Birth After Caesarean
age-old phrase "Once a caesarean always a caesarean" is no
longer valid and today many women are choosing to have a vaginal
birth after a caesarean section. For many years women could
not deliver their babies vaginally after having a caesarean
delivery. The incisions in the uterus were made vertically
and the risk of uterine rupture was too great and repeat c-sections
were standard procedure. Now, the incisions are usually horizontal
bikini cut style and having a vaginal birth after a c-section
isn't nearly the risk it used to be. According to studies,
of the women who attempt VBAC about 60 to 80 percent are successful.
The remaining women end up having another caesarean. If you're
healthy, and have no pregnancy risk factors, then VBAC may
be a possibility your obstetrician can help you evaluate.
Vaginal birth is inherently safer than a caesarean (or repeat
caesarean) simply because a caesarean is major surgery including
lots of risk factor such as infection, haemorrhage, anaesthesia
(whether it be general or local such as an epidural) related
complications, thereby causing injury to internal structures.
Thus surgery carries its own special risks and should not
be chosen simply for convenience of parents or doctor. If
a mother gives birth vaginally, she can avoid these risks.
However when there is a medical need, the lifesaving techniques
used in the caesarean are very much appreciated and warranted.
Advantages of VBAC:
The advantages to having a VBAC versus a repeat c-section
are numerous. The most obvious is that a c-section is major
abdominal surgery and it requires a longer recovery period.
It is also a higher risk for harm to mom and baby. Even though
doctors may lead you to believe it is safe, which it usually
is, it inherently has a greater risk just by the nature of
it. There is a reduction of the risk for possible blood transfusions,
thus decreasing risk of blood-borne disease for both mother
do much better in a vaginal birth as well. The natural squeezing
as they pass through the birth canal rids themselves of mucus
and fluids. This does not occur in a c-section and surgically
delivered babies often have more difficulty with respiration
at birth because of this.
Breastfeeding will also be better for you after a vaginal
birth. Without the pain of an incision, it is easier to position
your new baby in whatever way works best and have a better
start at a nursing relationship. Since shorter time is needed
for recovery there is a decrease in the length of hospital
stay. Also financially VBAC costs less than c-section.
What are the risks of VBAC?
The primary risk factor for VBAC is the possibility of uterine
rupture. Uterine rupture can be life threatening for mother
and baby. The likelihood of uterine rupture is rare, but because
it's a serious situation, your doctor must carefully evaluate
your health risks. There are several considerations for determining
who is a good candidate for VBAC. Your doctor will review
these factors and will tell you if VBAC is a risky proposition
Amongst the things that he will consider is:
type of incision you had previously. For example if you
had a high vertical or "classical" caesarean, made by
cutting vertically in the upper uterus, your risk of uterine
rupture is greater than if you had a lower horizontal
or vertical cut along the lower (and thinner) portion
of the uterus. Your doctor can tell which type of caesarean
you've previously had from your medical records.
other factor is the number of previous caesareans you
had. The risk of uterine rupture increases with each caesarean
performed. The risk of rupture is greatest along previous
The size of the baby will also be taken into consideration.
The doctor will evaluate whether the size of the baby
is relative to the size of your pelvis. If he can't fit,
your uterus may be subject to prolonged stress in a delivery
that won't progress properly. Your doctor can evaluate
the size of the baby relative to your pelvis through ultrasound.
Also the duration between pregnancy will be considered.
Ideally, a minimum of nine months will have elapsed before
you conceive again. The more time your body has to recover
after the surgery, the stronger it will be for the next
baby's position also has to be monitored. There may be
factors that could signal possible complications during
baby's delivery (for example, breech presentation), which
coupled with the other risk factors of prior caesarean,
might make VBAC too risky.