Jeni Vazquez had made up her mind before her pregnancy even began: She wanted a vaginal delivery for her second child.
Vazquez had delivered her first baby in 2007 by Caesarean section.
“I was fine and the baby was healthy,” Vazquez recalled. “But as time passed, I felt like I was robbed of my right to have a vaginal delivery.”
So she asked her physician about having a vaginal birth after Caesarean, or VBAC.
For decades, having one Cesarean section destined women to a life of C-sections. But in the 1980s, the mindset changed.
Reasoning that the recovery time would be faster, obstetricians began encouraging vaginal deliveries for some women who had previously delivered via C-section.
The trend toward VBACs gained traction through 1996, when one in four babies nationwide were delivered that way, according to the American Congress of Obstetricians and Gynecologists.
But the figure tumbled in the years that followed.
One reason was a growing concern among patients about uterine rupture. Though uterine rupture occurs in less than 1 percent of VBACs, it can be life-threatening for both mother and baby.
Hospitals also grew worried about the risk. In 2009, a survey by the American Congress of Obstetricians and Gynecologists found that one in three obstetricians had stopped performing VBACs for that very reason.
“There were some fairly significant malpractice awards,” recalled Dr. Nigel Spier, an obstetrician at Memorial Regional Hospital and Memorial Hospital West. “Given the litigious environment, particularly in Florida, a lot of physicians started to shy away from it.”
Doctors believe the VBAC rate is currently less than 10 percent.
But support for the practice may again be growing.
In 2010, the National Institutes of Health concluded that VBACs are a “reasonable option” for many pregnant women.
That same year, the American Congress of Obstetricians and Gynecologists issued less restrictive guidelines for VBACs. The professional organization declared VBACs “a safe and appropriate choice for most women who have had a prior Cesarean delivery,” including some women who have had two previous Cesareans.
“Women have more options because more people are starting to look at the VBAC again,” said Dr. Dibe Martin, a maternal-fetal medicine specialist and vice chair of obstetrics and gynecology at Florida International University’s Herbert Wertheim College of Medicine. “Unfortunately, it’s not for everyone. We have to be careful and make sure that we are not recommending it for the sake of recommending it.”
Doctors say about 80 percent of women who have had a C-section are candidates for a VBAC.
Of those candidates, roughly three-quarters will be able to deliver vaginally.
Gene Burkett, a professor of obstetrics and gynecology at the University of Miami Miller School of Medicine and interim director of the Division of Maternal-Fetal Medicine, said choosing to have a VBAC is a personal decision.
“We have to sit down and discuss the situation with each individual candidate,” he said. “In some cases, the likelihood of success is much higher than in others.”
Women who have had successful vaginal deliveries before their C-sections often make the best candidates, he said.
Vazquez’s family thought she was crazy when she first pitched the idea of having a VBAC, she said.