Is VBAC safe after a C-section?

Question

Hello doctor,

I had a category two cesarean two years ago due to fetal distress, and heart declarations, and the fetal heart rate remained high (180 bpm) during the latent labor phase. An abnormal tachycardia and chemoreceptor decelerations were detected. My baby was born in poor condition and was sent straight to resuscitative (by O2). I had high BP readings during the latent labor phase but only experienced mild contractions. I dilated to 3 cm. The baby was cephalic, the head of the baby deep in the pelvis, thick meconium. It was said I have a narrow pelvis and was predicted difficult future deliveries, hence, they recommended giving birth by elective C-sections in the future. A transverse or lower segment uterine incision was made. A small opening in the peritoneum was made, and my bladder was high, reaching up to the umbilicus, there was no space for opening my peritoneum, the rectus separated from my muscle on the upper edge, the peritoneum opened with a sharp dissection, the rectus muscle on right side cut, bladder pushed down. My uterus was closed in two layers, and my rectus sheath was repaired. I am due with my second child very soon and I am currently trying to outweigh the risks of a VBAC trial versus an elective C-section in my case. I would like to know if I am a good candidate for a VBAC given my background for the caesarean I had two years ago. Also,

1. Why was my son in fetal distress? Why did he have heart declarations and arrive in poor condition and need resuscitation by oxygen? I only dilated to 3 cm and the contractions were mild.

2. Why did my bladder move up?

3. Why did the surgeon mention a small pelvis? I thought women are made to birth and the pelvis opens during labor, so is the baby's head moldable.

4. If my pelvis is small, and the baby would get stuck this time as the contractions become stronger, will this raise the likelihood of a uterus rupture? Would not the risks of a C-section be higher (e.g., hemorrhage, infection, damage to other organs) than a uterus rupture?

5. Is a VBAC safe in my case?

Kindly give your suggestions.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

There are criteria for the trial of VBAC (vaginal birth after cesarean) and one of these criteria has to do with the mother's pelvis. The pelvis does not grow in adulthood, so if your pelvis was narrow then, it is still now and any delivery through it would not only jeopardize the baby's quality of life but also raise the risk of uterine rupture for you. Therefore, that history of a narrow pelvis disqualifies you from a trial for VBAC. Meconium-stained liquor is an indication that you had developed some uteroplacental insufficiency during pregnancy (some form of oxygen deprivation to the child).

Having hypertension in pregnancy is a risk factor for this to develop. This is most likely the reason why your baby was in distress from the early stage of labor. Your bladder was pulled up because as the head of the baby descends your pelvis, the bladder is displaced upwards. This displacement is more pronounced in women with the narrow mid cavity of the pelvis. This is one of the reasons that supports the diagnosis of a narrow pelvis. There are different types of pelvis and a woman can only have a type. It is not all these types of pelvis that favor vaginal delivery. So, yours might be in the types that do not favor vaginal delivery.

I hope you find this helpful.

Thank you.

Is VBAC safe after a C-section?

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