Pregnancy is a time that brings a lot many changes in a woman’s body. It is not just the belly that grows out to be bigger due to the baby inside the womb, but in some or the other way, the changes are observed in the entire body. Pregnancy brings many changes and mood swings that can be quite difficult to handle, but there is not anything more beautiful than a child birth. Having that little one in your arms and looking at them can be overwhelming and will make everything worth it. Where childbirth is such a great blessing of nature, a mother surely needs to go through a lot. On one hand, where some moths give a natural vaginal birth, others might have to go under the needles and give birth to her child by the cesarean method. Many women have this one question in their mind: is it possible for them to give a vaginal birth to their second child after they have given a cesarean birth once. Let us understand if a woman can give vaginal birth after a cesarean or c-section birth with Dr. Sarika Gupta, Consultant, Gynecology Oncology and robotic Gynaecology, Indraprastha Apollo Hospitals, New Delhi.
Is it possible to have a vaginal birth after c-section?
The simple one word answer to this most asked question is a “Yes”. It is possible to have a vaginal delivery after giving a cesarean birth once. Normally termed as VBAC or Vaginal Birth After C-section is something that is possible for many women. Although it is possible, there are a few factors that need to be considered before undergoing this procedure. Despite being possible, this procedure can be risky for a woman and her baby which can also result in various complications in the coming future. Let us take a look at what Dr. Sarika Gupta has to say about this “Vaginal birth is possible after one cesarean specially for women whose previous cesarean section was not a non-recurring one. Sometimes the indication is a recurring one when the pelvis is inadequate and it can be inadequate in the next pregnancy as well. If the pelvis is small then that becomes a recurring indication. Most of the times as the indication is non-occurring one so 60-80% of women can have a safe vaginal delivery after a cesarean section. There are multiple benefits of opting for a Vaginal Birth After C-section as it leads to a quick recovery that can happen within an hour after the delivery, it causes less pain, there are not any chances of infection in the wound and apart from this a person is spared from the complications of a c-section birth such as injury to the nearby structure. Moreover it also reduces the chances of c-section in the next pregnancy.
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The main risk involved in vaginal birth after a cesarean section is that the uterine might rapture because of weakened scar. This weakened scar can be caused due to multiple reasons such as 2 previous c-sections that causes the scar to get weakened twice. In most of the cases we advise the patient who has had 2 cesarean sections to go for a cesarean section only as the chances of uterine ruptures are higher in this condition. Women who get pregnant soon after their first c-section or within a year, their scar does not get enough time to heal properly and hence the chances of uterine rupture becomes high. Sometimes the condition of a woman is such that there are risks involved for Vaginal Birth After C-section. As the scar ruptures, there is a risk of mortality as well along with the chances of risk to the life of the mother and child as well. As the risk is only about 0.5 to 2% at max which is a very low risk and hence women should not be afraid of these risks as the chances are very low. If you are opting for a vaginal birth you should get it done in a proper centre where continuous monitoring is done and all the Vaginal Birth After C-section are available.”
Medical History
Your treatments and other factors have a lot to do with your medical history and things that your body has gone through. In order to see if a woman can undergo a vaginal delivery after the cesarean one, it is important to look at a few factors such as the way in which the c-section delivery before this was performed. Mainly there are 2 ways in which c-section childbirth can be performed that are-
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- Transverse incision- Also known as the horizontal incision method, transverse incision is something in which cuts are made across the lower and thinner part of the uterus. This procedure is followed during most of the c-section procedures.
- Vertical incision- In vertical incision the cuts are made in order to tear the uterine muscle that are strongly contracted during labour and can even cause a uterine rupture.
Knowing about both these types of uterine incisions is important in order to opt for a vaginal birth. At one hand where transverse incision is a common practice that is followed in cesarean births, it is said to be quite safer and makes the process of VBAC (Vaginal Birth After C-section) to be easier and more likely. On the other hand, as the uterine muscles are cut through in a vertical incision, it can male the VBAC too risky for the woman and child as a lot of pressure is exerted on the uterine muscles during labour that it can also result in rapturing the uterine.
Health Condition
It is not just your medical history and the previous c-section procedure that are taken in consideration while undergoing VBAC, but your present health condition has a crucial role to play. It is not just your but your baby’s health as well that needs to be taken in consideration by the doctor before going for a vaginal birth. Going through a vaginal birth after a c-section delivery can be quite risky if the women has high blood pressure during the time of pregnancy, gave a cesarean birth within 19 months, is obese and has a body mass index equal to or higheer that 30, is older than 35 years or has a very large fetus.
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All these factors mentioned above make the process of VBAC complicated and dangerous for a woman and its child.
Benefits
There has to be some reason that women want to opt for a Vaginal Birth After Cesarean and have got so many questions about it. Well it is important to know that a vaginal birth comes with a lot many benefits that involve lesser blood loss, a shorter recovery period, low risk of infection and no surgery. Not just this but a vaginal birth also reduces the risk of complications that can happen due to repeated surgeries such as bladder injuries, bowel injuries and scarring. This also helps in reducing the risk of complications in the future childbirth.
Risk Factors
As we have talked about the things that need to be taken into consideration while option for a Vaginal Birth After Cesarean like medical history and present health condition of the woman and child, let us take a close look at what possible dangers and risk factors can be there.
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The risk factors involved in the procedure of Vaginal Birth After Cesarean can range from infection to raputaring the uterus to an extent that it breaks open.This usually happens due to the vertical incision that a woman must have gone through in her c-section delivery, that can burst open or tear the scar. Not just to you but it can also cause great harm to your baby. Although this condition is very rare it can lead to a lot many complications to the mother and fetus as well.
With inputs from Dr. Sarika Gupta, Consultant, Gynecology Oncology and Robotic Gynaecology, Indraprastha Apollo Hospitals, New Delhi