Vaginal Birth After Cesarean

In most countries of the world, a vaginal birth following a cesarean is not unusual. The past 15 years have witnessed a surge of new information in this country strongly supporting the position that the majority of women can have a vaginal birth after cesarean (VBAC, pronounced VEE back).

If you had a transverse uterine incision, you may be a candidate for a future vaginal birth. The major concern is the rupture of the scar while you are in labor. Yet the risk of scar rupture is only 0.2 percent with this type of incision. This risk is thirty times lower than that for any other unpredictable childbirth emergency, such as acute fetal distress, premature separation of the placenta, and prolapsed umbilical cord. Because women who are having a VBAC are not considered to be at any greater risk than other low-risk women, they may even deliver in birth centers, if emergency care can be initiated within 30 minutes of the recognition of a problem.

As long as the indication for your previous cesarean does not recur and no new indications appear, your chances for a vaginal delivery are quite good. Your choice of caregiver is an important factor. You need to discuss with him his criteria for permitting a trial of labor. Studies show that a successful vaginal birth is possible if the original cesarean was performed for one of the following nonrecurring reasons—multiple birth, cephalopelvic disproportion, abruptio placentae, failed induction of labor, fetal distress, placenta previa, PIH, abnormal presentation, failure to progress, or abnormal labor.

In 1988, the American College of Obstetricians and Gynecologists released a statement supporting VBAC. Even so, many physicians still continue to perform routine repeat cesareans. They caution about the dangers of uterine rupture to the woman and the baby. However, they neglect to mention the dangers of a repeat cesarean, when in fact a c-section can be more risky than a vaginal birth. Possible complications include surgical damage to the bowel and bladder, hemorrhage, infection, poor wound healing, blood clots, and anesthesia-related problems.

Furthermore, a woman who has given birth surgically is more likely to experience depression, feelings of failure, and other negative emotions.19 Her feelings of inadequacy are greater when she believes that the surgery was performed unnecessarily. After having a VBAC, many women report that they feel “complete,” even if they had accepted the fact that the previous cesarean was justified.

Women planning a VBAC require good emotional and physical support, since they may receive many negative comments from lay persons as well as professionals. A good source book is Birth After Cesarean: The Medical Facts by Bruce Flamm. This book provides important medical facts to support the decision for a VBAC and helps the expectant mother to attain her goal. It is “must reading” for cesarean prevention.

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