Vaginal Birth After Cesarean?
By Maureen Connolly
Your first child wound up being delivered via cesarean section. Now
you're pregnant again and trying to decide whether to attempt a vaginal
birth. Why consider a vaginal birth after cesarean (VBAC)? If you're
successful -- 60 to 80 percent of women who attempt VBAC are -- you'll
have a shorter hospital stay and recovery period, lower risk of
dangerous blood clots and postpartum infection, and less risk of
serious complications in future pregnancies (c-sections create uterine
scar tissues that can create problems with the placenta).
guiding you in your decision, your caregiver doctor will want to take
into account your past medical history, as well as the current health
status of you and your baby-to-be. In addition, Dr. Bruce Flamm, a
professor of obstetrics and gynecology at the University of California,
Irvine, and author of Birth After Cesarean: The Medical Facts (Simon and Schuster), says if you can say "yes" to the following four statements, you're a good candidate for a VBAC:
- You're committed to having a VBAC Some experts believe that
feeling confident about your decision can positively impact the
outcome. "It seems that women who really desire a VBAC have a lower
cesarean rate," says Dr. Flamm. The opposite can also be true. "Some
midwives believe that fear of labor can actually stop progress," says
Dr. Flamm. One of the best ways to become comfortable and confident
about your decision is to read up on the subject and consult reputable
Websites and groups that offer support. In addition to Dr. Flamm's
book, two helpful guides include Vaginal Birth After Cesarean by Elizabeth Kaufman (Hunter House Publishers) and The VBAC Companion by Diana Korte (Harvard Common Press).
Two Websites to consult are the VBAC and ACOG Websites. You should also
find out if your local hospital offers a VBAC class or support group
for you and your partner. Having a partner who is behind your decision
to try VBAC is a major plus in the labor and delivery room.
- You have the support of your physician One of the most
common reasons physicians are hesitant to recommend a VBAC is the fear
of malpractice suits, which is a real risk for doctors. However, Dr.
Flamm says if your doctor isn't supportive of a VBAC, and there's no
medical reason to warrant a repeat c-section, find another doctor who
will see you through the labor.
- You had a low transverse uterine incision with your last c-section(s)
This isn't the scar you see just above your pubic bone, but the one
that's on your uterus. Your doctor can tell you which type of incision
you had. Unlike a vertical incision, a transverse incision is less
likely to rupture during childbirth, which makes a VBAC less risky.
- The hospital you plan to deliver at is equipped for an emergency c-section
If the hospital isn't able to perform an emergency c-section safely,
attempts at a VBAC should be discouraged, says Dr. Flamm. Uterine
rupture, a potentially life-threatening condition for mother and baby
can occur. While it's uncommon, occurring in about one percent of
patients, should it develop a quick cesarean section is needed to
protect the mother and child.