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Vaginal birth after cesarean: A complicated conundrum

Riddle Hospital September 15, 2014 General Wellness

Many people previously believed that once a woman has had a cesarean delivery, she can only have more cesareans. Today, many women who have had a cesarean section can safely give birth through the vagina. This decision to give birth vaginally is called a vaginal birth after cesarean (VBAC) delivery.  For women who are considering this option, however, several risks and benefits must be carefully weighed.

“There are some very good reasons to try VBAC,” says Jenny Graber, MD, an OB/GYN at Riddle Hospital, Main Line Health. “VBAC avoids major abdominal surgery for the patient, and allows a faster recovery with shorter hospital stay, lower risk of infection and decreased need for blood transfusion. However, each case requires a physician to closely evaluate a woman’s health history and discuss the risks.”

One of the biggest risks during a trial of labor after cesarean delivery is the possibility of uterine rupture, which, if it occurs, can have severe consequences to both mom and baby. While the risk of uterine rupture is generally less than one percent, it depends on how many and what types of scars are on the uterus from prior surgery. The obstetrician must carefully evaluate each patient’s history to determine if she is a reasonable candidate for VBAC.

“There is no one-size-fits-all rule,” says Dr. Graber. “In addition to prior uterine surgery, other factors to consider include the size of the baby and the circumstances of the prior delivery.  It is important to note that electing not to attempt labor and proceeding with repeat cesarean also carries significant risks of major abdominal surgery, including bleeding, infection, damage to surrounding structures and the risks associated with significant scar tissue formation.  There’s not always an easy answer.”

Generally speaking, the success rate with the VBAC procedure is about 70 percent. Many women would consider the worst option to be to attempt a trial of labor and to fail, thereby requiring repeat cesarean surgery. As Dr. Graber points out, there are several factors that can make it difficult to have a successful VBAC. According to the American College of Obstetricians and Gynecologists, women who have a higher-than-average body mass index, a baby with an estimated high birth weight, or a shorter-than-recommended interval between pregnancies have a higher risk of complications during a VBAC.

If you are interested in pursuing a trial of labor after a cesarean delivery, Dr. Graber says the most important thing you can do is talk with your physician.

“VBAC can be a safe and reasonable option for many women, but no labor or delivery is ever risk-free,” she says. “Your doctor can help you weigh the risks and help you decide which option is best for you.”

To schedule an appointment with an OB/GYN at Main Line Health, call 1.866.CALL.MLH (1.866.225.5654) or use our secure online appointment request form.