Can I give birth vaginally after a c-section?

Q: My first baby was born by c-section. Can I give birth vaginally this time?

A: That answer depends on a number of issues, but many women are able to give birth vaginally after having a previous c-section (a process nicknamed VBAC, vaginal birth after c-section). The main risk of having a VBAC is uterine rupture, in which the c-section incision re-opens during delivery. Today doctors are screening women more carefully before recommending VBACs. So while fewer are being performed, they are much safer and more successful. In fact, the success rate is between 60 and 80 percent.

About two-thirds of women who've had c-sections are good candidates for VBAC, but only your doctor can determine for sure if you're one of them. There are several medical factors that physicians consider when assessing your situation:

• The type of incision during your c-section: There are three types of incisions used during c-sections: low transverse (a side-to-side cut made on the lower part of the uterus), which is the most widely used; low vertical (an up-and-down incision made in the lower part of the uterus); and high vertical or "classical" (an up-and-down cut made in the upper part of the uterus). Classical incisions are most likely to rupture, so women with these are advised not to attempt a VBAC. The best VBAC candidates are those with low transverse incisions.

• The reason for your previous c-section: If your c-section was due to something physicians wouldn't expect to repeat, such as the fact that baby was breech or his heartbeat was irregular, then you have a good chance of having a successful VBAC without complications. But if you had a c-section because your cervix did not dilate adequately or the baby's head did not descend, or both, your chance of a successful VBAC is somewhat lower.

• How healthy you and your baby are: If your baby's health is unstable or if there are complications, such as your child being in a breech position, you can't have a VBAC. Your health is also considered, because conditions such as diabetes and high blood pressure can make VBAC riskier. If problems arise during labor, a c-section can still be performed quickly and safely. In fact, ACOG (American College of Obstetricians and Gynecologists) guidelines state that a physician capable of performing a c-section should be present during every VBAC delivery. For this reason, home births aren't recommended for moms-to-be attempting a VBAC.

• How many other c-sections you've had: The latest guidelines say that VBAC is a safe option for women who have had only one cesarean. Even though some women with multiple c-sections may want to try VBAC, it's difficult to find a doctor to do it.

Before you decide if a VBAC is right for you, it's important to be aware of the risks involved. Having a VBAC increases your risk of complications like uterine rupture, endometritis (a temporary inflammation or irritation of the uterine lining), and a variety of newborn injuries caused by the uterine rupture. The good news is that these complications are relatively rare. In fact, one of the largest studies ever done on VBAC found that the risk of developing a serious complication during a VBAC is about 1 in 2,000. --Stacey Stapleton


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