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Vaginal birth after a C-Section
Written by Webmaster
Thoughts about if I will be able to deliver normally for my next child...
For many years both obstetricians and expectant mothers believed that once a mother had given birth via a cesarean section that any additional babies would be born via cesarean section. This is not the case. More and more expectant mothers are having great births and quicker, easier recoveries when they choose a VBAC, Vaginal Birth After Cesarean delivery. It is estimated that 60-85% of mothers who have had cesareans the first time around are able to have a normal labor and deliver vaginally the second, third and subsequent babies without incidence. VBAC rates are higher for those women with non-recurring causes (e.g. a woman who had a cesarean for a breech, but has baby in the favorable head-down position the second time). In many instances, a mother who had a previous cesarean with the diagnosis of cephalopelvic disproportion (the baby's head was too large for her pelvis) and failure to progress in labor often is successful in her attempt at VBAC.
There are many reasons that you may want a vaginal birth after a cesarean. Some may be medical and some may be emotional. Others may be financial or in terms of recovery. For the mother, recovery is quicker, there's less risk of infection, less blood loss, and for many breastfeeding will come easier, after a vaginal birth. Just as there are many advantages for you, the same goes for your baby. The actual process of labor and delivery helps prepare your baby for life outside of the womb by helping your baby to expel much of the mucus and fluid they have lived in and breathed in for nine months. There is also a decreased incidence of surgery related fetal injuries (lacerations, broken bones) with a VBAC.
The deciding factor of whether you will be able to attempt a VBAC will depend on the type of uterine incision (which may be different from your abdominal incision) made in your previous cesarean section. If you had a low transverse (across the lower part of the uterus) there is an excellent chance you can deliver vaginally without incidence. If you have a classic vertical incision (down the middle of your uterus) most likely your obstetrician will not allow you to attempt a VBAC since the chance of a rupture increases dramatically with this type of uterine incision. Fear of uterine rupture is the most common fear associated with mothers considering a VBAC. The chance of uterine rupture is very small only 1-2%. Your doctor will be able to assess your risk and advise whether this is an option for you.
If you feel strongly about wanting a vaginal delivery this time, start talking with your obstetrician early in your pregnancy. Some doctors have strong feelings about this subject and cling to the "old school" thought that a woman with a cesarean-scarred uterus cannot successfully go through labor and delivery vaginally. On the other hand, there are those obstetricians out there who believe that the VBAC is perfectly safe for any healthy woman who desires a vaginal delivery. If your doctor isn't behind you in your desire for a VBAC, and it is really what you want, then find an obstetrician who will support you and be with you from the beginning of labor through delivery.
Once you have decided that you want a VBAC this time, you will want to discuss pain management with your obstetrician. Medication during labor and delivery is fairly controversial, even without a VBAC. Unless you do not want them or have a medical reason for not having them, pain relief medications can be used with a VBAC. It's important to use them wisely, however. It is well established that epidurals can slow labor and increase your chance of having a cesarean birth. You may want to consider delaying medications and using alternative methods of pain relief such as Lamaze breathing and other relaxation techniques as long as you possibly can. Some studies indicate that if you delay an epidural past 5 cms then your chances of having a cesarean delivery drop dramatically. Narcotics are also sometimes used in labor. While these do not have a direct effect on your chances of cesarean, they do have an effect on your physical mobility and your mind. Some women feel that their minds are clouded when they're given narcotics. Pitocin, used to induce or speed labor, was once controversial in VBAC births, however, the VBAC guidelines for the American College of Obstetricians and Gynecologist states that Pitocin is safe for use with VBAC births because the risk of uterine rupture is so small.
There is plenty you can do to help ensure your and your baby's safety during a VBAC delivery. You will definitely want to consider taking a childbirth refresher course and take it seriously. These classes will teach you techniques that will help you learn to labor efficiently to reduce stress on your body. You may even want to hire a doula to help coach you through effective labor. Get plenty of rest and good exercise throughout your pregnancy. As your due date approaches, make sure to let your doctor know about any and all first signs of labor pains (true or false). During labor, let your doctor know immediately if you feel any unusual abdominal pains or tenderness.
Emotions run high during pregnancy in general. Preparing for a VBAC can bring up plenty of extra emotions. Almost anything you feel is within the realm of normal. Some mothers are very excited about the thought of a VBAC, while others who may be forced into having a VBAC by their insurance or their obstetrician may feel apprehensive. You may be afraid of labor (especially if you had a long or frightening experience the first time). You may fear that history will repeat itself. For some expectant mothers, it is fear of the unknown. If a cesarean is the only way you have delivered one or more babies then you don't really know a lot about birth or labor.
The best way to prepare for your VBAC is to educate yourself and your partner about what to expect with a VBAC birth. Read everything you can about the subject and ask plenty of questions. Talk to other mothers who have experienced a VBAC, talk to those who have never had a cesarean, and talk to the nurses and nurse-midwives in your obstetrician's office.
Finally, deal with your emotions, don't try to ignore them and most of all don't feel guilty for them. Some mothers feel very upset about their previous cesarean(s), although this is not the case in all situations. They feel cheated, robbed, less-of-a-mother, and many other emotions. These emotions are real and expected to some degree when a mother has believed for nine months that she will have one of those storybook deliveries that everyone hears about, but no one knows anyone who has really had one. Give yourself a break and approach this labor and delivery with realistic expectations knowing that most VBACs are successful with planning and a concerted effort on behalf of the mother, her obstetrician, and the labor and delivery staff.
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