If you have had a caesarean delivery also called a C-section before, you may be able to deliver your next baby vaginally. This is called vaginal birth after caesarean, or VBAC. This means that you plan to go into labour with the goal to deliver vaginally. But as in any labour, it is hard to know if a VBAC will work. You still may need a C-section.
Of course, not all women who try to have a VBAC succeed. And, with a vaginal delivery, you can come home sooner and recover quicker. Medical records from the previous delivery should Vaginal after cesarean birth this information. For the aforementioned reasons, conducting VBAC deliveries has a special significance among the rural uneducated population. Four babies had birth asphyxia. Saving Cesarwan Vaginal after cesarean birth moment, please. Int J Aftdr Obstet. Vaginal birth after caesarean delivery: Are there useful and valid predictors of success or failure?
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Labor, delivery and postpartum care FAQ Is that nausea you're feeling actually morning sickness? The choice of VBAC or ERCS depends on many issues: medical and obstetric indications, maternal choice and availability of provider and birth setting hospitalbirthing centeror home. Chestnut DH. Having a cesarean delivery does not mean you will not be able to breastfeed your baby. Your health care provider might use your medical history to calculate the likelihood that you'll have a successful VBAC. A change in your baby's heartbeat is usually the earliest sign that there might be a problem. Is it safe to have sex during my pregnancy? One Vaginal after cesarean birth but serious risk with VBAC is Male nurse caduceus the cesarean Vaginal after cesarean birth on the uterus may rupture break open. Retrieved
The rate of primary cesarean section CS is on the rise.
- Of course, your chances of success are higher if the reason for your previous c-section isn't likely to be an issue this time around.
- In case of a previous caesarean section a subsequent pregnancy can be planned beforehand to be delivered by either of the following two main methods:.
- For years, it was believed that the safest choice after giving birth via cesarean was another cesarean delivery.
If you have had a caesarean delivery also called a C-section before, you may be able to deliver your next baby vaginally. This is called vaginal birth after caesarean, or VBAC. This means that you plan to go into labour with the goal to deliver vaginally.
But as in any labour, it is hard to know if a VBAC will work. You still may need a C-section. About 25 out of women who have a trial of labour need to have a C-section. Whether it is right for you depends on several things, including why you had a C-section before and how many C-sections you've had. You and your doctor or midwife can talk about your risk for having problems during a trial of labour. A woman who chooses VBAC is closely monitored.
As with any labour, if the mother or baby shows signs of distress, an emergency caesarean section is done. This is very rare. But when it does happen, it can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low caesarean scar and your labour is not started with medicine. If you have a trial of labour and need to have a C-section, your risk of infection is slightly higher than if you just had a C-section.
Health Tools help you make wise health decisions or take action to improve your health. But it can have risks for both the mother and the baby. Whether VBAC is right for you depends on what risk factors things that increase your risk you have that could make it unsafe. You and your doctor or midwife can decide whether VBAC is right for you.
As with a first-time childbirth, even if you are a good candidate for a successful VBAC, there is no guarantee that you will give birth vaginally and without complications. Pregnancy, labour, and delivery are different for every woman and difficult to predict.
Even if your first pregnancy required a caesarean, the next one may not. The likelihood of a successful vaginal birth after caesarean VBAC is influenced by many things. Usually a combination of things affects how well or poorly a trial of labour goes. Your chances of a successful VBAC are best when:. Your chances of a successful VBAC are lower when:.
VBAC can be considered for pregnancies with twins. Whether you deliver vaginally or by caesarean section, you are unlikely to have serious complications. Overall, a routine vaginal delivery is less risky than a routine caesarean, which is a major surgery. But a pregnant woman who has a caesarean scar on the uterus has a slight risk of the scar breaking open during labour. This is called uterine rupture. Although rare, uterine rupture can be life-threatening for both mother and baby.
