Vaginal Birth After Cesarean Delivery (cont.)
What factors affect whether a woman may be offered an attempt at VBAC
(vaginal birth after C-section)?
Factors affecting whether a woman may be offered an attempt at VBAC include:
- If a doctor has experienced complications with other women attempting VBAC,
he/she may be reluctant to recommend a trial of labor. Women who wish to
attempt a trial of labor should factor this consideration into their choice of a
- ACOG guidelines require the presence of an obstetrician,
anesthesiologist, and staff capable of performing an emergency cesarean delivery
during a woman's entire active phase of labor. Academic centers and larger
community hospitals typically offer such services. However, smaller
hospitals with a lower obstetrical volume may not be able to justify these
requirements. So this requirement is more difficult to comply with in smaller
hospitals. For women who want a trial of labor after C-section, this factor must
be acknowledged in their choice of a hospital.
- If the reason for the initial
C- section is recurrent in subsequent pregnancies (for example, very small
maternal pelvic dimensions), then an attempt to have a VBAC is inadvisable and
may be dangerous to both mother and baby.
- Some women may not be a candidate for
a vaginal birth after a prior cesarean delivery if the uterine incision was not
a low-transverse incision. In cases in which the uterine incision
included the upper muscular component of the uterus, attempting a vaginal
delivery is associated with a greater risk for uterine scar separation and an
increased risk of fetal and maternal death.
- Women should be counseled regarding the
risks of a trial of labor following a previous C-section. Uterine rupture
can occur in a small percentage of cases in which the uterine incision was of
the low-transverse variety.
- Women attempting VBAC should be
monitored closely during labor. Signs of uterine rupture can be difficult to
detect, and at times, a rapid change in the fetal heart rate or loss of
contractions on the monitor represents the first sign of a uterine rupture.
The decision to undergo a trial of labor after cesarean is serious, and it
should only be made after a complete discussion of this option between the
patient and her doctor. The doctor will review the medical information in regard
to woman's previous deliveries (both vaginal and C-section) and subsequently
estimate her risk for uterine rupture during her anticipated labor.
Medically Reviewed by a Doctor on 4/1/2016
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