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Vaginal Birth After Cesarean Section
Introduction
Vaginal Birth after Cesarean Delivery means that practice of delivering a baby vaginally (naturally) after a previous baby has been delivered through caesarean section (surgically).
A caesarean section leaves a scar in the wall of the womb, that makes uterine wall weaker than the normal uterine wall, so if the woman goes in labor in a subsequent pregnancy there is a higher than normal risk of a ruptured uterus. Because of increasing risk of normal vaginal delivery, most of the delivery after cesarean section was done by Re-cesarean.
The old concept "once a cesarean, always a cesarean." This concept is obsolete and should be change into "once a cesarean, always a hospital delivery."
Things to Consider about VBAC
Based on the epidemiological studies, showed that the number cesarean section in nineties was four times higher than sixties. Common indication for cesarean section: Dystocia, Fetal Distress, Malpresentation, and Uterine Scar.
There are several reasons why a woman may consider vaginal delivery compare to cesarean section, such as: shorter recovery period, lower risk of infection, and less blood loss. Also for women planning to have more children, VBAC may help them avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.
Based on the offering benefits from the vaginal delivery, recently VBAC is developed or promoted by the health providers for the pregnant women.
A woman who has had a previous cesarean delivery has the following choices when planning how to give birth again:
- She can have a scheduled cesarean delivery.
- She can try to have a VBAC. If a woman wants to try VBAC and is considered a good candidate.
From the women who undergo VBAC, about 60–80% succeed and are able to give birth vaginally. But if problems arise during VBAC, the baby may need to be born by emergency cesarean delivery. For example, if the baby is not tolerating labor, or if labor does not progress, an emergency cesarean delivery may be needed. There are more risks, such as a greater risk of infection, with having an emergency cesarean delivery after TOLAC than having a planned cesarean delivery. The least number of risks occur with a successful VBAC.
Vaginal Delivery after Cesarean
Old concept from Cragin (1916), once cesarean always a cesarean delivery, is obsolete, Previously the technique of cesarean section was done by vertical incision of the uterine wall, recently is done by lower transverse incision of uterine wall. The lower transverse incision carried the lower risk of uterine rupture compare to vertical incision.
Unfortunately, it's not possible to tell what kind of incision was made in the uterus by looking at the scar on the skin. Medical records from the previous delivery probably include this information. If medical records are not available, a woman should understand the risks associated with all three types of incisions. It is still possible to have a VBAC unless it is highly suspected that the incision is a high vertical incision.
Women with elective cesarean with previous history of cesarean delivery should be motivated to undergo sterilization, since there is an increased morbidity and mortality for the women with increased number of cesarean section.
In VBAC, the usage of induction or stimulation of uterine contraction is not recommended and maybe dangerous for the women.
Based on the report, the incidence of uterine wall rupture is quite high especially in the developing countries. In developed countries the incidence about 0-2%, compare to developing countries about 4-7%.
Selection for Vaginal Delivery after Cesarean Section
Patient Selection: in selecting the patient, we should know about the previous operation, VBAC is preferred for patient with lower transverse incision.
Contraindication for VBAC:
- Prolonged Labor (Dystocia), Malpresentation, Fetal Distress, and other conditions such as Placenta Previa, Cephalic Pelvic Disproportion, etc.
- Twin
- History of Uterine wall rupture
- unkown procedure of cesarean section, or High Vertical incision of uterine wall
Actually, there is no different between VBAC and normal delivery, but the observation and monitoring of uterine contraction and fetal condition is more intensive,
After all, the choice of delivery method is patient right or autonomy, and a medical provider should give a sufficient information to the patient, thus they could decide it well. A proper discussion with the medical provider is needed to get mutual understanding and agreement about the delivery method.
Vaginal Birth after Cesarean Delivery means that practice of delivering a baby vaginally (naturally) after a previous baby has been delivered through caesarean section (surgically).
A caesarean section leaves a scar in the wall of the womb, that makes uterine wall weaker than the normal uterine wall, so if the woman goes in labor in a subsequent pregnancy there is a higher than normal risk of a ruptured uterus. Because of increasing risk of normal vaginal delivery, most of the delivery after cesarean section was done by Re-cesarean.
The old concept "once a cesarean, always a cesarean." This concept is obsolete and should be change into "once a cesarean, always a hospital delivery."
Things to Consider about VBAC
Based on the epidemiological studies, showed that the number cesarean section in nineties was four times higher than sixties. Common indication for cesarean section: Dystocia, Fetal Distress, Malpresentation, and Uterine Scar.
There are several reasons why a woman may consider vaginal delivery compare to cesarean section, such as: shorter recovery period, lower risk of infection, and less blood loss. Also for women planning to have more children, VBAC may help them avoid problems linked to multiple cesarean deliveries. These problems include hysterectomy, bowel or bladder injury, and certain problems with the placenta.
Based on the offering benefits from the vaginal delivery, recently VBAC is developed or promoted by the health providers for the pregnant women.
A woman who has had a previous cesarean delivery has the following choices when planning how to give birth again:
- She can have a scheduled cesarean delivery.
- She can try to have a VBAC. If a woman wants to try VBAC and is considered a good candidate.
From the women who undergo VBAC, about 60–80% succeed and are able to give birth vaginally. But if problems arise during VBAC, the baby may need to be born by emergency cesarean delivery. For example, if the baby is not tolerating labor, or if labor does not progress, an emergency cesarean delivery may be needed. There are more risks, such as a greater risk of infection, with having an emergency cesarean delivery after TOLAC than having a planned cesarean delivery. The least number of risks occur with a successful VBAC.
Vaginal Delivery after Cesarean
Old concept from Cragin (1916), once cesarean always a cesarean delivery, is obsolete, Previously the technique of cesarean section was done by vertical incision of the uterine wall, recently is done by lower transverse incision of uterine wall. The lower transverse incision carried the lower risk of uterine rupture compare to vertical incision.
Unfortunately, it's not possible to tell what kind of incision was made in the uterus by looking at the scar on the skin. Medical records from the previous delivery probably include this information. If medical records are not available, a woman should understand the risks associated with all three types of incisions. It is still possible to have a VBAC unless it is highly suspected that the incision is a high vertical incision.
Women with elective cesarean with previous history of cesarean delivery should be motivated to undergo sterilization, since there is an increased morbidity and mortality for the women with increased number of cesarean section.
In VBAC, the usage of induction or stimulation of uterine contraction is not recommended and maybe dangerous for the women.
Based on the report, the incidence of uterine wall rupture is quite high especially in the developing countries. In developed countries the incidence about 0-2%, compare to developing countries about 4-7%.
Selection for Vaginal Delivery after Cesarean Section
Patient Selection: in selecting the patient, we should know about the previous operation, VBAC is preferred for patient with lower transverse incision.
Contraindication for VBAC:
- Prolonged Labor (Dystocia), Malpresentation, Fetal Distress, and other conditions such as Placenta Previa, Cephalic Pelvic Disproportion, etc.
- Twin
- History of Uterine wall rupture
- unkown procedure of cesarean section, or High Vertical incision of uterine wall
Actually, there is no different between VBAC and normal delivery, but the observation and monitoring of uterine contraction and fetal condition is more intensive,
After all, the choice of delivery method is patient right or autonomy, and a medical provider should give a sufficient information to the patient, thus they could decide it well. A proper discussion with the medical provider is needed to get mutual understanding and agreement about the delivery method.
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The normal physiologic delivery is depend on Passage, Passengger (the baby), and Power (Capability of uterine to do contraction).
In conclusion, the VBAC need more careful monitoring of the 3P, that should be done in the hospital