Vaginal birth after a C-Section.

>> Thursday, June 16, 2011

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“Dr. KnowYourV, I am having a lot of confusion and maybe you can help me. I am pregnant with my 2nd baby and I would like to have a vaginal birth this time. My first was delivered via c-section. The reason I had my first one c-section was because the baby was in a breech position and wouldn’t turn. I have seen two different Ob doctors and both of them have told me that it is safer for me to just have another c-section. I have been told my uterus could ‘pop’ open and rip during labor and this would result in an emergency c-section or the baby could die. I have friends and know other women who have had natural birth after they had c-sections, so I don’t know what to do. I also heard some hospitals are against it too. What is the best for a woman like me to do? Is it ok to try natural child birth?”

First, Maria, let me thank you for writing in because this has become very confusing and most pregnant couples wonder and worry about what is right for them. There was a time when any woman who previously had a c-section would continue to have them, no questions asked. Then, in late 80’s and early 90’s, it was decided that certain women were low risk for VBAC (vaginal birth after c-section) so it would be safe for them to have a trial of labor (TOLAC ). But by the early 2000's many hospitals and doctors had experienced at least one bad outcome during a VBAC so, again, VBAC's went out of favor. That is until about a year ago, when ACOG (The American College of Obstetricians & Gynecologists) decided that women with one prior c-section and no other health complications were safe candidates for TOLAC. So, you can see why you are confused - because even the top decision makers have trouble deciding.

So let’s look at what is important for you to consider in making a safe decision for you and your baby. TOLAC and VBAC lower your risk of hemorrhage and infection, and will shorten your post-partum hospital stay. The overall risks of repeat c-section include an increase in maternal hemorrhage, infection, and operative injury. Uterine rupture is what worries most women the most, and can be the reason for the hemorrhage and infection when it happens. Fortunately it is rare and happens only 0.7- 0.9% of the time, but when it happens it becomes an immediate emergency. If staff, nursing and physician care is not readily available, there can be serious consequences, including death to mother or baby.

The reason for your past c-section was the baby’s position being breech. If this baby is in the correct position then you will need to find a good Ob/Gyn who is willing to work with you if you want to attempt a vaginal delivery. There are many good OB/GYNs who will be willing to help you. I hope all continues to go well for you during your pregnancy.

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