Pregnancy is a confusing period. Not only do you have to make several dietary and lifestyle changes to prepare yourself for the baby’s arrival, there are also important decisions you need to make about the delivery itself. And one such decision is to choose between a vaginal birth or a C-section. Of course, the choice isn’t always in your hands, but if it is, then it’s necessary that you make an informed choice. One of the most common questions asked by mothers-to-be is about their options of delivery, especially if they have previously undergone a C-section.
So, you have undergone a C-section before and are carrying again, there are two ways you could go about it:
- A scheduled cesarean delivery (or a C-section)
- A natural vaginal birth
Yes, it is possible to give birth naturally after you’ve had a C-section. But only if you meet the criteria for a vaginal birth.
Guidelines For Vaginal Birth After C-Section
To be considered an appropriate candidate for a vaginal birth, there are some factors that need to be considered. To understand them better, here are the guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) for vaginal birth after a C-section delivery.1 A vaginal birth is considered safe for you if you meet these guidelines.
Previous Cesarean Incision Type
If your previous cesarean incision was a low-transverse uterine incision, – a vertical incision rather than a horizontal or a T-shaped one – you can consider vaginal birth. If your incision was vertical, it increases your risk of uterus rupture and hence, the risk of labor failure.
Your pelvis needs to be big enough to accommodate and allow the baby to pass through it. A round and large pelvic opening is ideal for a vaginal birth.
Uterine Scars Or Rupture
To be able to have a safe natural birth, it is important that you have not had any uterine scars or previous ruptures on your uterus. It also essential that you have not had any serious uterine surgery, such as a myomectomy.
Availability Of A Capable Physician
To promote a smooth delivery, it is mandatory that a physician is available throughout the process of labor. It is also critical that your physician is capable of performing an emergency cesarean delivery, in case the vaginal birth fails. Additionally, instruments needed for a cesarean birth must be available in the hospital.
Vaginal Birth: Chances Of Success
If you opt to have a vaginal birth, it is referred to as trial of labor after cesarean delivery or TOLAC. The success of TOLAC is higher, if the mother-to-be, apart from the previous C-section, has also had a natural delivery in the past. In fact, the chance of failure is reduced by up to 30% if the most recent delivery was a vaginal birth. A vaginal birth is also most likely to be successful if the reason for the previous C-section does not exist this time around.
Although there is no sure-shot way to determine if a trial of labor after cesarean delivery is going to be successful, statistics say that the success rate is about 60–80%.2
Factors That Decrease Chances Of Success
Although the success rate is fairly high, your chances might be affected by these factors:
- If you are an older mother
- If you are overweight
- If the fetus weighs higher than over 8.8 pounds
- If you have carried the baby for over 40 weeks
- If the time-gap between your current and last pregnancy is less than 18 months.
Risks Of TOLAC
- Rupture of the cesarean scar on the uterus
- Rupture of the uterus
- Risk of failed labor
- Risk of fetal death
Advantages Of TOLAC
- Shorter hospital stay
- Fewer infections
- Less blood loss and fewer transfusions
- Fewer thromboembolic (broken blood clot) events
- Fewer neonatal breathing problems
- Fewer instances of postpartum fever, wound, or uterine infection
Before making any decision, carefully weigh the pros and cons of TOLAC. Also, consult with your gynecologist and determine the method that is the safest for you and the baby. Even if you choose to proceed with vaginal birth, always be prepared for a sudden change in delivery plan, as your doctor might call for a C-section, if complications arise during labor.
|↑1, ↑2, ↑6||Neff, Matthew J. “ACOG Releases guidelines for vaginal birth after cesarean delivery.” American family physician 70, no. 7 (2004): 1397-1398.|
|↑3||Vaginal Birth After Cesarean Delivery – Deciding on a Trial of Labor After Cesarean Delivery. The American Congress of Obstetrician and Gynecologists|
|↑4||Vaginal birth after caesarean section (VBAC). East Melbourne Obstetrics and Gynaecology.|
|↑5||Vaginal birth after caesarean section (VBAC). East Melbourne Obstetrics and Gynaecology.|