Birth After A Ceasarean Section

When 1 in 4 births in the UK are via caesarean section operation, for many parents-to-be a vaginal birth after a caesarean is something to consider and plan for in their new pregnancy.

Ultimately, it is your decision to have either a VBAC or an elective repeat caesarean section (ERCS). If you are fit and healthy, both are safe choices with very small risks.  What you decide to do may depend on several things. This includes your pregnancy history, your medical history and how your current pregnancy is progressing. 

VBAC

Reassuringly most women have a successful VBAC without any complications.  About 75% of VBAC’s are successful and baby is born without any complications. 

The benefits of a VBAC include:

  • a vaginal birth (which might include an assisted birth)
  • a greater chance of an uncomplicated normal birth in future pregnancies
  • a shorter recovery and a shorter stay in hospital
  • less abdominal pain after birth
  • avoiding surgery
  • easier breast feeding

There are some risks to be aware of – mainly that the scar from your previous c-section could tear. This is called uterine rupture.  Reassuringly uterine rupture affects just one in 200 women trying for a VBAC, and it is something your maternity team will monitor for closely during your labour through continuous electronic fetal monitoring. This will measure your baby’s heart rate and your contractions.

If your baby’s heart rate doesn’t sound right, it could be an early sign that there’s a problem with your scar. The team looking after you can then act quickly to keep you and your baby safe.

Because of the risks surrounding VBAC, your doctor is likely to recommend that you give birth at a unit that has an operating theatre and access to any other specialists you may need. Don’t be alarmed by this, it’s just a precaution to make sure you and your baby are in safe hands.

Your pain relief options during your VBAC will be the same as they would be for any other birth, including access to an epidural if you request it. Depending on your pregnancy history and your hospital, you may be able to use a birth pool to help you to cope with your contractions. Using a pool may mean it’s not possible to monitor your baby all the time. Some units have special continuous monitoring systems (telemetry), which have waterproof pads that attach to your tummy and work wirelessly.

A successful VBAC carries the lowest risk of complications. If you have a VBAC, you’ll avoid the risks associated with repeat caesareans and have a quicker recovery time.  You’ll also have a shorter stay in hospital and you should experience less pain and discomfort in the weeks and months after the birth.

If you are planning more pregnancies, then trying for a VBAC may help you to avoid future complications that are more likely after repeat caesareans, including placenta praevia, placenta accreta and hysterectomy.

 

Trying for a VBAC after one previous caesarean, instead of choosing a repeat caesarean, carries a slightly higher risk of some more serious complications, such as:

 

  • a blood transfusion
  • infection in your uterus
  • uterine rupture


However, these serious complications are not common, and the risk of them happening to you is very small.

The risk of complications is generally higher with an emergency c-section than with a planned c-section. The risk of serious complications for your baby is also very low and similar to a woman trying for a vaginal birth with her first baby.

ERCS

The alternative to a VBAC is a planned Elective Repeat Caesarean Section (ERCS).  The advantages of ECRS include:

  • A smaller risk of the c-section scar separating or tearing (1 in 1000). 
  • Knowing the date of planned birth. Although some women go into labour before this date and sometimes this date may be changed for other reasons.    

A repeat caesarean section usually takes longer than the first operation because of the formation of scar tissue. Scar tissue may also make the operation more difficult and can cause damage to your bowel or bladder.  Other risks include:

  • A wound infection that can take several weeks to heal. 
  • You may need a blood transfusion. 
  • You have a higher risk of developing a blood clot (thrombosis) in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
  • You may have a longer recovery period and may need extra help at home. You will be unable to drive for about 6 weeks after surgery (check with your insurance company).
  • You are more likely to need a planned c-section in future pregnancies
  • Breathing problems for your baby are quite common after a c-section but usually do not last long. This risk is slightly higher after a c-section than after a vaginal birth.

Planning and deciding on having a VBAC or an ERCS is a big decision for many and depends on many factors.  You don’t have to make it alone – your maternity team can help and advise you, often with a special appointment to discuss any concerns you may have.

As with any decision in pregnancy the choice is yours – you will not be forced into any decision and your informed consent is essential.  During our antenatal classes we discuss in detail how to advocate for yourself and using skills such as the BRAIN acronym to help you determine the best option for you and your baby.