Can I Have A Natural Birth After A Cesarean?

There are a lot of myths about natural birth after a Cesarean that lots of us heard from gynecologists. It seems complicated, although it shouldn`t be. In most countries, vaginal birth remains the first option of doctors and mothers, even after a C-section (or more), if the health state of the mother and baby allow it.

What Does Natural Birth After a Cesarean Mean?

If you gave birth through Caesarean birth, for your next pregnancy you can try through natural birth. This procedure is also known as vaginal birth after Caesarean (VBAC). Most women who tried it didn`t had any problems in bringing out a healthy child into this world.

VBAC involves a labor test or an attempt to try and see if the actual birth can occur naturally. It cannot really be said in advance if it can work or not. It`s important for the doctor to carefully monitor the pregnant woman`s labor, so he can be ready to intervene surgically in cases there are any complications.  If this happens, the birth will occur through C-section.

Statistics show that 4 out of 10 women who tried VBAC have eventually still gave birth through a Caesarean birth. However, statistics are good in that there are still 6 out of 10 women who are successful in their attempt.

Labor during VBAC

When it comes to a natural birth after Cesarean, labor is the same as it would normally be, only that the mother and baby will be more carefully monitored and doctors will be ready for a possible emergency surgery.

It should be specified that a VBAC should be performed in a hospital that has all the necessary equipment for an emergency C-section. In case that the pregnant woman didn`t went through a vaginal birth before, labor in the case of VBAC can be considered to be the first one and maybe longer as well. If she had a vaginal birth before, her organism may be already used to labor, making it easier and shorter.

Medications Used during VBAC

When a VBAC is concerned, doctors avoid using drugs that would trigger or stimulate this procedure, so they won`t risk a uterine rupture.

If labor is too slow or it stops, the pregnant woman can receive oxytocin to strengthen the uterine contractions.

Drugs against pains caused by vaginal birth are allowed and even recommended in case of VBAC. Local anesthesia (epidural) can be performed if the cervix is sufficiently dilated or narcotic medication or sedatives may be administered.

Recovery after VBAC

The recovery is the same as in the case of normal birth. At 24 to 48 hours after birth, the mother and baby can go home, while recovery after C-section may take between 2 and 5 days of hospitalization, and a few weeks in which it`s forbidden certain normal activities until the incision is healed.

How Does the Doctor Influence the Decision?

There are lots of factors that are taken into consideration when a doctor decides one or way or another regarding a VBAC. It`s very likely that a midwife or anesthesiologist be present when such a birth is attempted, as well as qualified personnel to perform a Cesarean birth in case of any complications occurred.

The doctor`s decision can be influenced by the reason for which the first birth wasn`t performed naturally, requiring a Caesarean birth in the first place. Some women are advised to avoid giving birth naturally due to the incision performed with the first birth.

More exactly, if the procedure has involved injury of the upper uterine muscle, a natural birth increases the chances of uterine scar enlargement. That`s why, it`s very recommended consulting a doctor in detail before the final term of pregnancy.

Uterine Rupture

The risk of uterine rupture after a C-section performed at the panty line is of 0.5% – 1%, depending on several factors. Mothers who find themselves at their first birth are subject to risks just as serious as a uterine rupture and it happens just as often as the displacement of the child`s shoulder, placenta abruption, the descent of the umbilicus

Although uterine rupture rarely happens, it`s a very severe condition. This may lead to hysterectomy, infant brain damage in case of not enough oxygen, urinary tract damage, urinary infection, emergency transfusions and even the death of the mother or baby.

The cause of uterine rupture can involve a trauma, baby`s size or multiple pregnancies.

Women who want to give birth vaginally, or already went through Caesarean birth, are monitored closely during delivery and, although it`s very difficult to notice a uterine rupture, sometimes a rapid cardiac rhythm can be a sign that the scar has already spread.

Is VBAC Safer than Repeat Cesarean?

The biggest worry of women who already experienced a C-section is the risk of uterine rupture during natural birth. According to ACOG, if you already experienced a Cesarean delivery with a low transverse incision, this risk is of 0.2% to 1.5%, which means around 1 chance in 500. However, ACOG recently stated that VBAC is considered safer than a repeat Caesarean birth, and VBAC with more than one single previous C-section doesn`t pose an increased risk.

Advantages of VBAC

The advantages of VBAC compared with Caesarean birth include:

• You avoid having a uterine scar. This is crucial if you want more children in the future. The more uterine scars you have, the higher is the risk to experience issues and complications in a future pregnancy.
• Less pain after birth.
• Less hospitalization days and a shorter recovery period at home.
• Decreased risk of infection.
• A more active role in the birth process for both you and your partner.

What Can Prevent the Success of VBAC?

Pregnancy, labor and birth are different for each woman and are difficult to predict. Even if you first gave birth through Caesarean birth, it`s possible to not have to for the second time.

The likelihood of VBAC occurring in a normal and safe manner is influenced by several factors. Usually, a combination of more factors affects how well or badly a labor test goes:

The chances of VBAC running normally increase when:

• The previous C-section wasn’t performed due to a prolonged labor.
• You don`t experience the same medical issue as when performing the Caesarean birth in the past (such as a fetus in the pelvic position or with his legs down).
• You already experienced a successful natural birth or VBAC.
• Labor starts naturally, and the cervix expands well.
• You are less than 35 years old.
• The fetus is very big (more than 4.082 g).
• You have more than 40 weeks of pregnancy.
• You have twins.

Risks Involving VBAC

The most serious risk is the emergency surgery in case the natural birth cannot take place in safety conditions. This rarely happens, but an emergency C-section isn`t the same as the scheduled and controlled cut. In case of emergency Caesarean delivery, the risk of infection is pretty high.

Also, there may be a mild opening of the old scar known as dehiscence. This doesn`t affect the medical condition of the mother at all, and most of the times it isn`t even noticed, being able to heal without treatment. The risk of uterine rupture is extremely rare, however, very severe. As mentioned above, it can even come to hysterectomy (removing the uterus) to limit bleeding.

In conclusion, vaginal birth after Cesarean is possible and even recommended for healthy expecting mothers, who have a perfect pregnancy and a well developed baby. However, for a VBAC to succeed, the mother needs to talk with a doctor first and make all the proper investigations and tests.

What Is the Success Rate of a VBAC?

If you have already delivered a child by Caesarean birth once and you are pregnant with a second child, you may be able to opt between a VBAC and a repeat Caesarean birth.

For lots of women, VBAC consists a real option. Actually, studies performed on women who attempt TOLAC (trial of labor after Caesarean) outlines that around 60% to 80% have a successful vaginal birth. – Find out more!

VBAC is not right for any woman. Particular factors, like increased risks of uterine scar, can make this procedure rather inappropriate. There are hospitals that don`t even offer this as an option because they don`t really have the required resources or staff to handle Caesarean births in case of emergency. Still, if you are considering this, your doctor can help you make sense of these details.

Birth & Education on VBAC

To prepare yourself for labor, take into account to register at a birth course at your hospital or clinic. Both, you and your partner can learn:

• What to expect during labor and delivery.
• How to manage birth after C-section using breathing exercises and emotional and physical support.
• About your options in reducing pain for a natural birth.