Vaginal delivery after a cesarean section

Vaginal delivery after a cesarean section is possible.

A delivery after a cesarean section occurs when a woman delivers a baby through the vagina after having delivered a baby by cesarean section on another occasion.

Years ago, doctors thought that once a woman had a C-section, she should have all her subsequent babies by C-section. Although C-section surgery ensures good suturing and closure of the uterus, doctors were concerned that the original cut would reopen when the mother went into active labor.

Today, scientific evidence shows that although the incidence of uterine rupture after a cesarean section is slightly elevated compared to a history of vaginal delivery, it is very low and does not limit the ability to have a vaginal delivery after a caesarean section safely.

Route of delivery after caesarean section

The method of delivery of choice after a Caesarean section prior is the vaginal route, with an approximate success rate of 80%. Despite this, the mother's preferences should be taken into account, as well as informing her of an increase in the risk of uterine rupture of approximately 0,5%.

Currently, a woman who has had a C-section usually has the following options in her subsequent pregnancies:

• Opt for spontaneous labor and have a vaginal delivery. Attempted labor can work and end in a vaginal delivery, although sometimes it does not work and the woman must undergo another C-section to deliver her baby. The reason for the first cesarean section could condition a greater or lesser probability of a new cesarean section.
• If the woman does not go into labor spontaneously, an induction of labor with the appropriate medication and monitoring of uterine and fetal dynamics could also be performed to reduce the risk. An increase in uterine dynamics greater than what is recommended would cause a greater risk of uterine rupture and consequently risk to the baby. The risk of this complication in labor induction with this history is around 1%.
• Plan another C-section before labor begins.

A minimum of 12 months after the cesarean section is recommended before a new pregnancy.

What are the advantages of vaginal delivery?

The advantages of vaginal delivery after a previous cesarean section are, among others:

• A shorter hospital stay after delivery
• Less pain and faster recovery (usually)
• Fewer problems after childbirth – Women who undergo a cesarean section are more likely to have complications associated with abdominal surgery (fever, surgical wound infection, slight increase in thrombosis or clots in the lower extremities, among others).

What problems could there be?

There can be different problems in an attempted labor, but the problem that most worries professionals is that the uterus tears or that the scar from the previous cesarean section opens. That's an emergency. In that case, the mother and baby may be harmed. If it happens, a caesarean section should be performed immediately to deliver the baby and repair the tear.

Also, sometimes the attempted labor does not work. Labor may not progress normally and the baby may have to be delivered by C-section, which can be upsetting and stressful for a woman.

What if I want to have a vaginal birth?

If you want to have a vaginal birth after a cesarean section, based on your particular situation, your doctor will help you decide if an attempted labor is the right option for you.

In general, an attempted labor is more likely to work when:

• The woman has already had a vaginal delivery (in addition to having had a C-section).
• The first C-section was performed because the baby was in the breech position, that is, the legs or buttocks (and not the head) were closer to the vagina.

For some women it is not advisable to attempt labor. This happens when:

• The uterus did not open in the usual way in the previous caesarean section. Instead of having a transverse incision in the lower part of the uterus, it was made in the upper part, called a body incision.
• The woman has already had many C-sections.
• Vaginal delivery is not safe for the mother or the baby.

In addition, the doctor will only recommend that you attempt labor in a hospital or facility where a C-section can be performed immediately if necessary.

 

Bibliography: UpToDate on: Feb 02, 2018.