Vaginal Birth After Cesarean Delivery (cont.)
IN THIS ARTICLE
Factors Affecting Whether a Woman May Be Offered an Attempt at VBAC
Factors affecting whether a woman may be offered an attempt at VBAC include the following:
Women should be counseled about the risks of a trial of labor, such as rupture of the uterus. Uterine rupture can occur in up to 1% of cases (in which the uterine incision was a low-transverse incision).
With uterine rupture, other complications can occur:
Women attempting VBAC are closely monitored 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 can be a sign of uterine scar separation.
The decision to undergo a trial of labor after cesarean delivery should be carefully made between the woman and her doctor. The doctor will review the medical information on the woman's previous deliveries (both vaginal and cesarean) and estimate her risk for uterine rupture with her current pregnancy.
If possible, the doctor will avoid inducing labor with prostaglandin agents (used for cervical ripening) as these have been associated with an increase in the risk of uterine scar separation. Inducing labor when the cervix is dilated or with oxytocin (Pitocin) does not appear to increase the risk of uterine scar separation.
Harish M Sehdev, MD
Bryan D Cowan, MD
Mary L Windle, PharmD
Lee P Shulman, MD
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