Here's The Deal With Having A VBAC After An Emergency C-Section

Sometimes C-sections are unavoidable during labor and delivery and there are definitely emergencies that come up and require a C-section for the health and safety of you and your baby. If you were hoping to try a vaginal birth for your next pregnancy (or pregnancies), you may be wondering, can you have a VBAC if your first C-section was an emergency? It's one thing to need a C-section for something not-so-serious, but it can feel totally different to need one in an intense situation.

But the answer is simple. Board certified OB-GYN and high-risk pregnancy expert Sasha Davidson tells Romper, yes, you can have a VBAC after an emergency C-section, but it depends on what kind of incision you had with your prior C-section. “Whether she had a normal bikini-type incision (pfannenstiel/horizontal incision) on her uterus, or if she was cut up and down (classical/vertical incision),” will determine whether she can have a VBAC.

“Patients who had a classical C-section, which means an up-and-down incision on the uterus, cannot try vaginal birth anymore due to higher risk for uterine rupture,” Dr. Daniel Roshan, who is also a leading board certified high-risk maternal fetal medicine doctor and OB-GYN, tells Romper. Additional risks of having a VBAC after having a classical C-section include “abnormal implantation of the placenta,” in addition to the uterus rupturing, according to Davidson, explaining that a uterine rupture is when the previous C- section scar opens up under pressure.

Dr. James Betoni, another leading board certified high-risk maternal fetal medicine doctor and OB-GYN agrees, telling Romper that the issue of having a VBAC is not whether the C-section is an emergency or not, but simply the type of incision that was made. Betoni adds, “Many factors can come into play, but ‘additional’ risk factors with ‘emergency’ C-sections really depend on what was done at the time of the ‘emergency.’” Roshan adds, “Patients who had a C-section for fetal distress or breech are usually better candidates for VBAC than patients who had a C-section due to a failure to progress in labor and have a smaller pelvis.”

As far as what constitutes an “emergency” C-section as opposed to a regular C-section, according to Betoni, is an “emergency is for an immediate need to have the baby, such as something with the fetal heart tracing like bradycardia. Urgent is that baby needs to be delivered in a timely manner, such as a non-reassuring fetal heart rate pattern, but still signs that baby is OK, and then an elective is scheduled.”

There are many important reasons to have a C-section, including “the baby's heart rate [becoming] very low and [staying] low after attempts to resuscitate the baby in utero (oxygen to mom, changing positions like side to side, on all fours, etc.) and a breech baby with physicians not trained in vaginal breech delivery present in active labor,” Betoni says.

If you don’t want to have to have a C-section, is there anything you can possibly do to avoid it in the first place? Obviously things happen (see above), especially when moving babies are involved, but according to Roshan, “There are strategies that could be followed to decrease the risk for primary C-section or to improve the success of VBAC, such as diet and exercise, herbal medicine, acupuncture, having a good labor coach, and being properly trained on what to expect in labor and what to do. We have combined all these strategies to have an extremely successful VBAC rate for our patients, especially those who would like to have multiple children.”

Sometimes, C-sections are just a fact of labor for many women — and that absolutely doesn’t make her birth “lazy” or “unnatural." And the only reason you couldn’t have a VBAC in subsequent pregnancies depends on the type of scar you have from your C-section, regardless of whether it was an "emergency" or not. As always, make sure your OB-GYN is aware of what you’re hoping your birth plan will be, and that they are well versed in VBACs if you’ve had a previous C-section but want a vaginal delivery this time around.

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