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Is vaginal birth after cesarean possible?

If you’ve already delivered a baby via C-section, does that pre-determine that you must deliver your next child that way, too? Or is it safe to attempt a conventional birth? You need to weigh these seven factors carefully in the quest for vaginal birth after cesarean (VBAC):

  1. The old myth has been busted: Having one cesarean birth does not automatically lead to another. Experts cite that about 60 percent to 80 percent of women who choose to have a VBAC succeed (and the success rate is even higher if you had a vaginal delivery before an earlier C-section).
  2. A key factor is the type of incision you had the first time. Women with high vertical scars have greater risks of a dangerous uterine rupture (a tear in the uterine wall, often on the site of a prior incision) and infection than women who have more modern low-transverse (horizontal) scars. Uterine rupture puts you and your baby at risk. If you have more than two scars from previous cesarean deliveries, the risk of rupture will be greater and a repeat cesarean is advisable.
  3. VBAC brings big benefits, particularly that you avoid major surgery, with all the usual risks it presents. The scale is also tipped in favor of VBAC because of decreased risk of medical complications and infection for both mother and baby, less blood loss, fewer blood transfusions, lower cost and a shorter hospital stay with a quicker post-delivery recovery time overall.
  4. Patients who have a failed VBAC (when they must be switched to a cesarean midway through delivery) have higher risks of uterine rupture and infection than patients who have a successful VBAC or elective repeat C-section. As with any attempt to deliver vaginally, your doctor will recommend a cesarean midway if the infant is too large for your pelvis or if the contractions are not productive and the cervix doesn’t dilate, making labor last too long.
  5. Experts advise against home VBAC deliveries. You must have a physician and an anesthesiologist ready to perform an emergency cesarean delivery in the event of a uterine tear, which can threaten the lives of both you and your baby.
  6. Take your overall health into consideration—your doctor will. Cesareans have been more frequently performed for women with medical risk factors or complications of delivery, such as diabetes, genital herpes, hypertension, eclampsia, incompetent cervix and uterine bleeding.
  7. Neither an elective repeat C-section nor VBAC is risk-free; discuss the matter carefully with your partner and your healthcare provider.