A lady has the right to change her mind. And her method of delivering a baby.
Vaginal Birth After a Cesarean (VBAC) is a much discussed and studied subject in obstetrics. We now know that it is not only fairly safe, but also highly desirable.
Earlier, we believed that "once a cesarean, always a cesarean." Normal delivery was considered very risky if a women had had a cesarean section. The wall of the uterus would be weak after the incision, so the reasoning went. The tremendous strain of a normal delivery would cause the weakened wall to give way, leading to a catastrophe.
However, we now know that women who have had a cesarean can still have the next baby normally (vaginally). The risks are a little higher than in a second normal delivery, but in a good obstetric unit, a trial of normal delivery should not be very risky for mother or child.
No surgery should be undertaken without good and sufficient cause. A cesarean is a major operation. There should be a good reason for subjecting a woman to it, and a previous cesarean does not seem to be enough of a good reason.
A normal delivery is - well, normal. It is natural, physiological. Women recover quickly after it, are up and about in a few days, and can feed and look after baby sooner. A cesarean section needs prolonged bed rest, a long recovery time, and a longer delay before baby can be managed without aid.
The main risk is of uterine rupture - the wall of the uterus giving way, because it has been weakened by the earlier cesarean section. This can be very serious, and even fatal, for the baby, mother, or both. However, it occurs rarely (about 5 times per 1000 deliveries). In a well equipped and staffed hospital, uterine rupture can be detected early, and serious consequences avoided.
VBAC has increased overall risks for the baby. The perinatal mortality (death of the baby shortly before or after birth) is several times higher with VBAC than with a planned repeat cesarean birth. Apart from death of the baby, there may be lesser adverse effects like hypoxic-ischemic encephalopathy, brain damage, and cerebral palsy.
The most important is good monitoring. The increased risk of this type of delivery mandates very careful monitoring of the mother to be and the unborn baby. There should be frequent listening to the baby's heartbeat, or continuous electronic fetal monitoring.
Another important requirement is the immediate availability of a cesarean section. There should be an operation theater close by, and a competent team to perform the surgical delivery.
Trials of normal delivery after a previous cesarean delivery have a success rate of 60-80%. However, in some situations, the trial has to be abandoned, and a cesarean section done.
This is the group at highest risk of complications - women in whom a trial of labour is unsuccessful, and who then require a cesarean.
Last Revision: February 15, 2016
A trial of normal delivery is not appropriate for all women who have had a cesarean earlier. Careful selection is essential to reduce the risks associated with VBAC. The following are favourable for a trial of normal delivery:
The following conditions are not compatible with VBAC:
Dr. Parang Mehta,
Opposite Putli, Sagrampura,
Surat. Tel: +91 9429486624.
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