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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).

In 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.

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