If you have undergone a cesarean delivery, you are not alone. In November 2005, the Centers for Disease Control and Prevention reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries.
If you desire to try a vaginal delivery this time around, you’ll be happy to know that 90% of women who have undergone cesarean deliveries are candidates for VBAC. Quite interestingly, the highest rate of VBAC is in women who have experienced both vaginal and cesarean births and given the choice, decide to deliver vaginally.
In most published studies, 60-80% or 3 to 4 out of 5 women who have previously undergone cesarean birth can successfully give birth vaginally. After reading the information below and discussing it with your health care provider, you will be able to make an informed decision on whether VBAC may be an option for you this time around.
VBAC and the Risk of Uterine Rupture:
The greatest concern for women who have had a previous cesarean is the risk of a uterine rupture during a vaginal birth. According to the American College of Obstetricians and Gynecologists (ACOG), if you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5%, which is approximately 1 in 5001.
Some studies have documented increased rates of uterine rupture in women who undergo labor induction or augmentation. You will want to discuss the possible complications of induction with your health care provider. Recently, ACOG stated that VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk.2
If you were given the following reasons for a previous cesarean and are considering a repeat cesarean, you may wish to discuss the following with your health care provider:
Dystocia: Dystocia refers to a long and difficult labor due to slow cervical dilation, a small pelvis, or a big baby. Many women who are given this reason for previous cesareans, deliver vaginally the next time, and give birth to a bigger baby than the first! ACOG states that the effects [or difficulties] of labor with a baby more than 8 ¾ lbs have not been substantiated.
There is not evidence that a big baby necessitates a cesarean. The pelvis and the baby’s head are not rigid structures and both mold and change shape to allow for birth. During labor there are certain positions that a woman can use to help open up the pelvis, allowing a larger baby to move through. For example, squatting opens the outlet of the pelvis by 10%.
Genital Herpes: For many years, women with a history of herpes almost always delivered by cesarean, due to the risk of passing herpes to the baby during delivery. Physicians would do cultures in the last weeks of pregnancy and if the virus were active, a cesarean would be scheduled. Now ACOG has determined and recommended that unless there is a visible lesion at the time of birth, a vaginal birth is acceptable.
Fetal Distress: When it comes to the life of the baby, there is no question in a mother’s mind of what to do. If the baby is in distress, cesarean deliveries can be life saving. According to the Centers for Disease Control and Prevention, 9% of cesarean deliveries in 1991 were due to fetal distress. Fetal heart rate monitoring can be a routine part of the VBAC procedure, which helps detect fetal distress.
What is the criterion I must meet to be considered for VBAC?
- No more than 2 low transverse cesarean deliveries.
- No additional uterine scars, anomalies or previous ruptures.
- Your health care provider 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 VBAC?
- If the original reason for a 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
In what situations would VBAC not be recommended?
- If you are pregnant with twins
- If you have diabetes
- If you have high-blood pressure
Comparing a Repeat Cesarean to a VBAC:
|Usual risks of a surgical procedure||Less than 1% chance of uterine rupture. If uterine rupture occurs you have risks of blood loss, hysterectomy, damage to bladder, infection, & blood clots|
|Hospital stay of approximately 4 days||Hospital stay of approximately 2 days|
|Development of an infection in the uterus, bladder, or skin incision||Risk of infection doubles if vaginal delivery is attempted but results in cesarean|
|Injury to the bladder, bowel, or adjacent organs||Possibility of tearing or episiotomy|
|Development of blood clots in the legs or pelvis after the operation|
|On-going pain & discomfort around incision||Temporary pain and discomfort around vagina|
|Small chance that the baby will have respiratory problems3||The baby’s lungs will clear as baby passes through birth canal|
|If you plan for many more children, take into account that the more surgeries a woman has had the greater the risk of surgical complications. A fourth or fifth cesarean has more risk than the first or second.|
1. ACOG Practice Bulletin, No. 5, July 1999
2. ACOG, Midwifery Today, Winter No 36, page 47.
3. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.
International Cesarean Awareness Network, http://www.ican-online.org/
American Pregnancy Association, http://www.americanpregnancy.org