There used to be an old adage, "Once a cesarean always a cesarean."
Nowadays practitioners, women, and researchers are finding that this is not always true.
Current research shows us that the reasoning behind the adage, that a uterus that had a previous incision was too weak to withstand labor — is not a fact. In fact, over 86% of women who have had a previous cesarean can have a subsequent vaginal birth.
Why would I want a vaginal birth?
A vaginal birth has many advantages over a planned repeat cesarean surgery.
What about uterine rupture?
This is a common fear among women who have had a previous cesarean. Most of this fear dates back to when the incisions of the original cesarean were of the classical variety (vertical incisions). Nowadays, most incisions are the low transverse type. There are two types of uterine rupture: complete and incomplete.
Complete uterine rupture is very unlikely today, for a variety of reasons. One is that when we use Pitocin, if needed, during a labor, we regulate the amount that goes in. In other times it was given IV to a woman and allowed to flow freely. These have also decreased due to some obstetrical practices being abandoned, like high forceps, internal version, etc. And the final reason is because of the rarity of the classical incision. A complete rupture occurs in far less than 1% of women attempting VBAC.
Incomplete rupture (dehiscence) occurs about 1-2% of the time. However, these women are usually asymptomatic, and neither mother nor infant require any assistance.
"True uterine rupture is often sudden and associated with pain, blood loss and fetal morbidity. It is most commonly seen in spontaneous or traumatic rupture of the unscarred uterus. It also has been associated with classic uterine scars, often occurring without. Conversely, uterine dehiscence in partial separation of the uterine wall that is usually asymptomatic and rarely contributes to fetal or maternal morbidity. This is often the type of separation seen in lower segment scars, and usually occurs during labor. Often asymptomatic windows are incidentally noted at the time of repeat cesarean section," says Dr. Robert Silver, in OB/GYN Secrets, edited by Wilkins-Haug and Fredrickson.
How do I know if I'm a candidate for a vaginal birth?
The only criteria you must meet in most circumstances is that you are willing to have a vaginal birth, you have a lower segment incision on the uterus (You have to ask the physician who did the surgery because the outside incision is not always the same as the internal incision.), and you have a non- repeating factor for the previous cesarean surgery.
What do you need to know to attempt a vaginal birth after a previous cesarean?
There is basically no difference. Women who are having a vaginal birth after a cesarean will be treated the same as other pregnant mothers, with the exception of possibly more monitoring during labor, depending on the physician. You may still have pain medications and medications to induce labor (Pitocin, prostaglandin, etc.).
I encourage you to read as much as possible about labor, birth, and VBAC as possible. Hiring a doula or labor support person might be useful. Expect that you may have certain feelings come up in labor (fear or giving birth, being stuck where you were with the previous cesarean, etc.) and be prepared to handle them. Consider going to support groups for women who have had a cesarean, like the International Cesarean Awareness Network.
Good luck and good birth!
