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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 physician.
  • 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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