A vaginal delivery after a previous caesarean section is an option for some women who wish to try for a vaginal delivery in a subsequent pregnancy.
There are strict guidelines that need to be followed.
There are some serious potential complications with having a V.B.A.C.
Each request needs to be considered on its merits assessing all potential risks. There are some women who have clear contra indications to any attempted vaginal birth. The risks and benefits will be discussed in every case.
Approximately 30% of all pregnancies will end in a caesarean section.
Some of these will be planned caesarean sections and some will be emergencies.
Some of the emergency caesarean sections will be for fetal distress and others because of cephalopelvic disproportion, C.P.D. (small pelvis / big baby).
Certain patients will have clear reasons why a V.B.A.C. should not be performed.
All women who have had C.P.D. or who have any other contraindication to a vaginal delivery should have elective repeat caesarean sections.
On the other hand those women who have a good prospect of a successful vaginal delivery can have an attempt at a V.B.A.C.
Factors to consider in every case:
- Previous complex past obstetric history.
- Estimated size of the fetus in the current pregnancy.
- Estimated pelvic size of the mother.
The risksof a V.B.A.C. are serious and include:
- Rupture of the uterus (1:200).
- Risk of major haemorrhage and blood transfusion.
- Emergency hysterectomy with permanent loss of fertility.
- Fetal distress, fetal disability and fetal loss.
- Bladder damage in the process of uterine rupture.
- Maternal loss.
The requirements for having a V.B.A.C. are:
- The pregnancy must be uncomplicated.
- Labour must start spontaneously. There is no place for induction of labour.
- Cervical dilatation needs to progress appropriately at a rate of about 1cm/hr, without augmentation of contractions.
- The second stage of labour should be less than 1 hr in duration.
The management guidelines for conducting a V.B.A.C. include:
- Regular vaginal examinations to confirm cervical dilatation is occurring.
- An intravenous line.
- Continuous fetal monitoring.
- Obstetrician near or on site.
All patients must be aware that if there is any reason for concern about the progress in labour or the condition of the baby that an emergency caesarean section will be performed.
As long as all the criteria are met, V.B.A.C. is an option.
Safety of the mother and baby are more important.
All risks, requirements and guidelines will be discussed in every case.
All patients requesting a V.B.A.C. need to sign a consent form.
A successful V.B.A.C. is great!