The Importance of a Low C-Section Rate and Benefits of Vaginal Birth After Cesarean (VBAC)

This is weekly dose of wellness brought to you by MemorialCare health system. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about the importance of a low C-section rate and the benefits of vaginal birth after cesarean. Our guest today is Dr. Tasha Kalra, an obstetrician and gynecologist at Orange Coast Women's Medical Group at Saddleback Medical Center. Welcome, Dr. Kalra.

Tasha Kalra, MD: Thank you so much. It's so great to be on. Thanks for having me.

Deborah Howell (Host): Love having you today. Hey, MemorialCare Saddleback Medical Center has the lowest C-section rate in Orange County. Now, why is this significant?

Tasha Kalra, MD: Well, cesarean deliveries do carry some more risks than vaginal deliveries. Therefore, we try to aim for a vaginal delivery every time when possible. So we're really proud to have the lowest cesarean rate in the area and therefore the lowest complication rate. However, that being said, when they're medically necessary, cesarean sections can help save the lives of mothers and children. So patients shouldn't feel bad if the outcome of their delivery is a cesarean section, but we definitely try to aim for vaginal deliveries.

Deborah Howell (Host): Absolutely. Understood. What is VBAC?

Tasha Kalra, MD: And we love our acronyms in OBGYN. So let me explain some of them. VBAC stands for vaginal birth after cesarean section. You may also hear the term TOLAC, which stands for trial of labor after cesarean section. So the difference is TOLAC, refers to a planned attempt to deliver vaginally by a woman who's had a previous cesarean delivery, regardless of the outcome. And VBAC refers to the outcome of attaining a vaginal delivery.

Deborah Howell (Host): Understood. Now, who might be a candidate for VBAC?

Tasha Kalra, MD: Most women with one previous cesarean delivery that was done with a low transverse or horizontal incision on the uterus are candidates for TOLEC. However, there are certain women who are advised not to pursue this, and those are women who have had previous uterine surgeries like a fibroid removal or a vertical incision on their uterus. That is called a classical C-section. Other than these cases, appropriate candidates are assessed on an individualized basis. So there are several different factors that go into whether or not a woman might be more successful or less successful in a VBAC. So important factors include the reason for the first cesarean section. For example, a woman whose first cesarean delivery was performed because of an arrest of labor or arrest of dissent where she was pushing for a long time, they're less likely to succeed in their attempt at VBAC than those whose first cesarean deliveries was for what we call a non-recurring indication, like breach presentation or concerning fetal heart rate. In addition, women who undergo induction of labor are less likely to achieve a VBAC than those women who go into spontaneous labor. And then there are some other, you know, yeah, there's some other factors too, including age, the women's BMI or body mass index, the gestational age of the pregnancy. There are several different factors that kind of go into, you know, a success of having a VBAC.

Deborah Howell (Host): Got it. Now you love your acronym, so it must be important. What are the benefits of VBAC?

Tasha Kalra, MD: So one of the major benefits is providing an option to experience a vaginal birth for women who want that, but then haven't been able to have it yet. Women who achieve a VBAC are also, they're avoiding major abdominal surgery and they therefore have lower rates of bleeding, infection, and developing complications such as blood clots in their lungs or their legs. Women who achieve VBAC also have shorter recovery period than women who have an elective repeat cesarean delivery. And it's also important when considering future pregnancies. VBAC may decrease the risk related to multiple cesarean deliveries down the road, such as injury to surrounding organ structures during the surgery, because we know that after a lot of C-sections, you can build up some scar tissue.

Deborah Howell (Host): Understood. Okay. That's all the good stuff. Now, there must be a few risks associated with VBAC.

