The Pros and Cons of VBAC

Breezy’s favorite go-to OB Dr. Rothbart answered our questions on Vaginal Birth After Cesarean (VBAC).

What are the risks for both mom and baby in doing a vbac?
The risks for a vbac exist because of concern over the uterine scar (from the previous c-section) rupturing, or tearing open. This presents risks to the mom because of bleeding, and potential for the rupture site to be unrepairable thus leading to an emergency hysterectomy. The risks to the baby arise from the compromise to the placenta that exists if the uterus does rupture. This cuts off oxygen supply to the baby and emergent surgical delivery is necessary.

Why are vbacs more popular in some states than others?
It really just depends on the culture of the different communites, the malpractice rates, the number of obgyns on staff in certain areas, etc.

If a woman is considering a vbac, are there things she should do to prepare (kegels, strong abs)?
Though strong abs and kegels are always helpful for any delivery, there is no real preparation that can be done to insure a successful vbac.

Studies show that “planned c-sections” may cause asthma in kids–is this something that a mom should worry about when having to go in for her 2nd c-section?
It must be made clear the difference between a first, “planned” c-section, versus a repeat c-section. If a woman had a c-section secondary to a small pelvis or other factors that make her a poor candidate for vbac, then the theoretical risks of asthma from a c-section (not universally agreed upon) do not outweigh the need for one.

Is a vbac more worrisome than the possibility of her kid having asthma?
Again, asthma has in no way been directly linked to c-section deliveries so that is not a directly proportional argument to make. ie, it would be poor counseling by an obgyn to have a patient make her choice for a vbac as weighed against the risk of asthma.

Will only some Dr’s / hospitals perform vbacs?
Yes, some doctors and even hospitals refuse to allow vbacs.

Are vbacs covered by insurance?
Yes, as a vbac truly is just a vaginal delivery.

Is it true that it is recommended that a woman have no more than 3 c-sections? Would this be an incentive for a woman who wants more than three to try a vbac?
It is true that the risk of uterine rupture increases with the number of c-sections. More importantly, the risk of the placenta implanting abnormally into the uterine scar increases greatly with the number of c-sections. If the uterus implants deeply in the previous uterine scar (placenta percreta), then a hysterectomy at the time of c-section is usually needed. Most c-sections are indicated, and thus the number of babies a woman wants isn’t part of the equation. But for those women choosing an elective primary c-section, it is imperative that their obgyn ask about how many babies she wants. If a woman wants more than 3, than she should be counseled strongly against a primary c-section.

Are there any advantages to a vbac?
The advantages to a vbac are the same as for all vaginal deliveries, including but not limited to, avoiding surgery, quicker recovery, less pain post delivery, having the experience of childbirth, less risk of pulmonary embolus and less risk of infection.

Famously flown to Namibia to deliver Brad Pitt and Angelina Jolie’s baby Shiloh in 2006 as well as appearing on Tori Spelling’s reality show, Jason A. Rothbart, M.D. is an Obstetrician/Gynecologist in Los Angeles. He attended college at the University of California at Davis, and medical school at The Chicago Medical School. He was trained in obstetrics and gynecology at the University of Southern California in the Los Angeles County Medical Center. He is back home practicing minutes from where he grew up, and has a wonderful practice with all ages, and is currently on the surgical and obstetric staff at Cedars-Sinai Medical Center.

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