So women with risk factors for uterine rupture should not attempt a vaginal birth after caesarean VBAC. Future risks. If you are planning to get pregnant again, it's important to think about scarring. After you have two C-section scars, each added scar in the uterus raises the risk of placenta problems in a later pregnancy.
These problems include placenta previa and placenta accreta , which raise the risk of problems for the baby and your risk of needing a hysterectomy to stop bleeding. Besides the usual prenatal tests, your doctor will take measures to assess whether vaginal delivery is likely to be a safe birthing option for you. These extra measures can help you and your doctor make a well-informed decision about your delivery. Assessments done sometime during the pregnancy to help find out whether a trial of labour is a safe option may include:.
Information, preparation, and teamwork are needed for a successful vaginal birth after caesarean VBAC. To prepare for labour, consider taking a childbirth education class at your local hospital or clinic. You and your birthing partner can learn:. Other than requiring closer monitoring, trial of labour after caesarean, or TOLAC labour, is the same as normal labour. During early labour, a woman can remain as active and mobile as she wants. During the active period of labour, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture.
If you are attempting a trial of labour and you have not had a previous vaginal birth or your previous caesarean was done early on in labour, your labour will be like a first-time labour. As the end of pregnancy nears, the cervix normally becomes soft and begins to open dilate and thin efface , preparing for labour and delivery.
When labour does not naturally start on its own, labour may be started artificially induced. Some doctors avoid the use of any medicine to start induce a trial of labour , because they are concerned about uterine rupture.
Other doctors are comfortable with the careful use of oxytocin to start labour when the cervix is soft and opening dilating. If your labour slows or stops progressing, your doctor may use oxytocin to strengthen augment contractions. Pain medicine usually is started when the cervix has opened dilated 3 cm 1. Types of pain medicines used include:.
Vaginal birth after caesarean VBAC recovery is similar to recovery after any vaginal birth. After a vaginal delivery, the mother and baby can usually go home within 24 to 48 hours. By comparison, recovery from a caesarean section requires 2 to 4 days in the hospital and a period of limited activity as the incision heals. The overall risk of infection is low for both vaginal and caesarean deliveries.
But it is lower after a vaginal birth. Before you leave the hospital, you will receive a list of signs of infection to watch for in the first few weeks after delivery. Any woman in labour—not just one attempting a vaginal birth after caesarean VBAC —might have complications during childbirth that require a caesarean section delivery. If there is no medical reason for a caesarean, vaginal delivery is generally a safe option for both mother and baby.
It is common, though, to fear going through labour after having had a caesarean delivery. This is especially true for women who have tried a vaginal birth but, after a long and difficult labour, ended up delivering by caesarean. The ultimate decision to try a vaginal birth is made by you and your doctor or midwife. If you want to try a VBAC but your doctor is not in favour of your choice and does not have a clear reason, consider getting a second opinion. If you are considering VBAC, talk with your doctor about:.
Top of the page. Is a trial of labour safe? This is important if you are planning on a future pregnancy. Less pain after delivery. Fewer days in the hospital and a shorter recovery at home. A lower risk of infection. Health Tools Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems. Your chances of a successful VBAC are best when: Your previous caesarean was not done for stalled labour. You do not have the same condition that led to a previous caesarean such as a breech , or feet-down, fetus.
You have had a vaginal delivery or a successful VBAC before. Your labour starts on its own and your cervix dilates well. You are younger than Your chances of a successful VBAC are lower when: Your previous caesarean was because of difficult labour, which is called dystocia.
This is especially true if you were fully dilated when you had a caesarean section for dystocia. You are obese. You are older than Your fetus is estimated to be very large [bigger than g 9 lbs ].
You are beyond 40 weeks of pregnancy. Your last pregnancy was less than 19 months ago. You have pre-eclampsia. Risks of VBAC and Caesarean Deliveries Whether you deliver vaginally or by caesarean section, you are unlikely to have serious complications. This occurs with about 25 out of women who try VBAC.
