Vaginal birth after cesarean section
If you want to try vaginal
birth after cesarean section, you should know that 90% of women who have had cesarean
section are candidates for vaginal birth after cesarean section. Statistically,
the highest rate of vaginal birth after cesarean section is among women who
have had both a vaginal birth and a cesarean section and who, given the choice,
choose to give birth vaginally.
In most published studies,
60-80%, or about 3-4 out of 5 women who have had a previous cesarean section,
can successfully deliver vaginally. By reading the following information and
discussing this possibility with your doctor, you can make an informed decision
about having a vaginal birth after a cesarean section.
Vaginal birth after cesarean section and the risk of uterine rupture
The greatest concern for women
who have had a previous cesarean section is the risk of uterine rupture during
vaginal birth. If you have ever had a cesarean section with a low transverse
incision, the risk of uterine rupture during vaginal birth is 0.2 to 1.5%, or
about 1 chance in 5000.
Some studies have documented
an increased incidence of uterine ruptures in women undergoing induction or
induction of labor. You should discuss with your doctor the possible
complications associated with induction. Vaginal birth after a cesarean section
is safer than a repeat cesarean section, and vaginal birth after a cesarean
section with more than one prior cesarean section does not pose an increased
risk.2
If you were told the following
reasons for a previous cesarean section and you are considering a second cesarean
section, you may want to discuss the following with your doctor:
- Dystocia:
Dystocia refers to a long and difficult labor due to slow opening of the
cervix, pelvis or large baby. Many women who have had this reason for previous cesarean
sections give birth vaginally next time and tend to have a larger baby than the
first time. Difficulties in childbirth with a baby weighing more than 4 kg are
not justified.
There is no evidence that a
large baby requires a cesarean section. The pelvis and head of the baby are not
rigid structures, they form and change shape to enable birth. During
childbirth, there are certain methods a woman can use to help open her pelvis,
allowing for a large baby. For example, squatting increases pelvic output by
10%.
- Genital herpes:
For many years, due to the risk of passing herpes to the baby during
childbirth, women with a history of herpes almost always give birth by cesarean
section. Doctors will examine cultures during the last weeks of pregnancy and,
if they find active virus, will order a cesarean section. Today, if there is no
visible lesion during childbirth, vaginal birth is acceptable.
- Fetal distress: if
the life of the child is threatened by fetal distress or other complication,
there is no doubt that most mothers will consider a cesarean section. Fetal
heart rate monitoring to detect fetal distress may be part of routine vaginal
birth after cesarean section.
What criteria do I need to
meet to be eligible for a vaginal birth after a cesarean section?
- No more than 2 low transverse cesarean deliveries.
- No additional uterine scars, anomalies or previous ruptures.
- Your doctor should be prepared to monitor labor and perform or refer for a cesarean if necessary.
- Your birth location should have personnel available on weekends and evenings in case a cesarean is necessary.
What other criteria would make me a good candidate for a vaginal birth after a cesarean section?
- If the original reason for cesarean delivery is not repeated with this pregnancy
- You have no major medical problems
- The baby is a normal size
- The baby is head-down