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Vaginal birth after caesarean: Facts, safety and risks

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 If your previous delivery was through CS, do not assume it is necessary for all your future pregnancies (Photo: Courtesy)

You may have delivered your previous baby by caesarean, but you are pregnant again and you wonder if you could repeat a C-section or go all natural.

Trial of labor after a previous caesarean is a possibility for many women with a 70 percent success rate. If your previous child was born through caesarean, do not assume that caesarean delivery is necessary for all your future pregnancies.

Reasons for opting a trial of labour

If you are open to having more children, opting for VBAC may help reduce the risks associated with multiple caesarean section deliveries including placenta previa. This also gives you a chance to increase the number of babies you would like to have; a factor that could be limited by multiple caesarean deliveries.

Avoiding surgery would result in a shorter recovery time and earlier resumption of normal activities. Vaginal delivery also helps to clear the baby’s lungs preparing it to boost breathing habits after birth.

If you have had one or even two prior caesarean deliveries though low transverse incisions (bikini line) and have no additional problems that could complicate delivery, your doctor could put you as a candidate for VBAC.

Is it right for every woman?

As much as many women do have successful vaginal birth after delivery (VBAC), it may not be suitable option for some women. Here are risks that may make VBAC unsuccessful;

·         A prior classical uterine incision caesarean delivery (high vertical) puts the mother at risk of uterine rupture. Such incisions are done at the thinner part of the uterus. There are concerns that the pressure associated with labour can provoke your uterus to tear along the scar. A high incision is sometimes to blame for preterm birth.

·         Uterine rapture in previous pregnancy. Uterine rupture can result in blood loss, damage to the bladder, blood clots, infection and removal of the uterus (hysterectomy)

·         Previous surgery involving pelvic organs such as myomectomy (fibroid removal)

·         If you are experiencing prolonged labour

·         Advanced maternal age

·         Pregnancy that has gone beyond the expected date of delivery

·         Obesity and pre-eclampia

·         Labour induction due to a closed cervix

·         Previous delivery within one and a half years.

·         If the baby is in not in cephalic position (the normal position for natural delivery)

Advice from your gynecologist is vital for a successful VBAC. Preparation for VBAC may start as early as your first antenatal clinic with vivid history taking. The choice of health facility also matters. Some hospitals do not offer VBAC due to the lack specialists or medical infrastructure to handle medical emergencies.

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