AHN Staff Highly Skilled at Performing Vaginal Birth After Cesarean (VBAC)
Dr. David A. Logan remembers the patient well.
Jane was one week from delivering her baby. And she had just learned that the obstetrician overseeing her pregnancy had resigned unexpectedly from the local hospital.
Having delivered her first child by cesarean section (C-section), Jane wanted nothing more than to have this baby as naturally as possible and at her hometown hospital.
“She wanted to attempt a vaginal birth after cesarean, or ‘VBAC,'” says Dr. Logan, medical director of the labor and delivery unit at Allegheny Health Network’s (AHN’s) Jefferson Hospital. “We got a call from her nurse midwife asking if we could help. We gladly said ‘yes.'”
Complicating matters was that Jane lived in another Pennsylvania county, some 80 miles from the Pittsburgh area.
Despite the distance, Jefferson Hospital was ideally suited to help Jane deliver her baby.
That’s because Dr. Logan and his staff are highly skilled at VBAC and are dedicated to helping mothers attempt it safely. And, Jefferson Hospital’s state-of-the-art birthing center, opened in 2014, offers many safety nets.
“You need 24-hour neonatal care. You need 24-hour anesthesia. And you need 24-hour emergency obstetrical care, so if there are any issues during VBAC, you can act quickly,” Dr. Logan says. “Here at Jefferson, we offer all those services.”
A Leading Center for VBAC
“Women who want to attempt VBAC need to be in a center that supports them all the way around,” Dr. Logan says. “Our team offers that full support and expertise. And we always have a doctor on-site 24-7.”
The commitment to help women prepare for VBAC actually starts when a mother has a C-section for the first time.
Dr. David Logan and Louise Urban, CEO of Jefferson Hospital
That surgery must be completed in a manner that meets the guidelines of the American Congress of Obstetricians and Gynecologists (ACOG), Dr. Logan notes.
“We achieve that by making the incision in what’s called a transverse manner, meaning left to right and not up and down, or vertical,” Dr. Logan says. “And it must be made on the lower part of the uterus.
“It permits the mother to be a VBAC candidate another day.”
If the C-section isn’t performed that way, VBAC won’t be possible because the mother easily could suffer a ruptured uterus, putting her and the baby in danger. But for women who’ve had a C-section according to ACOG guidelines, VBAC carries only a 1% chance of that happening, Dr. Logan notes.
“So, most women who’ve had a proper C-section are good candidates for VBAC when it’s time to deliver their next baby,” he says.
Each mother’s case is unique, however.
“For example, if a woman previously couldn’t deliver a 6 1/2 pound baby vaginally and had to have a C-section, and she’s now expecting a 7 1/2 pound baby, she’ll probably have harder time with VBAC than some mothers,” Dr. Logan says. “We have to look at each woman’s individual situation. And sometimes we have to decide in the final few minutes whether VBAC can work safely for her.”
The Benefits of VBAC
Women who succeed with VBAC (or with traditional vaginal delivery without having had a prior C-section) typically have shorter hospital stays than with a C-section delivery — one to two days versus two to four days. VBAC has less bleeding and a lower risk of infection.
“With VBAC, a mother can be up and moving around within an hour or two of delivery,” Dr. Logan says. “And she can be taking care of her children much sooner than if she had to recover from a surgical delivery.
“Plus, there are psychological benefits to having a more natural delivery with VBAC.”
A new Steelers fan born at Jefferson Hospital
Many women have believed that once they’ve had a C-section, they’ll always need to have that procedure each time they give birth. “That’s not necessarily the case now,” Dr. Logan says. “VBAC was developed so women have it as a viable option after C-section.”
In order for VBAC to work, doctors need to see a standard progression of the three phases of labor, which are latent, active, pushing. “If labor isn’t moving along well, we’ll let the mother know that we’re concerned and VBAC probably won’t be safe for her,” Dr. Logan says. “In that case, there is a lower risk to her and the baby with a C-section.”
A Longer Distance But a Happy Result
Jane’s plans to have her baby in her hometown hospital had suddenly fallen through. But she found an ideal setting with compassionate, caring labor and delivery experts at Jefferson Hospital.
Jefferson Hospital in Jefferson Hills
“Although there was a short window of opportunity, we invited Jane to visit us in advance so she and her family could get familiar with the drive here,” Dr. Logan says. “We wanted to meet her and give her a tour of the birthing unit, show her which door and elevator to use, and set other plans so she felt comfortable for her delivery date.”
And, most importantly, Jane had a successful VBAC delivery and welcomed a happy, healthy baby girl to the family.
“Jane seemed very thrilled with opportunity to have her baby here at Jefferson,” Dr. Logan says. “We’re proud that we were able to help her family resolve a stressful situation and help Jane deliver her baby the way she had wanted all along.”
To speak to learn more about VBAC or to arrange a tour of Jefferson Hospital’s birthing unit, call 412-267-6600.