But it doesn't happen with 75 out of women who try VBAC. Rupture of the scar on the uterus , which is rare but can be deadly to the mother and baby. About 5 out of women have a uterine rupture during a trial of labour.
VBACs can be controversial, and it may be challenging to find a practitioner who's willing to assist at one. Having given birth vaginally boosts your odds dramatically. On the other hand, keloid scars should have their margins left without any incision because of risk of tissue reaction in the subsequent scar. If general anesthesia is used, you will not be awake during the delivery. What are my chances of giving birth vaginally after having a c-section? This increases the risk of uterine rupture. The cut made in the uterine wall for cesarean birth may be transverse left or vertical right.
Vaginal after cesarean birth. What would make me a good candidate a VBAC?
Vaginal Birth after Cesarean Section
The rate of primary cesarean section CS is on the rise. A trial of vaginal delivery can save these women from the risk of repeat CS.
The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. There was no maternal or neonatal mortality.
Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Vaginal birth after cesarean section VBAC is one of the strategies developed to control the rising rate of cesarean sections CSs.
It is a trial of vaginal delivery in selected cases of a previous CS in a well-equipped hospital. In the present era of lower segment caesarean section LSCS , cesarean-related morbidity and mortality are significantly reduced. The reasons which led to the reversal of the old dictum are based upon the newer concepts of the assessment of scar integrity, fetal well-being, and improved facilities of emergency CS. Nevertheless, a previous CS does cast a shadow over the outcome of future pregnancies.
The strength of the uterine scar and its capacity to withstand the stress of subsequent pregnancy and labor cannot be completely assessed or guaranteed in advance. These cases require the assessment and supervision of a senior obstetrician during labor. This prospective observational study was carried out at a tertiary care teaching hospital located in a rural area of central India from January to December This hospital gets referrals of high-risk cases from neighbouring villages and townships.
A total of cases of a previous CS were selected either from the outpatient department booked or in labor unbooked. Booked cases were regularly followed up in the antenatal clinic and the unbooked patients, who reported directly for labor, were then assessed for a trial of vaginal delivery. A study protocol was submitted to the institutional ethical committee of the Pravara Institute of Medical Sciences, and approval was sought before start of the study.
Cases with a single previous transverse lower uterine segment scar with adequate size of pelvis were included in the study after informed consent. A total of cases that fulfilled the selection criteria were enrolled in the study. They were also explained about the risk of scar dehiscence and the need for emergency CS, if trial of vaginal delivery failed. Written informed consent was obtained at the time of enrolment in the study. The patients were asked to come for regular antenatal checkups and were advised to plan their delivery in the hospital where the study was conducted.
Hematological and serological investigations and obstetric sonography were performed during antenatal visits. The women were advised to get admitted in the ward, one week prior to their expected date of delivery. After going through the record related to her previous CS, a decision regarding VBAC was taken by a senior obstetrician in the later weeks of pregnancy or during labor. The cases selected for VBAC were monitored carefully during labor by continuous electronic fetal monitoring.
All the cases were provisionally prepared for emergency CS. Four-hourly internal examinations were performed to assess the progress, and special attention was paid toward the evidence of scar dehiscence or rupture. The trial of vaginal delivery was continued till there was satisfactory progress.
The trial was terminated by emergency repeat CS, when there was evidence of unsatisfactory progress, scar tenderness, or fetal distress. Cases with successful VBAC delivery were kept in the hospital for five days and those who required repeat CS were kept for seven days after the operation.
All cases received broad-spectrum antibiotics injection ampicillin mg intravenously and injection metronidazole mg intravenously six-hourly for either five or seven days. Relevant information on maternal and fetal parameters including outcome of the present pregnancy age, parity, registration status, interval between present pregnancy and previous CS, place, indication, and outcome of previous CS, mode of delivery in the present pregnancy, and maternal and perinatal outcome in individual cases was collected in a structured pro-forma, entered in Microsoft Office Excel format, and statistical analysis was performed using SPSS software version Indication of previous caesarean section and outcome of trial of VBAC in present pregnancy.
