VAGINAL BIRTH AFTER C SECTION

 Here we will talk about vaginal birth after cesarean section, many women around 20 to 30 percent will have a cesarean section for their first delivery sometimes the c-section was planned for presentation meaning that the baby was breached or not head down or because of another complication from the pregnancy such as placenta previa where the placenta is covering the cervix sometimes the c-section is unplanned and occurs during the labor process as a result of fetal distress meaning that the baby was not tolerating labor or for failure to progress meaning that the mother stopped dilating in the labor process women who have had a prior cesarean delivery have the option of having a repeat c-section or attempting a vaginal delivery some women desire to attempt a vaginal birth after a caesarean delivery this is called vaginal birth after caesarean or trial of labor after caesarean.

Here are some things to consider number one does your provider support the attempt this is something that you will have to discuss with your gynecologist, it depends on the physician and the support of the hospital and the resources available, number two why did you have the first c-section was it because you pushed for three hours or was it because of distress or was it scheduled because of other complications all of these factors can affect your success of a vaginal birth, number three how is the first cesarean section completed there are different types of incisions we make on the uterus generally we make a low transverse incision this means that we make an incision on the lower part of the uterus there are some reasons why your gynecologist may need to make a vertical or called a classical incision on the uterus this is an incision that goes up and down on the uterus sometimes there are other complications that happen during the delivery this can impact your risk of complications with labor, number four what resources does your hospital have as an gynecologist i believe the safest place to attempt to be back is in a hospital setting or their in-house anesthesia is there a hospitalist know that while you are in labor with a vbac you will have to be monitored continuously you can still move around but we need to monitor the baby's heart rate most hospitals require that a surgeon such as an gynecologist be in the hospital at all times while a patient is in labor with a history of cesarean delivery this is for the safety of the mother for if she would require an emergent delivery, number five timing of delivery many providers will not induce someone with a prior cesarean section this is because many of the medications we do for induction are to start labor when it is not spontaneous can cause extra stress to the scar on the uterus and increase the risk of severe complications it is preferred that women start labor on their own we can augment labor by breaking the water or using different medications to modify labor many providers will set an end point where if you have not gone into labor by a certain time a repeat cesarean section may be recommended, number six know your risk the main concern related to vaginal birth after caesarean is something called uterine rupture this is an uncommon complication but can have devastating results this is where the scar of the uterus opens during labor the risk of uterine rupture after one prior cesarean delivery is still less than one percent there are risk to consider with repeat c-sections too especially if you are planning to have a larger family there are often many questions and these things are discussed over the course of the pregnancy.