Vaginal Birth After C Section

If you’ve already had a cesarean birth (also known as a C-section), you may be able to deliver your next baby vaginally. This is called vaginal birth after a cesarean (also called a VBAC). Cesarean birth is surgery in which your baby is born through a cut that your healthcare provider makes in your abdomen and uterus. If you’re pregnant again and your last baby was delivered by cesarean section, you may wonder if a vaginal birth might be an option for you this time around. Vaginal birth after a C-section (VBAC) is possible for many women, but there are factors to help you and your doctor decide if it’s right for you.

The most important thing to think about is the safety of you and your baby. Vagianl birth after a cesarean is not always safe for every woman. If you attempt a vaginal birth and are at high risk for complications, it can cause serious problems for you and your baby some even fatal. That’s why it’s necessary to talk to your doctor about the risks. But now, vaginal birth after cesarean (or VBAC) is considered a safer option for many women and their babies. And, with vaginal delivery, you can come home sooner and recover faster.

Know if having a vaginal birth after a cesarean is right for you?

• If you are thinking about having a VBAC, talk to your provider. Your provider can help you know the risks and benefits. If your risks are low and your chances of having a successful VBAC are high, you may decide that a VBAC is right for you.
• Your chances of having a successful vaginal birth after cesarean are better if:
• You have had a vaginal birth before.
• You’ve only had a C-section in the past with a low transverse incision (also known as a bikini cut).
• This means the cut was horizontal (on one side) and low on the uterus.
• It also creates a stronger scar on the uterus, making it less likely to rupture.
• You and your baby are in good health during the duration of pregnancy.
• Your labor starts on its own just before or before your due date.
• Your chances of having a successful vaginal birth after cesarean are worse if:
• This pregnancy you have the same condition that necessitated your C-section last pregnancy. For example, your baby has a problem with his heartbeat or is lying on his side in the womb.
• You’re past your due date or your labor is motivated.
• You are obese or have gained weight during pregnancy. If you are obese, you have a high amount of body fat and a body mass index (also known as BMI) of 30 or higher. You have preeclampsia. This is a condition that can occur after the 20th week of pregnancy or soon after pregnancy. It occurs when a pregnant woman has high blood pressure and some of her organs, such as her kidneys and liver, are not working properly.

Symptoms of Preeclampsia

• Symptoms of preeclampsia include protein in the urine, changes in vision, and severe headaches.
• There is an interval of less than 18 months between your previous pregnancy and your current pregnancy (called a short gestational interval).
• Your baby is too big.
• Your provider, hospital, or birth center is not prepare to handle an emergency C-section if you need one.
• Talk to your provider about the level of medical care available at the hospital or birth center where you plan to have your baby.
• You are over 35 or are of a race other than white.
• Some providers may not offer a VBAC if you’ve had more than two C-sections in the past or if you’re pregnant with triplets or more.

It is not safe to have Vaginal Birth After C Section if:

• In the past, you had a C-section and your incision was not low transverse but rather high vertical. A high vertical incision cuts up and down through the muscles at the top of the uterus that contract strongly during labor. This can lead to uterine rupture (tear in the muscles of the uterus).
• You had a uterine rupture in your previous pregnancy. This happens when the uterus (womb) dilates during labor. This happens very rarely.
  You have certain health conditions or complications during pregnancy, such as diabetes, heart disease, genital herpes, or placenta previa, that make a C-section necessary.

Treatment/Management of Vaginal Birth After C Section

Patients planning a trial of labor after cesarean section require general prenatal care with additional counseling about the option of TOLAC versus PRCD. Additionally, an early ultrasound to confirm gestational age may be helpful if a cesarean section is schedule. In terms of labor management, spontaneous induction of labor is preferres because spontaneous labor carries a higher risk of successful vaginal delivery and a lower risk of uterine rupture. Induction of labor remains an option. Although prostaglandins are used for cervical ripening when indicates, several studies have shown an increased risk of uterine rupture when prostaglandins (such as misoprostol or dinoprostone) are used for cervical ripening.

Some centers use low-dose oxytocin and/or mechanical dilation with intracervical balloons to facilitate induction in patients undergoing TOLAC with an immature cervix. Studies of the use of mechanical dilators when used in the setting of VBAC are limit and show mixed results. Although not requires, epidural analgesia may be useful to improve patient comfort with the advantage of providing a faster option for anesthesia if cesarean delivery is requires. Continuous monitoring of fetal heart rate is strongly recommendes. If there are concerns about possible uterine prolapse or rupture, an immediate cesarean delivery should be perform.

Symptoms of Uterine Rupture

The most common symptom of uterine rupture is abnormal fetal heart rate detection, which is seen in about 70% of cases of uterine rupture. Other findings that may be see in the case of uterine rupture include increases or decreased uterine contractions, severe abdominal pain/labor pain, sudden loss of fetal station, or urine or urine in the collection bag. Blood transfusions are include. Even with close and meticulous monitoring, uterine rupture can occur suddenly and without warning, resulting in fetal compromise, fetal loss, or death.

Vaginal delivery, placental delivery, and postpartum support are common for patients undergoing VBAC delivery. Rarely, manual palpation of the uterus after delivery of the placenta may suspect or discover a previously undetected uterine scar dehiscence. Such a defect does not require repair unless bleeding continues. Similarly, patients may experience occult uterine rupture that may lead to post-delivery bleeding. VBAC patients who experience hypotension or other signs of hypovolemia after delivery should be evaluate promptly, considering the possible diagnosis of uterine rupture.