Vaginal Birth After Cesarean Delivery - Safe or Not Safe

Introduction

A vaginal birth after a cesarean section (VBAC) is a person who has had a previous cesarean section done and is now attempting to give birth through the vagina. A cesarean section involves an incision through the stomach area and then to the uterus. The baby is then delivered through the incision.

Can a Person Have a Vaginal Birth After a Cesarean Section?

Before attempting a vaginal birth after a cesarean section, it is essential to consult a healthcare provider to understand the person’s health history, pregnancy circumstances, and why a cesarean section was done previously. The chances of VBAC can be increased if a person has had not more than two cesarean section deliveries with low transverse incisions, had no other abnormalities or uterine scars, and had no previous uterine ruptures. If a person has had a successful VBAC without complications like a ruptured uterus, they are more likely to have a successful future vaginal delivery.

Is Vaginal Birth Safe After a Cesarean Section?

According to the American Pregnancy Association, studies have shown that around 60 to 80 % of women who underwent cesarean section have had a successful vaginal birth during their next pregnancy. Since a surgical cut causes a scar on the uterus, the concern is whether the labor pressure could cause the uterus to rupture along with the scar. Another statistic supported by the National Institute of Child Health and Human Development showed that around 75 % of VBAC has been successful.

Will Uterine Rupture Occur if a Previous Cesarean Section Was Done?

According to the American College of Obstetricians and Gynecologists, if a person has had a previous C-section with a horizontal cut, then the risk of a ruptured uterus is less than 1 in 100 or 0.9%. If a uterus ruptures, the risks include hysterectomy, blood loss, blood clots, infections, and damage to the bladder.

Is the Incision Type Made During Cesarean Section Related to a Future Uterine Rupture?

Even though it is not scientifically confirmed, it is thought that,

• A low transverse incision is connected with a low risk of uterine rupture. Across the low thin part of the uterus, a horizontal cut is made.

• A low vertical infection is connected with a higher risk of uterine rupture than a low transverse incision. This vertical cut is made in the low, thin portion of the uterus.

• A high vertical incision is associated with the highest risk in the upper portion of the uterus. To deliver preterm babies, sometimes this type of incision is made.

It is essential to understand that the direction and location of the outer incision made in the abdomen does not necessarily mean that the incision in the uterus was made in the same direction or location. Information about the direction and location of the incision on the uterus will be present in the medical record of the cesarean section. When the safety and appropriateness of VBAC are discussed with the doctor, the doctor reviews the medical record and the previous reasons why a person has had a cesarean section.

Are There Any Benefits of Vaginal Birth After a Cesarean Section?

There are certain benefits of VBAC compared to a C-section. They include:

• A faster recovery period.

• No abdominal surgery.

• Very less blood loss.

• Vaginal birth will help clear the baby’s lungs as the baby passes through the birth canal. This will prepare the baby for a better way to breathe oxygen even after birth.

• When the baby travels through the birth canal, it will pick up good bacteria, which will help boost its immune system.

• Vaginal birth avoids or lowers the complications associated with a cesarean section.

What Are the Risks Associated With a Vaginal Birth?

The complications associated with a vaginal delivery include:

• Labor that does not progress even after the beginning of contractions.

• Perineal tears in the vagina and nearby tissues happen during the delivery.

• Perinatal asphyxia or a condition when the baby does not get enough oxygen.

• Shoulder dystocia or when the shoulder of the baby gets stuck in the vagina.

• Problems associated with the umbilical cord include getting compressed, wrapped around the neck or limbs, or coming out before the baby.

• Increased placental bleeding that remains behind in the uterus.

What Are the Risks Associated With a Cesarean Section?

Some of the general risks associated with a cesarean section include:

• Anesthesia risks.

• Excessive blood loss from surgery.

• Infections from the bladder, uterus, or incision.

• Injury to the bowel, bladder, and other organs.

• A longer recovery period.

• Discomfort and pain around the incision site.

• Blood clot in the legs or pelvic area.

• An increased risk of hysterectomy, uterine rupture, and surgical complications associated with cesarean section.

• An increased risk of abnormal placental attachment due to scar tissues in future pregnancies. The placenta provides enough nutrients and oxygen to the baby and removes waste products and carbon dioxide.

What Should Be Kept in Mind Before Attempting Vaginal Birth After a Cesarean Section?

Both vaginal birth and cesarean sections have their risks and benefits. However, discussing with the respective healthcare providers the risks and benefits of them affecting the pregnancy is essential. Certain topics that have to be discussed include:

1. Previous deliveries and pregnancies.

2. Reasons why a C-section was done previously.

3. The safety factor of a VBAC and a repeat cesarean section for the woman and her baby.

4. Reasons why a person should or should not consider VBAC.

5. Reasons why a person should or should not consider a repeat cesarean section.

6. The ability of the delivery facility to manage an emergency delivery complication.

7. A person's plan to induce labor and plan to have children.

Conclusion

A person should not assume that because their previous child was born through a cesarean section, all their future children must be delivered the same way. Even though there are chances for a scar from a cesarean section to rupture in a future pregnancy, the likelihood of splitting open is very low. Discussing a vaginal birth after a cesarean section and a cesarean section option with their respective doctor early during the pregnancy is important. Always understand the risks and that the provider understands the person's preference as the pregnancy progresses. Discuss with the provider and evaluate the delivery plan in each late-term visit.