Vaginal Birth After Caesarean

The age-old phrase "Once a caesarean always a caesarean" is no longer valid and today many women are choosing to have a vaginal birth after a caesarean section.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 and baby.

Babies generally 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 for you.

Amongst the things that he will consider is:

  • The 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.
  • The 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 caesarean scars.
  • 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 birth.
  • The 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.

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