If your obstetrician delivered your last baby by caesarean section, you may wonder whether trying for a vaginal birth is a good idea when your next baby comes.
Many women do it, but there are risks.
The greatest concern is that the scar on your uterus could come open during labor. It’s a serious complication that requires emergency surgery. And it’s dangerous for both you and your baby.
“After one C-section, there’s less than a 1 percent chance for a uterine rupture, but that level of risk is acceptable,” says Jeff Chapa, MD, Head of the Section of Maternal-Fetal Medicine in Cleveland Clinic Children’s Hospital Department of Obstetrics and Gynecology.
“After two C-sections, your level of risk goes up to 1 to 2 percent, and at that point, most physicians would recommend a repeat C-section,” he says.
You and your doctor should discuss three key questions before you decide whether to try a vaginal birth with your next baby.
If you had a successful vaginal delivery before or if there was a nonrecurring reason for your caesarean, then it’s likely that you can try a vaginal birth the next time.
“Nonrecurrent indications, such as breech presentation [when the baby is bottom-first instead of head-first] or fetal distress, give you a favorable chance to deliver vaginally in a subsequent pregnancy,” says Dr. Chapa.
However, if the problem is likely to happen again — such as arrest of labor, where you tried to labor but the baby would not come out — it could mean the shape of your pelvis cannot accommodate a vaginal delivery.
“If your labor didn’t progress and you had to have a C-section, you’re more likely to have the same thing occur in a future pregnancy,” says Dr. Chapa.
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Doctors typically use two basic types of incision — transverse (horizontally across your uterus) or classical (vertical). The type of incision figures into the decision on whether it is safe for you to attempt labor for your next delivery.
“If you had a low transverse cesarean section, meaning the incision on the uterus was in the lower segment — which is how most C-sections are today — then it’s safe to have a trial of labor,” Dr. Chapa says.
However, there is a much higher risk that your uterus will rupture if your surgeon used a classical (up and down) incision on the uterus. Though a transverse incision is generally preferred, doctors sometimes still use classical incisions, especially in emergencies or when the baby is extremely premature.
If you aren’t sure which type you had, you can find out by asking for a report from your delivery.
Although there is no perfect predictive model, there are several other risk factors that make a successful vaginal birth after cesarean section less likely. You are at great risk to end up with a failed trial of labor if you:
It’s a good idea to talk to your doctor about delivery options early in your pregnancy.
You’ll want to discuss:
The conversation should continue throughout your pregnancy. If circumstances change, you may need to adjust your plan.
It’s important to think carefully about what you feel is right for you. “This is an individual decision and one you should make based on your own history and preferences, concerns and beliefs,” says Dr. Chapa.
“It’s a decision you should make along with your doctor; if a family member or friend had a vaginal birth after C-section, that doesn’t mean it’s necessarily the way to go for you,” he adds.
He says it’s fine to try a vaginal birth after C-section. However you should know that the risk for surgical complications is somewhat higher with a C-section performed after a failed trial of labor than if you choose a repeat cesarean section.