This is called uterine rupture. Although rare, uterine rupture can be life-threatening for both mother and baby. So women with risk factors for uterine rupture should not attempt a vaginal birth after caesarean VBAC.
Future risks. If you are planning to get pregnant again, it's important to think about scarring. After you have two C-section scars, each added scar in the uterus raises the risk of placenta problems in a later pregnancy.
These problems include placenta previa and placenta accreta , which raise the risk of problems for the baby and your risk of needing a hysterectomy to stop bleeding. For more information about caesarean risks, see the topic Caesarean Section. Besides the usual prenatal tests, your doctor will take measures to assess whether vaginal delivery is likely to be a safe birthing option for you.
For more information on standard prenatal tests, see the topic Pregnancy. These extra measures can help you and your doctor make a well-informed decision about your delivery. Assessments done sometime during the pregnancy to help find out whether a trial of labour is a safe option may include:. Information, preparation, and teamwork are needed for a successful vaginal birth after caesarean VBAC. To prepare for labour, consider taking a childbirth education class at your local hospital or clinic.
You and your birthing partner can learn:. Other than requiring closer monitoring, trial of labour after caesarean, or TOLAC labour, is the same as normal labour. During early labour, a woman can remain as active and mobile as she wants. During the active period of labour, continuous fetal heart monitoring is done to watch for early signs of fetal distress or uterine rupture. For more information, see Examinations and Tests. If you are attempting a trial of labour and you have not had a previous vaginal birth or your previous caesarean was done early on in labour, your labour will be like a first-time labour.
For more information about labour and delivery, see the topic Labour and Delivery. As the end of pregnancy nears, the cervix normally becomes soft and begins to open dilate and thin efface , preparing for labour and delivery. When labour does not naturally start on its own, labour may be started artificially induced. Some doctors avoid the use of any medicine to start induce a trial of labour , because they are concerned about uterine rupture.
Other doctors are comfortable with the careful use of oxytocin to start labour when the cervix is soft and opening dilating. If your labour slows or stops progressing, your doctor may use oxytocin to strengthen augment contractions. As with most vaginal births, most women who choose VBAC can safely use pain medicine during labour. Pain medicine usually is started when the cervix has opened dilated 3 cm 1. Types of pain medicines used include:. Vaginal birth after caesarean VBAC recovery is similar to recovery after any vaginal birth.
After a vaginal delivery, the mother and baby can usually go home within 24 to 48 hours. By comparison, recovery from a caesarean section requires 2 to 4 days in the hospital and a period of limited activity as the incision heals.
The overall risk of infection is low for both vaginal and caesarean deliveries. But it is lower after a vaginal birth. Before you leave the hospital, you will receive a list of signs of infection to watch for in the first few weeks after delivery. Any woman in labour—not just one attempting a vaginal birth after caesarean VBAC —might have complications during childbirth that require a caesarean section delivery.
If there is no medical reason for a caesarean, vaginal delivery is generally a safe option for both mother and baby. It is common, though, to fear going through labour after having had a caesarean delivery. This is especially true for women who have tried a vaginal birth but, after a long and difficult labour, ended up delivering by caesarean.
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Your health The chances of having a successful VBAC are higher if you and your baby are in good health and your pregnancy is progressing normally. Your location Doctors usually recommend that women choosing a VBAC deliver their baby in a hospital instead of using a birthing centre or having a home birth. Benefits of VBAC Some benefits of vaginal births — including VBACs — are: a lower risk of some complications such as infections or blood clots a shorter recovery time and hospital stay a higher likelihood that you can feed and cuddle your baby straight after birth a lower risk of complications during future pregnancies less abdominal pain after birth you are more physically able to care for your baby and any other children you may have soon after delivery, allowing for quicker bonding babies born vaginally have a lower risk of respiratory problems Risks of VBAC The risk of the scar in your womb uterus and abdomen tearing during labour is very low — about 5 to 7 in every VBACs — but this is the main reason doctors and midwives closely monitor VBACs in a properly equipped hospital.
If you decide to go ahead with a VBAC, you can do things to boost your chances of having a successful and positive experience, such as: learn about VBAC — read about it and take a VBAC childbirth class with your partner or another loved one choose a well-equipped hospital that offers VBAC eat healthily and keep active during your pregnancy allow your labour to start naturally, if possible — inducing labour with medicines can make the contractions very strong, putting extra strain on your scar be prepared for a caesarean — even though you have your heart set on a VBAC, you may need to have a caesarean if complications arise.
