C-Section, VBAC, Operative Vaginal Delivery, Singleton Vertex C-Section, Oh My

No two deliveries are quite the same. Your body, your baby, and your OBGYN or Midwife all have their own influence (some more pronounced than others), making each delivery almost entirely unique. While deliveries are often portrayed rather similarly in popular media, the reality is that there are many medical techniques which may be used to assist with or supplant routine delivery. 

Which delivery option is right for you will depend on your health, your baby’s health, and any possible complications that may arise. As a result, your optimal delivery mode may change from moment to moment. A routine delivery may suddenly become a C-Section or Operative Vaginal Delivery due to your immediate medical needs.

What Does it All Mean?

When you’re pregnant, you hear no shortage of acronyms and jargon! So, it’s nice to have a quick definition of what all of these mean:

• C-Section: During a Cesarean Section, the baby is delivered via a surgical incision made in the abdomen and uterus. 

• Singleton Vertex C-Section: This is a C-Section performed on a single baby (not twins, triplets, or more) whose head is pointed down, towards the birth canal. In other words, Singleton Vertex C-Sections tend to be those which are either less predictable or elective.

• Operative vaginal delivery: When your OBGYN or Midwife uses forceps, a special vacuum or other tools, it’s usually referred to as operative vaginal delivery.

• VBAC: Also known as Vaginal Birth After C-Section, this is exactly what it sounds like. A woman who is giving birth vaginally after having given birth via C-Section in the past.

• TOLAC: Trial of Labor After C-Section is when a birthing person attempts to have vaginal birth after C-Section or VBAC. If unsuccessful, a Repeat C-Section (RCS) will be performed. 

C-Sections

A C-Section is a surgical procedure in which an incision is made along the abdomen and through the uterus. The baby is then delivered via this incision. Some women elect to deliver via C-Section as a matter of preference. For most, however, a C-Section is used due to complications or risk factors that arise during pregnancy or labor.

In general, C-Sections are performed under regional anesthesia–which means you won’t be able to feel anything from the waist down. Recovery from the procedure usually means 3 days or so in the hospital–and then several weeks of rest and recuperation once home. 

A C-Section may be performed for a wide variety of reasons, including the following:

• The baby is not in the correct birthing position (the head is not pointing towards the birth canal).
• The baby may be in apparent distress.
• The mother may be giving birth to multiple babies (such as twins, triplets, or more)
• The mother may have previously given birth via C-Section

This list is not exhaustive, but it does represent some of the more common reasons for undergoing a C-Section.

What is a Singleton Vertex C-Section?

A Singleton Vertex C-Section is a Cesarean Birth in which there is a single baby being delivered and that baby’s head is in the downward facing position. Singleton Vertex C-Sections are closely tracked by medical professionals because they are often elective. This can provide medical professionals with a good data set to compare the health and safety of C-Sections and vaginal births.

On an individual basis, however, a Singleton Vertex C-Section may be performed for a wide variety of reasons, some of which are elective and some of which are in response to complications. 

So don’t let the jargon throw you for a loop! Many C-Sections are Singleton Vertex C-Sections. The nomenclature is simply a way of designating how many babies are being delivered (1) and what position that baby is in (head facing the birth canal). 

Operative Vaginal Delivery

During an operative vaginal delivery, an OBGYNwill use either forceps, vacuum extraction, or a combination of both in order to assist with the delivery. 

Operative vaginal delivery methods are usually deployed only when problems or complications arise during labor–usually during the second stage. As a result, operative vaginal delivery is not something expectant mothers can elect to undergo (as they could with a C-Section, for example) and must be performed by a trained provider like OBGYN. Still, the possibility that these methods may be used is a good reason to discuss the procedure with your OBGYN or Midwife. 

When is Operative Vaginal Delivery Used?

Operative Vaginal Delivery is an interventional approach designed to assist with birth when problems develop. Your OBGYN or Midwife will use either forceps or vacuum extraction (or a combination of both) depending on a variety of factors. Using these tools, your OBGYN will attempt to gently coax your baby through the birth canal.

An operative vaginal delivery is usually deployed when:

• The progress of the delivery stalls even when labor continues (and the mother continues to actively push). 
• There’s an indication that the baby is in distress.

Operative vaginal deliveries account for something like 3% of all births. So they aren’t exactly common, but they do happen. 

TOLAC and VBAC

TOLAC stands for Trial of Labor After C-Section. A successful TOLAC will result in Vaginal Birth After Cesarean (VBAC).

After a woman has a C-Section delivery, certain complications may crop up which could make vaginal delivery more challenging. TOLAC is designed to help women deliver again without the need for a C-Section. 90% of women who have had a C-Section are candidates to deliver vaginally. But VBAC isn’t for everyone. Your OBGYN or Midwife will have a consultation with you to discuss the risks vs benefits to make sure you’re healthy enough for a vaginal delivery after a C-Section.

You may not be a good fit for a VBAC if you:

• Have delivered via C-Section multiple times.
• You have a prior vertical incision along your uterus.
• Your C-Section scar has broken open on previous occasions.
• You have undergone certain other surgical procedures (such as fibroid removal).

However, everyone’s body is different, so your OBGYN or Midwife will carefully review your history and provide counseling on your risks vs benefits. VBAC is generally done because it provides some significant benefits. Those benefits include:

• Lower risk of complications, such as infection, excessive bleeding, or blood clots.
• A shorter hospital stay and recovery time after your delivery. 
• More options for future deliveries. Most women who have two C-Sections in a row are not able to safely select VBAC as an option. This also means you’ll have more of an ability to individualize your birth plan.

The best candidates for VBAC are generally women who have delivered vaginally in the past. 

Choosing the Right Delivery Option for You

When you work with an OBGYN or Midwife, you’ll have the option to create a birth plan that best suits your healthcare needs and your desires. Sometimes, a C-Section or VBAC approach is part of that plan.

In other cases, a C-Section or Operative Vaginal Delivery may occur because complications present during labor. The more you know about these approaches beforehand, the fewer questions you may have at the moment, so be sure to talk to your OBGYN or Midwife about all of the possibilities.

Our providers track their patients’ birth rates via each of these methods. If you’d like to learn more about those rates or have questions, please contact us at our Glenview or Wilmette locations.