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| |    Risks and Benefits of VBAC by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. If you've had a prior low transverse cesarean and are pregnant again, you have three childbirth possibilities. You might have a scheduled repeat cesarean without labor, you might have a vaginal birth after cesarean (VBAC), or you might go through labor and then, for one reason or another, give birth by cesarean. Safety considerations In general, the safest of these possibilities is vaginal birth. Vaginal birth avoids the risks of surgery and allows the fluid in the baby's lungs to be squeezed out as he passes through the birth canal. Recovery for the mother is generally quicker and much more comfortable than after a cesarean delivery. While both you and your doctor may be concerned about the possibility of the old uterine incision breaking open (uterine rupture) during labor, this is a rare event (less than one percent). Even when it does occur, if it happens in a well-equipped hospital, the mother and baby usually fare well. Scheduled repeat cesarean is the second safest of these three possibilities. While all surgery has risk, advances in anesthesia and medical care keep the risk of surgery low for most mothers. In general, scheduled surgery is safer than emergency surgery. The third and least desirable possibility is trying for vaginal birth but ending up with the need for a cesarean anyway. The risks are still generally low, but there is an increased likelihood of infection and exhaustion after the operation, as well as a slight chance of more surgical complications. Pros and cons of scheduling repeat cesarean: Pros • Convenience-especially with the need for childcare arrangements this time around. • Avoidance of a repeat of the last labor-then-cesarean experience, especially if it was emotionally traumatic. • Decrease in the (small) risk of uterine rupture. Cons • Increased chance that the baby will have some trouble clearing the fluid out of his lungs at birth (call transient tachypnea of the newborn or TTN), which occasionally is difficult to distinguish from pneumonia and may require the baby to be transferred to the newborn ICU for observation and antibiotics. • If the exact due date isn't known, may need amniocentesis to check fetal lung maturity so a preemie isn't delivered accidentally. • You may have surgical complications such as bladder, bowel, or blood vessel injury and infection. • If you plan for many more children, you should take into account that the more surgeries a woman has had, the greater the risk of surgical complications. A fourth or fifth cesarean has more risk than the first or second. • More difficult recovery than vaginal birth. • Some people feel that since they will be having a tubal ligation anyway, they might as well have a repeat cesarean. However, tubal ligation generally involves fewer risks and less recovery time than a cesarean delivery. Besides, the desire for tubal ligation isn't usually seen as a reason not to try for VBAC. Pros and Cons of trying for vaginal birth: Pros • Easier recovery than cesarean. • Satisfaction of achieving vaginal delivery. • Sense of undoing prior negative experience. • Slightly safer for mother and baby in most cases. • Knowledge that at least you tried, even if cesarean is ultimately needed. Cons • Rare major complication of uterine rupture, which can lead to emergency surgery, possible blood transfusions for mother or baby, possible hysterectomy, and even death of the baby or mother. • Greater risk of uterine infection for mothers who have labor and then cesarean. • Risk of repeating prior negative experience if cesarean becomes necessary. • Risk of need for emergency cesarean, which is more frightening than a scheduled cesarean and has a somewhat greater risk of complications. Since there are risks and benefits on both sides of the decision, the choice usually comes down to personal preference. So get all your information, and then sit down with your practitioner and make the decision that is right for you.
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