Tasha Kalra, MD: Yeah. You know, one of the major risks with VBAC is very rare, but potentially serious. This is called uterine rupture, or it's where the uterus opens up at the previous scar site from the C-section. This is very rare. It happens less than 1 in 200, so that's less than 0.5% of cases. The chances are slightly increased when a patient has had multiple C-sections before or uterine surgery such as fibroid removal or that vertical incision classical C-section. That's why those women are probably not good candidates, but it does happen very rarely. Another more common risk of VBAC is when a woman who is undergoing a trial of labor requires a repeat C-section. So the outcomes are obviously the best for mom and baby after a vaginal delivery, but the outcomes are actually better after a scheduled repeat C-section when compared to a repeat C-section needed after another trial of labor, if that makes sense.

Deborah Howell (Host): Oh, no, it totally makes sense. And what is the recovery like after VBAC?

Tasha Kalra, MD: Yeah, the recovery after a vaginal delivery is definitely shorter than after a C-section. So pain is generally limited to mild uterine cramping, especially related to breastfeeding or to kind of a soreness in the vaginal or perineal areas. You spend less days in the hospital. You're able to return to normal activity quicker. And overall, you just feel a little bit more energized.

Deborah Howell (Host): Got it. Okay. Well, it sounds like it's the way to go, if at all possible. And I'm sure there are some borderline cases and it's up to a great doctor like yourself to make that call.

Tasha Kalra, MD: Absolutely. It's definitely a conversation that I think is very individualized and needs to be a conversation with the patient. There's no crystal ball to know what's going to happen and it's definitely weighing the risks and the benefits.

Deborah Howell (Host): Absolutely. And there must be an emotional component to all of this.

Tasha Kalra, MD: Oh, absolutely. Like I said before, I mean, a lot of women want to be able to experience that vaginal birth when they haven't been able to. But that being said, sometimes going through the hours, days long of labor and then having to need another C-section is also just emotionally very strenuating and it's easier to come in for your scheduled C-section. So definitely you have to feel out what a woman is thinking, what her experiences were last time and where her emotions lie now.

Deborah Howell (Host): Yeah, and what are the connections for a woman in a vaginal birth?

Tasha Kalra, MD: Oh, it's … you know, in every birth, and we try to give similar birth experiences, whether it's a vaginal delivery or a cesarean section, but inevitably, during a vaginal delivery, you're a little bit more in touch and in tune because everything's happening right there. There's not the big drapes going on. You're not in an operating room. And it's definitely a very intimate and personal moment. We try to do the same with the cesarean section, but unfortunately in the operating room with the lights and the multiple people, it gets a little bit drowned out, but that vaginal delivery is very special.

Deborah Howell (Host): Got it. Either way, the healthy baby is the most important thing.

Tasha Kalra, MD: Exactly, that's our outcome. It's a healthy mom and a healthy baby.

Deborah Howell (Host): Where can people find out more information?

Tasha Kalra, MD: Yeah, I mean, the best place to find out more information is to talk directly with your healthcare provider. You can also find helpful information on our website. So that's www.memorialcare.org/baby and www.memorialcare.org/SBbabyclasses. We are proud of it here at MemorialCare to give a lot of information on childbirth, pregnancy classes, preconception classes, and we actually have an upcoming VBAC class on January 20th at Saddleback Medical Center.

Deborah Howell (Host): Oh, nice. Okay, great. Dr. Kalra, my father was also a physician who delivered babies, and he said each and every time it was a miracle.

Tasha Kalra, MD: Oh, I completely agree. This job never gets old. It's so special. It still brings tears to my eyes every time. These are very, very little miracles in our everyday life.

Deborah Howell (Host): So no matter how that little baby enters the world, remember, it's always a miracle.

Tasha Kalra, MD: That's right. That's right.

Deborah Howell (Host): Thank you so much, Dr. Kalra, for your time today.

Tasha Kalra, MD: Oh, thank you so much, Deborah. It was a pleasure.

Deborah Howell (Host): You've been a sheer delight. We appreciate your time. And for more information or to listen to a podcast of this show, please go to memorialcare.org. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a great day.