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| |    Vaginal Birth after a Cesarean Delivery by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. When I discuss the possibility of vaginal birth with my patients who have had a prior cesarean, I get a range of initial responses--from "Of course I want to have a vaginal delivery" to "Why would I choose to go through labor when I can just schedule surgery?" While you, too, may have an initial emotional reaction to the idea of vaginal birth after a cesarean, commonly known as VBAC, you will make the best decision for yourself and your family if you know all the facts. One thing to consider is that the vast majority of women who have had both a vaginal birth and cesarean choose to go for VBAC rather than schedule surgery. They generally cite the easier recovery as the reason they want to avoid cesarean if possible. Talking to women who have experienced both types of birth can be helpful in making these decisions, and many hospitals offer VBAC preparation classes. Once you have learned about general pros and cons of VBAC, discuss your individual circumstances with your practitioner. One of the reasons that VBAC and scheduled repeat cesarean are both considered reasonable choices is that there are risks and benefits on both sides of the decision. In most cases, the benefits of trying for vaginal birth outweigh its risks, and the chance of delivering vaginally is high. In some cases, though, the risks of labor are significant, and repeat cesarean will be strongly recommended by your doctor. Moms in this situation are said to not be candidates for VBAC. Who is a candidate for VBAC? • VBAC is usually recommended (or at least offered) to women who have had one or two prior low transverse cesarean sections. The risk of major complications such as uterine rupture (where the old scar on the uterus pops open) is very low in this group, and labor is considered safe. Who isn't a good candidate? • Women who have had a classical cesarean, where the uterine incision runs up to the top of the uterus, are not usually considered candidates for VBAC. The risk of uterine rupture in this group may be as high as 10 percent. While some uterine ruptures occur prior to labor and are not considered preventable, scheduling a repeat cesarean can prevent loss of blood, and even loss of life for the fetus and the mother. • Women with prior uterine rupture or other major uterine surgery are also at risk for uterine rupture, and can prevent complications by scheduling a repeat cesarean. The surgeon normally will make this recommendation at the time of the original surgery. • Women who have a specific indication for cesarean this pregnancy (like placenta previa) are generally better off having a scheduled cesarean than waiting for labor. For more information on benefits and risks of VBAC and the chances for success, see our articles "Risks and Benefits of VBAC" and "Chances for a Successful VBAC".
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