In the present study, there were two cases of scar dehiscence, one case of broad ligament hematoma, and one case of cervico-vaginal laceration. Two cases required blood transfusion. Four babies had birth asphyxia. There was no stillbirth or neonatal death. The average duration of hospital stay for women having a successful VBAC was lower 4.
With the significant rise in the incidence of primary CS for various indications, an increasing proportion of the pregnant women coming for antenatal care report with a history of a previous CS. These women belong to a high-risk group due to the risk of a scar rupture. The obstetrician is always in a dilemma regarding the mode of delivery in these cases. Assessment of the individual case with regard to the possibility of a successful VBAC is necessary while taking the decision.
The unending dilemma of an obstetrician is about the management of subsequent labor, once the patient has a scar on the uterus. Some suggest an elective CS for such cases, whereas others choose a trial of labor. Many take a middle route, that is, individualization of case. By far, the greatest problem for the attendant in subsequent labor is the integrity of the uterine scar. Shipp et al. He reported that the rate of scar rupture was 2. In the present study, the commonest indication for a previous CS was fetal distress.
Studies by Jansen et al. Phelan et al. Flamm et al. Lao et al. They concluded that higher rates of infusion of oxytocin increase the rate of scar rupture, and that the use of a standard rate of infusion is useful in increasing the success rate of VBAC.
In the present study, there were two cases of scar rupture. Both cases had a spontaneous onset of labor and oxytocin was not used in them. Landon et al. There were two cases of scar dehiscence and one case each of cervicovaginal laceration and broad ligament hematoma. Cases with scar dehiscence were managed by CSs. Obara et al. Dayal V[ 14 ] reported a higher rate 4. The American college of Obstetricians and Gynecologists ACOG [ 27 ] estimated the risk of uterine rupture in women with a previous CS and concluded that the lower segment caesarean scar has a minimum risk 0.
There was no maternal mortality in the present study. The remaining three babies were born by emergency CS, following failed trial of vaginal delivery. One CS was performed for scar dehiscence and the other two were performed for fetal distress.
Two babies had a tight loop of cord around the neck. All three caesarean babies had developed meconium aspiration, which resulted in birth asphyxia. There was no associated co-morbidity in these babies. All the four babies born with low Apgar score were kept in the neonatal intensive care unit. They received prophylactic antibiotics and breast feeding and were discharged from hospital with their mothers. Similar observations were reported in other studies. It was observed that the success rate of VBAC depends on the birth weight of the baby.
The success rate of VBAC decreased Similar observations were made by other workers. Benson et al. Many women do not accept sterilization even during the second CS. This decision exposes them to the development of complications related to scar rupture in subsequent pregnancy and labor. They ignore the possible increase in the risk of scar rupture with two previous CSs, the incidence of which has risen over the last few decades.
For the aforementioned reasons, conducting VBAC deliveries has a special significance among the rural uneducated population. The limitation of the study lies in the fact that the study was carried out in a tertiary care centre, where there is adequate manpower to supervise each delivery, reducing complication rates of VBAC. Majority of the cases of previous CS done for nonrecurrent indication can be delivered safely by the vaginal route, without any major complication to the mother and the newborn, in an institution having facilities for emergency CSs.
It has been proved to be a safe alternative to repeat an elective CS. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. N Am J Med Sci. Author information Copyright and License information Disclaimer.
Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Abstract Background: The rate of primary cesarean section CS is on the rise. Materials and Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. Conclusion: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.
Keywords: Lower segment cesarean section, Rural India, Scar dehiscence, Trial of labor, Vaginal birth after cesarean section. Introduction Vaginal birth after cesarean section VBAC is one of the strategies developed to control the rising rate of cesarean sections CSs. Materials and Methods This prospective observational study was carried out at a tertiary care teaching hospital located in a rural area of central India from January to December