• Dr Peter Chew

Vaginal birth after caesarean section

My first pregnancy ended in caesarean section because my baby was in a breech position. I am now in the last trimester of my second pregnancy. The baby is in a head- down position. I am very keen to experience a normal vaginal birth. Can I try? What are the risks?

In general, vaginal delivery has physical and emotional benefits for mother and baby. They include:

· reduced blood loss,

· less post-delivery complications such as wound infection and pain,

· shorter recuperative period,

· decreased risks in future pregnancies of placental problems,

· positive emotional experience of achieving a vaginal delivery.

But for a vaginal delivery after caesarean section (CS), one has to consider the risk of uterine scar rupture. A CS scar in the uterus is the weakest part of the womb. The stretching that occurs during pregnancy and the strong contractions of labour can cause the scar to become thin and split open, a condition called uterine rupture. It may be life threatening as it can cause massive bleeding and injuries to neighbouring organs like bladder and intestines. An immediate CS has to be done and blood transfusion and possible hysterectomy (removal of the uterus or womb) may be required to save the mother’s life. Sometimes, the baby may not be delivered in time and foetal death or brain injuries may occur.

Luckily, the incidence of uterine rupture is low, occurring in 0.5% in spontaneous labour and increasing to 2% in induced labour using medications like prostaglandins or oxytocin. Research has shown that women who try to deliver vaginally after a CS can achieve a success rate of 60-80 %

The choice of vaginal delivery after a CS has to be individualised. Your obstetrician may allow you to have vaginal birth if:

· You have an uncomplicated pregnancy,

· You have a lower segment CS,

· You do not have the same reason as for the previous CS.

To maximise your chances of having a vaginal birth, your obstetrician may

· Allow labour to start naturally without induction,

· Let your water bag break spontaneously,

· Avoid using medications to induce or ‘speed up’ labour,

· Monitor the foetal heart rate continuously and closely during labour.

Since you have expressed a desire to experience a vaginal birth after a previous caesarean section, you should consult your obstetrician and follow his/her advice.

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