The aim is to have a healthy mother and baby, regardless of how you get there. Back To Top. More telling is a paper in the journal Obstetrics and Gynecology that found that 42 percent of Florida physicians surveyed stated litigation as the primary reason they did not do VBAC, whereas lack of experience handling uterine ruptures was the primary concern for only 11 percent of these doctors.
Pamela Berens, who has been doing VBACs at UT Children's Memorial Hermann Hospital in Houston since her residency there in the early '90s, says she routinely accepts patients from providers who don't do a "trial of labor. She feels VBAC is safe for the majority of women, explaining, "I suggest VBAC for most people, especially the woman with one prior C-section for a fairly non-reproducible reason like a breech baby or fetal distress.
Of course, there are plenty of women who weigh their options and decide that a repeat cesarean, not a VBAC, is the best choice. All pregnant people want to give birth in a way that's safe for them and their babies. But what about when women aren't given all their options or don't have access to up-to-date information and choices about their method of delivery? Is it fair to make people undergo major surgery because they can't access care that the governing body of obstetrics in America says is safe?
Of course, even if a patient finds a VBAC-supportive doctor, it's often the case that some doctors in a practice will do VBAC and others won't, and there's no guarantee as to who will actually be at the birth or what will happen in the hospital. Other times, patients fear a bait-and-switch scenario, where a mother is led to believe she can attempt VBAC or do a trial of labor, but then at the end of pregnancy, the doctor finds a reason to do a repeat C-section, while the patient wonders if perhaps they had that in mind all along.
Tucson, Arizona, mom Rianne Maldonado wanted to have a VBAC when she was pregnant with her second child in , 11 years after her first child was born via cesarean. When she asked her obstetrician about the possibility, she alleges that he told her, "Do you want your vagina to fall out? I don't know why you would want to go through that when you could have a nice easy cesarean and be on your way.
Suffering from hyperemesis gravidarum a type of extreme, ongoing pregnancy nausea , she didn't have the energy to push the practice to support her and had a repeat cesarean. When she got pregnant with her third child, Maldonado still wanted to attempt the VBAC, to do a trial of labor. Finally, at 31 weeks, she found a doctor who thought she was a great candidate, just 45 minutes away in Spokane, Washington.
Maldonado's daughter was born vaginally in the hospital. Nobody does that,'" she recalls. Maldonado, now 38, has gone on to have two more VBACs. Many women, like Maldonado, are forced to find creative ways to find a VBAC-supportive doctor or hospital in their areas.
Some will drive hours to access another provider. Other parents will temporarily move to a different city or stay in a hotel, waiting for labor to start. But most women can't afford to spend hours researching options and then planning and paying for travel, alternative housing, and child care, or mustering up the money for an out-of-hospital birth or private insurance.
Then she learned that her insurance provider, Oregon Medicaid, would not pay for an out-of-hospital birth. Most women can't afford to spend hours researching options and then planning and paying for travel, alternative housing, and child care, or mustering up the money for an out-of-hospital birth or private insurance.
Blevins ultimately scraped together the funds to pay for a few months of private insurance and had a healthy vaginal birth at the birth center. Then she hired a lawyer and appealed the Oregon Health Plan's policy on behalf of other low-income women in the state. You cannot tell what kind of cut was made in the uterus by looking at the scar on the skin. Medical records from the previous delivery should include this information.
It is a good idea to get your medical records of your prior cesarean delivery so your obstetrician-gynecologist ob-gyn or other health care professional can review them. VBAC should take place in a hospital that can manage situations that threaten the life of the woman or her fetus. Some hospitals may not offer VBAC because hospital staff do not feel they can provide this type of emergency care.
You and your ob-gyn or other health care professional should consider the resources available at the hospital you have chosen. If you have chosen to try a VBAC, things can happen that alter the balance of risks and benefits. For example, you may need to have your labor induced started with drugs or other methods. This can reduce the chances of a successful vaginal delivery. Labor induction also may increase the chance of complications during labor.
If circumstances change, you and your ob-gyn or other health care professional may want to reconsider your decision. The reverse also may be true.
For example, if you have planned a cesarean delivery but go into labor before your scheduled surgery, it may be best to consider VBAC if you are far enough along in your labor and your fetus is healthy. Fetus : The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.
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