Brief Answer:
She is a candidate for VBAC if she meets certain criteria.

Detailed Answer:
Hello, and I hope I can help you today.

The decision whether to attempt a VBAC is a complex one and I want to go over all the relevant factors with you so you and your wife can make the best decision for you.

The overall rate of success of VBAC in the United States is around 70 percent in women with one prior cesarean section who go into labor by themselves (are not induced). But for safety reasons there are guidelines that need to be met for making sure the mother and the baby have the least risk.

I advise you to try for VBAC only if your wife can deliver at a hospital with 24 hour anesthesia coverage and a doctor available within 30 minutes to do an emergency c/section if necessary. These are the minimum safety standards recommended for VBAC in the U.S.

The second thing that must be known to make sure VBAC is safe is the type of incision the doctor made on your wife's uterus for the first c/section. This information can be obtained from the hospital record of her first c/section. She needs to have had a transverse (side to side) incision on her uterus to be safe to VBAC. This incision is called a Kerr or Pfannensteil incision and is the most common one used for a c-section.

The third thing that should be known is the approximate weight of the baby. Babies over 4000 grams have a much lower chance to deliver vaginally a second time.

However, if you have a small baby, your wife goes into labor by herself, and you want a large family, as long as the doctor and hospital you use are experienced with VBAC I do think it is a good idea to try. Regarding pain of birth, I advise having your wife use epidural anesthesia for labor as it also can be used for another c/section if necessary. Epidural anesthesia can give her pain relief for the whole labor and delivery, and her recovery afterwards without having the pain of a c-section scar will be much better than after surgery.

But I want to make sure that you both understand that VBAC is risky- about 1 in 2000 women can rupture their uterus which can endanger her and the baby. Also she could try and need another c/section anyway. Your doctor, if they are comfortable
managing VBAC should have explained these risks to you. But I have never met a woman who succesfully delivers vaginally who regretted the decision to VBAC.

So I agree that it would be beneficial for your wife to try to have a trial of labor if all those safety conditions can be met. But ultimately it is her body and her decision, but pain during the delivery can be treated, and if you have another child it would be much easier.

I hope I have answered your questions and that this information was helpful. I wish you the best for the rest of the pregnancy. Feel free to follow up if you have any further questions.

Dr. Brown

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