Exams and Tests

Besides the usual prenatal tests, your doctor will take measures to assess whether vaginal delivery is likely to be a safe birthing option for you. (For more information on standard prenatal tests, see the topic Pregnancy.) These extra measures can help you and your doctor make a well-informed decision about your delivery.

Assessments done sometime during the pregnancy to help find out whether vaginal birth after cesarean (VBAC) is a safe option may include:

• A review of surgery records to verify the type of incision used for a previous cesarean.
• A fetal ultrasound.
• Fetal heart monitoring, which is also used during labor and delivery to watch for fetal distress. Fetal heart monitoring can also help detect a sudden uterine rupture. A rupture is typically followed by a sudden and then ongoing drop in fetal heart rate. The mother might notice bleeding and pain.

What to Expect

Information, preparation, and teamwork are needed for a successful vaginal birth after cesarean (VBAC).

Childbirth and VBAC education

To prepare for labor, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:

• What to expect during VBAC labor and delivery.
• How to manage the birth using controlled breathing and emotional and physical support.
• What medical pain control options may be available for a vaginal delivery.

Labor

Other than requiring closer monitoring, labor for a VBAC is the same as normal labor. During early labor, a woman can remain as active and mobile as she wants. There are no specific restrictions for VBAC until active labor begins. During the active period of labor, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. (For more information, see the Exams and Tests section of this topic.)

• If you are attempting VBAC and you have not had a previous vaginal birth or your previous cesarean was done early on in labor, your labor will be like a first-time labor. For example, it could take a long time.
• If you have previously had a longer trial of labor or have delivered vaginally, your body is likely to have adapted to the process, making labor easier.

For more information about labor and delivery, see the topic Labor, Delivery, and Postpartum Period.

Medicines for starting or strengthening VBAC labor

As the end of pregnancy nears, the cervix normally becomes soft and begins to open (dilate) and thin (efface), preparing for labor and delivery. When labor does not naturally start on its own, labor may be started artificially (induced).

Some doctors avoid the use of any medicine to start (induce) a VBAC trial of labor, because they are concerned about uterine rupture. Other doctors are comfortable with the careful use of oxytocin (Pitocin) to start labor when the cervix is soft and opening (dilating).

If your labor slows or stops progressing, your doctor may use oxytocin to strengthen (augment) contractions.

Pain medicine

As with most vaginal births, most women who choose VBAC can safely use pain medicine during labor.

Pain medicine usually is started when the cervix has opened (dilated) 3 cm (1.2 in.) to 4 cm (1.6 in.). Types of pain medicines used include:

• Local anesthesia, which numbs the small area where the medicine is injected.
• Epidural anesthesia, which partially or fully numbs the entire lower part of the body. Studies have shown that epidural anesthesia does not increase uterine rupture rates during vaginal birth after cesarean (VBAC) trials of labor.³
• Opioids (narcotics), which partially relieve pain and help you relax.