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Labour & Delivery / Pregnancy / Smartmum

The Expert Guide to VBAC in Singapore

The Expert Guide to VBAC in Singapore

The Expert Guide to VBAC in Singapore

If you’re pregnant and you know your options, you may well prefer a vaginal birth for a number of reasons. Even if you have had a caesarean (C-section) before, you will be glad to know that does not rule out your chances of natural labour for your next child.

In fact, the American College of Obstetricians and Gynecologists guidelines state that a vaginal birth after caesarean (VBAC) is safe and appropriate for most women. The statistics back this up: a VBAC (pronounced “vee-back”) is successful in 2 out of every 3 delivery attempts — the same odds for successful vaginal birth for mums who have never had a C-section.

Hospitals in Singapore adopt strict guidelines that restrict VBAC procedures. To have a higher chance of being accepted for a VBAC, you’ll need to fulfil three key criteria.

You Have Had Only One Prior Caesarean Delivery

“In Singapore, your practitioner and hospital will only open up the option of a VBAC to you if you’ve only had one prior C-section,” says obstetrician and gynaecologist Dr Tan Thiam Chye. “Moreover, your C-section would have had to be carried out with a low traverse (horizontal) incision and without any complications.”

Dr Tan explains: “Women who’ve previously had a classical C-section, one that involves a vertical cut in the upper part of the uterus, are deemed unsuitable for VBAC as there is a higher risk of uterine rupture, which could be life-threatening if it happens.”

You Have No Medical Issues With Your Current Pregnancy

This is an obvious precaution for you and your baby’s safety! “Any medical issues with your current pregnancy that may prevent a safe vaginal delivery, such as low-lying placenta or abnormal presentation, may rule out a VBAC,” says Dr Tan.

He adds that, if the mother-to-be has certain heart diseases or severe high blood pressure, or a previous fibroid removal operation on her uterus, her obstetrician is also likely to rule out the option of a VBAC to protect her from the physical stresses of a vaginal delivery.

Before a decision to allow a VBAC is made, your obstetrician will review the medical records of your previous pregnancy and also assess your current one. He or she will also discuss with you the associated risks and benefits of a VBAC.

Undergo a Successful Trial of Labour

Even though you’re deemed suitable for VBAC, you may still have to undergo a trial of labour — as recommended by your obstetrician — just before attempting vaginal delivery. The trial of labour is a short procedure where you and your baby’s vital stats are closely monitored as you go into spontaneous labour. “During VBAC, you may also opt for epidural pain relief. Doing so is perfectly safe for you and your baby,” Dr Tan reassures.

If, during your trial of labour, your doctor deems that the labour is not progressing as well as expected, or if your baby’s heartbeat starts to show worrying signs, an emergency C-section may be ordered and carried out.

Even though a VBAC can be safe, a decision for or against VBAC should be jointly made between you and your obstetrician. Speak to your doctor about VBAC as early into your pregnancy as possible so there’s ample time to review and assess your suitability. Be it a vaginal or caesarean delivery, the safety of mother and baby should always come first.

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A/Prof Tan Thiam Chye
MBBS (S'pore), M.Med(O&G) (S'pore) Head & Senior Consultant Department of Obstetrics and Gynaecology KK Women's and Children's Hospital Director (Clinical), Office of Patient Experience Deputy Director (Education), KKH Campus Associate Professor Duke - NUS Graduate Medical School Singapore

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