Vaginal Birth After Cesarean Section: What Are the Risks?

A vaginal birth after a Cesarean section (VBAC) is a viable and safe option for many women, offering a chance for a natural birth experience and a swifter recovery. However, VBAC is not without risks, and the thin line between a successful VBAC and an adverse outcome can be influenced by various factors, including medical malpractice. 

This article provides an in-depth look at VBAC, including potential risks, to help expectant mothers make informed decisions in cases of birth trauma and consult a birth trauma lawyer.

Understanding VBAC and Its Risks

VBAC refers to giving birth vaginally after a previous pregnancy was delivered by Cesarean section. This approach is considered for women who have had one or two previous Cesarean deliveries and are pregnant again, but want to avoid another surgery.

The success rate of VBAC varies, but typically falls between 60% and 80%, depending on numerous individual factors.

Risks Associated With VBAC

While VBAC is associated with lower morbidity than repeat Cesareans in some cases, it also carries risks that must be carefully weighed. Understanding these risks and the potential for medical malpractice is crucial for both patients and healthcare providers to make informed decisions and ensure the safety of both mother and child.

One of the most severe risks associated with VBAC is uterine rupture, where the scar from the previous C-section tears open. When uterine rupture happens, it can lead to severe blood loss in the mother and oxygen deprivation in the baby, potentially resulting in life-threatening situations for both.

The signs and symptoms of uterine rupture include the following:

• Fetal distress: The first sign of uterine rupture may be a sudden change in the baby’s heartbeat, often slowing down drastically (bradycardia).
• Vaginal bleeding: Uncontrolled bleeding may occur, though it is not always present.
• Abdominal pain: Some women experience intense pain in the abdomen as the uterus tears.
• Shock and rapid pulse: In severe cases, the mother may experience signs of shock, including a fast heart rate and low blood pressure.

Other Complications

Other potential risks associated with VBAC include:

• Infection: Both VBAC and repeat C-sections carry a risk of infection, but the risk profiles differ based on individual health and procedural circumstances.
• Labour complications: These can include stalled labour or issues with the baby’s heart rate, leading to emergency interventions.
• Perineal trauma: This is more common in vaginal births, but a considered risk in VBAC due to potential interventions.

When is VBAC considered safe?

The following factors are crucial in determining whether a VBAC might be successful or if the risks outweigh the potential benefits:

Type of Previous Cesarean Incision

• Low transverse incision: This horizontal cut across the lower part of the uterus is associated with the highest VBAC success rates due to lower risk of uterine rupture.
• High vertical (classical) incision: A vertical cut in the upper uterus significantly lowers the chances of successful VBAC because it increases the risk of uterine rupture.

Number of Previous Cesareans

• Single previous Cesarean: Women with only one prior Cesarean often have a higher success rate for VBAC.
• Multiple Cesareans: Success rates decline with each additional Cesarean due to increased scar tissue and other complications.

Interval Between Pregnancies

• A shorter interval between deliveries (less than 18 months) can reduce VBAC success due to insufficient healing time for the uterine scar.
• Longer intervals typically increase the chances of success.

Maternal Age

• Women younger than 35 tend to have higher VBAC success rates than older women, possibly due to more favourable biological and health conditions.

Pelvic and Uterine Factors

• A favourable pelvic shape and a positive history of vaginal delivery (even after a Cesarean) enhance the likelihood of a successful VBAC.
• Conditions like a high Bishop score, indicating a cervix favourable for delivery, also improve VBAC prospects.

Labour Characteristics

• Induced labour: Using certain methods to induce labour can lower VBAC success compared to spontaneous labour due to the increased risk of complications.
• Progress of labour: Women who have previously reached full dilation before a Cesarean have a higher chance of a successful VBAC.

Fetal Factors

• Size of the baby: Larger babies (macrosomia) can reduce VBAC success due to the higher risk of complications during labour.
• Position of the baby: Non-vertex positions (like breech) decrease the likelihood of successful VBAC.

Experience and Attitudes of the Healthcare Provider

• The expertise and support of the healthcare team are critical. Providers who are experienced and supportive of VBAC can significantly influence outcomes.
• Hospital policies, including guidelines for fetal monitoring and immediate surgical support, are also crucial.

The Role of Medical Providers

Obstetric caregivers have a heightened responsibility when managing VBAC patients. They must do the following:

• Monitor labour progress: Careful monitoring of fetal health through fetal monitoring strips is essential. There is a lower threshold for intervening with a Cesarean section if there are signs of fetal distress.
• Assess and respond quickly: Medical staff must be ready to perform an emergency Cesarean if the risks to the mother or baby escalate.
• Thoroughly educate: Women considering VBAC should be well-informed about the risks, benefits, and potential outcomes to help them make a decision that aligns with their preferences and values.

Medical Negligence in VBAC Cases

Negligence may manifest when healthcare providers overlook pertinent medical histories or, fail to engage in comprehensive discussions regarding the associated risks with expectant mothers and require the involvement of a birth trauma attorney.

Healthcare providers must navigate the complexities of VBAC with utmost care to avoid medical negligence. Common issues in VBAC negligence cases include:

• Failure to communicate risks and benefits: A lack of comprehensive discussion about potential outcomes, including uterine rupture, the likelihood of successful vaginal delivery, and emergency Cesarean scenarios.
• Misjudging suitability: Permitting a VBAC when medical history or other health factors make the procedure too risky.
• Delayed emergency response: Failing to quickly switch to a Cesarean delivery when there are signs of distress or other complications.
• Inadequate monitoring: Not properly monitoring vital signs during VBAC, delaying the detection of fetal distress.
• Lack of trained staff: Attempting VBAC in a facility where staff are not adequately trained can lead to substandard care.
• Poor response to distress signals: Not acting swiftly on signs of fetal distress or other risk indicators to the baby.
• Inadequate facilities: Performing VBAC in a hospital lacking the equipment or protocols for emergency Cesarean sections increases the risk of complications.
• Absence of clear protocols: Failing to have or follow policies that guide the response to VBAC-related emergencies.

The Imperative of Informed Consent

Informed consent is vital in VBAC discussions. Patients must be made aware of the following:

• The risk of uterine rupture and its potential consequences.
• The likelihood of requiring an emergency Cesarean section.
• Comparative success rates and possible outcomes of opting for a VBAC.

Negligence claims can also arise when it is perceived that a healthcare provider failed to provide comprehensive risk information, especially if an adverse outcome was not fully communicated as a possibility.

Contact a Birth Trauma Lawyer Today for Help After a VBAC Complication

Obstetric malpractice claims are complex, requiring both medical expertise and legal acumen. Birth trauma lawyers possess in-depth knowledge and extensive trial experience in medical malpractice law. Moreover, consulting a birth trauma law firm can help guide you through your compensation for medical negligence. 

If you or your child has suffered from obstetrical malpractice resulting in birth trauma, seek legal guidance from a reputable birth trauma lawyer. At Sommers Roth & Elmaleh, we specialize in obstetrical malpractice and have a proven track record of advocating for families affected by birth injuries.

We offer compassionate, skilled, and knowledgeable guidance to ensure your case is handled with the care and attention it deserves. Contact Sommers Roth & Elmaleh online or call us at 1-844-940-2386 for a free consultation.