections if they are warranted. It’s just these days WAYYY to many people have them out of convenience and not medical need. I had to have Strep B too.
I had a c-section with my first and am so thankful for it, my son would had died if it hadn’t been done right when it was. Another 10 minutes of try to deliver vaginally and I would have lost him. Since then I have had 2 VBACs and they both went well. The article says to skip the Strep B test, but I was told that I couldn’t do a VBAC without it. Maybe that’s just my hospital. Also, there are no midwives in my area that will do VBACs because of the amount of insurance they are required to have inorder to do them. Plus…with my VBACs I wanted to have my Dr right there with me, after my first experience I wanted to be able to get right into surgery if needed. So I’m for both, c-section if that’s what’s best, but vaginal if you can!
I had 2 c-sections – 3 years apart and my OB wouldn’t give me an option – said the risks were too great. Definitely would have preferred a vbac.
I have three kids and my second one was a VBAC sandwiched between two c-sections. My first was breech and my third wouldn’t drop and I started running out of fluid…doc said we had to get him out. I had NO problems with my VBAC. I SOOO prefer vaginal to c-section. My recovery was SOOOOOO much easier. I also had post-partum with the c-sections, but not my vaginal. Weird. Maybe it’s because I felt so much better. Only GOOD thing about a c is you can go to the bathroom pain-free. 🙂 It really irritates me when I hear people say, “my doctor won’t let me have a vaginal because I’ve had a c-section”. My doctor didn’t even offer me a c-section with my second. He would have if it became necessary, but unless it was indicated….he didn’t even offer. I went into labor with no induction and had a completely normal delivery. If you have a good doctor who does the correction incision, you will have no problems with a VBAC.
I had a c-section in 1999 with a traditional (up and down) cut. Fortunately the Dr. cut my uterus transverse and I was able to attempt a VBAC 12 yrs later. My (new) midwife read the notes and deemed the c-section unnecessary as they said my pelvis wasn’t big enough to fit my little girl, 7lbs 11oz and they wouldn’t even let my try to birth her naturally-not one push. After giving me a thorough examine she said that her team of midwives and Dr’s would have no problem letting me attempt a VBAC. After 45 minutes of pushing out came my little man weighing in at 9lbs 2oz. I have no clue what type of closure I have but either way it held up!
I had a VBAC with my second daughter (the beauty in my pic). It is important to find a doctor willing to allow the mother to do one and who will acutally listen to the patients wishes…and choose a bigger hospital. The smaller ones don’t seem to have the resources if something does go wrong.
I had a C-Section in 1995 with my first. I don’t know how they sutured but I do know they used the bikini line cut. With Children 2-5 I delivered Vaginally. When I was having child #3 I looked into an OB closer to where I live and discovered that the Fort Bend County Medical Board will not allow a person who has had a C-section to deliver vaginally even if they have delivered vaginally after a C-section and have a proven uterus (as my midwife called it). Thankfully, I live in a big metropolitan area and the next county is actually only a few miles away, Harris County Medical Board has left that decision up to the Doctor who will be present at delivery. I’m not allowed to deliver with a mid-wife if I go to the hospital because of the C-section but my OB is great and lets me do my own thing.
I don’t know if anyother places have County Medical Boards, but if you’re getting a lot of “no, I won’t deliver” answers, it might be because of some type of Medical Board in your area.
I had a c-section in 2006 and again in 2007, both were done with the double layer sutures. When I got pregnant again in 2009 I was determined to have a VBAC…. problem was that although some doctors will allow a VBAC after 1 c-section I couldn’t find ANY who would even entertain the possibility after two.
So I was forced into having a home birth (which I had always wanted anyway!) It was an amazing experience and incredibly empowering. The doctors had stripped the power away from me by bullying me into c-section the previous times.
I not only had far superior prenatal care but was finally able to carry a baby to term! My labor lasted a total of 4 hours and I delivered a 9 # 3 oz. little girl. My recovery time was SOOOOO much faster and easier.
I am a testimony that VBAC’s can work!