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The chance of a successful VBAC is lower: 67 in 100 (67%). Because of these risks the decision to induce labour should be discussed with you by a Consultant Obstetrician. It may be that even if you planned a vaginal birth, you will decide that if your pregnancy is overdue, you will have a caesarean section (abdominal birth) rather than an induction of labour.
When is VBAC less likely to be successful?
A number of factors (risk factors) make the chance of a successful vaginal birth less likely:
- If you never had a vaginal birth.
- If you need to be induced.
- If you are overweight – Body Mass Index (BMI) over 30. When all of these factors are present, 4 in 10 women (40%) have a vaginal birth.
Other factors that make VBAC success slightly less likely are: • If you have not gone into labour by 41 weeks.
- You have a big baby (more than 4 kilograms, 8lb 13oz)
- You do not have an epidural
- You had a previous caesarean birth before 37 weeks
- You are still in early labour (less than 4cms dilated) when you come into hospital.
- It is less than two years since your last caesarean delivery. • You are older in age (40+).
What are the advantages of a successful VBAC?
- The advantages of a successful VBAC include:
- A shorter stay in hospital
- Less abdominal pain after birth.
- No restriction on driving a car.
- A greater chance of an uncomplicated vaginal birth in future pregnancies.
- A reduced chance of needing a blood transfusion.
- A reduced chance of developing a thrombosis (blood clot in the legs).
What are the risks from VBAC?
They include:
- Emergency Caesarean delivery – There is a chance you will have an emergency caesarean delivery during your labour/induction. This happens in 25 out of 100 women (25%). This is only slightly higher than it is in your first pregnancy when the chance is 20 in a 100 women (20%). The usual reasons for emergency caesarean are slow labour or if there is concern for the wellbeing of the baby.
- Blood Transfusion – Women with unsuccessful VBAC (Emergency caesarean section) have a 3 in 100 (3%) chance of needing a blood transfusion compared to 1 in 100 for those who deliver vaginally or have an elective caesarean.
- Infection in the uterus (womb) – In an unsuccessful VBAC there is an 8% chance of developing an infection in the uterus compared to 1% for those who have a VBAC or choose a repeat planned caesarean.
- Scar weakening or scar rupture – There is a small chance that the scar on your womb (uterus) will weaken and open. This is called scar rupture (separation). If you into labour naturally, the chance of this happening is 1 in 200 (0.5%). If you are induced with prostaglandins (Propess, Prostin), the chance of this happening is 1-2 in 100 (1-2%). The chance of this happening is increased when the length of time from your previous caesarean is less than 12 months.
Risks to your baby – The risk of your baby dying or being brain damaged in labour is very small 2 in 1,000 women (0.2%). This is no higher than if you were labouring for the first time, but it is higher than if you have an elective repeat caesarean 1 in 1,000 (0.1%). However this must be balanced against the risks to you if you have a caesarean delivery.
Are there any differences in how I’m cared for in labour?
- Electronic Monitoring – As with all inductions of labour you will be continuously monitored throughout your labour once your waters have been broken. This will help us detect any changes in your baby’s heart rate that could be related to problems with your scar.
- Intravenous cannula – We recommend that you have a cannula in a vein in your forearm so that if you should need a caesarean it is easy to attach a ‘drip’ (intravenous infusion). Any blood tests can also be done at the same time.
- Progress of labour – In order to minimise the likelihood of problems with your scar in labour. Excessively slow progress may indicate that a problem is developing. In some circumstances we can give you the hormone drip (Syntocinon) as previously mentioned in this leaflet. This can increase the risk of your scar opening by about 2-3 times, so the Obstetrician would discuss this with you prior to it starting and gain your consent.
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