The goal of this procedure is to give birth vaginally, rather than through an elective C-section. Many women who have had a C-section in the past can deliver future babies vaginally with a low risk of complications.
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
Problems from anesthesia, such as wheezing or sore throat
Tear of tissue around the vagina
Complications requiring forceps or vacuum extraction
Injury to the baby
Unsuccessful VBAC—A repeat C-section may be needed if the fetus is in distress or labor is not progressing.
Uterine rupture (rare)—A repeat C-section will be needed if the uterus tears along the prior C-section scar due to poor healing of the uterine incision.
Read about giving birth and take a childbirth class.
Choose a support person for labor and delivery.
Create a birth plan that details preferences for labor, such as methods of pain relief.
Talk to your doctor about:
Ways to communicate, such as calling after hours
Steps to take when in labor
The use of pain relief methods during labor
Perineal massage of the area between the anus and vagina to lower the risk of trauma
Travel options to the hospital
Arrangements for home and work
Be aware of the signs of labor, such as:
Water breaking—amniotic fluid that surrounds the baby leaks out through the vagina
Light vaginal bleeding
True Versus False Labor
There may be periods of false labor before true labor begins. These are irregular contractions of the uterus, called Braxton Hicks contractions. They are normal, but can be painful. Timing the contractions is a good way to tell the true and false labor apart. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. If the contractions are getting closer together, longer, and stronger, then it may be true labor. Call the doctor.
The uterus will start to contract at the beginning of labor. This will move the baby down the vagina (birth canal). The opening (cervix) of the uterus into the vagina will slowly enlarge to a diameter of about 10 centimeters. This will allow the baby to pass through and be delivered through the opening of the vagina.
Labor can cause severe pain. In the beginning stages of labor, relaxation methods like meditation and rhythmic breathing may be helpful. Keep in mind that every mother's labor is different and everyone feels pain differently.
There are many options for pain control. The doctor may give:
Pain medicines by IV or intramuscular injection:
Given when contractions become stronger and more painful
Often used for C-sections, especially those done in emergency situations
Description of Procedure
After the cervix is fully dilated (opened) and the baby seems to be heading down the birth canal, the care team will help prepare you for delivery. Your legs may be draped with cloths. The area around the vagina will be cleaned with an antiseptic solution.
You may put your legs into holders, especially if you have an epidural. The care team may hold your legs in a position. This will help you to push. You may be asked to find a position that is right for you. You will be asked to push each time you have a contraction. This involves bearing down like you are trying to have a bowel movement.
Crowning is when the baby's head is seen at the opening to the vagina. When this happens, you may be asked to slow your pushing. Depending on your delivery plan, the doctor may massage your perineum to gently stretch it. Some people may need an episiotomy, but it is not routine.
You will be asked to stop pushing when your baby's head is out. The doctor will check to make sure that the umbilical cord is not around the baby's neck. Then, you will be able to push the rest of the baby out. If the baby appears healthy and is breathing well, your baby may be placed on your stomach. The umbilical cord will be clamped and cut. Within the next 20 minutes, the placenta will be delivered.
Sometimes the baby's head does not move as expected through the birth canal. If this happens, the doctor may use forceps or vacuum extraction to move the baby. These will only be used if the baby is most of the way through the birth canal.
Abdominal massage to help the uterus clamp down and decrease bleeding
Cleansing of the vaginal area, perineum, and rectum
An ice pack to soothe and decrease swelling of the perineum
An injection of medicine to help decrease uterine bleeding
How Long Will It Take?
How long it takes varies from person to person. The average time to deliver a first baby vaginally is 12 hours.
Will It Hurt?
Pain and swelling are common in the first few days. Medicine and home care help.
Average Hospital Stay
Most people can go home in 1 to 3 days. If there are any problems, you may need to stay longer.
Having a baby will change you physically and emotionally.
Physically, you might have the following:
Sore breasts—Your breasts may be painfully engorged when your milk comes in. Also, your nipples may be sore.
Constipation—You may not be able to move your bowels until the third or fourth day after delivery.
Stitches may make it painful to sit or walk.
Hemorrhoids—Hemorrhoids are common. They may make it painful for you to move your bowels.
Hot and cold flashes—This is due to your body trying to adjust to the change in hormones and blood flow levels.
or fecal incontinence—During delivery, your muscles were stretched. This may make it hard for you to control your urine and bowel movements.
After pains—The shrinking of your uterus can cause contractions. These can worsen when your baby nurses or when you take medicine to reduce bleeding. It is normal to have this after delivery.
Vaginal discharge—This is heavier than your period and often contains clots. The discharge gradually fades to white or yellow and stops within two months.
Weight—Your postpartum weight will probably be about 10 pounds below your full-term weight. Water weight drops off within the first week as your body regains its salt balance.
Emotionally, you may be feeling:
Baby blues—About 75% of new moms have irritability, sadness, crying, or
anxiety. This begins within days or weeks of giving birth. These feelings can come from hormonal changes, exhaustion, unexpected birth experiences, adjustments to changing roles, and a sense of lack of control over your new life.
(PPD)—This condition is more serious and happens in about 25% of new moms. It may cause mood swings, anxiety, guilt, and lasting sadness. Your baby may be several months old before PPD strikes. It is more common in women with a personal or family history of depression.
Postpartum psychosis—Postpartum psychosis is a rare, but severe health problem. Symptoms include difficulty thinking and thoughts of harming the baby. Care is needed right away.
Sexual relations—You may not feel physically or emotionally ready to begin sexual relations right away.
Ways to Take Care of Yourself
Here are tips to take care of yourself:
Take a nap when your baby sleeps.
Set aside time each day to relax with a book or listen to music.
Get plenty of exercise and outdoor time.
Schedule regular time for you and your partner to be alone and talk.
Make time each day to enjoy your baby. Encourage your partner to do so, too.
Breastfeeding is encouraged unless your doctor tells you otherwise.
Clean less and have easier meals. Take a break from having visitors if you feel stressed.
ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116(2 Pt 1):450-463. doi:10.1097/AOG.0b013e3181eeb251.
Trial of labor after Cesarean section (TOLAC). EBSCO DynaMed website. Available at: https://www.dynamed.com/management/trial-of-labor-after-cesarean-section-tolac. Accessed August 27, 2021.
Vaginal birth after Cesarean delivery. The American Congress of Obstetricians and Gynecologists website. Available at: https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery. Accessed August 27, 2021.
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