Birth options after previous caesarean section
About this information
This information is for you ,if you have had one caesarian section and want to know more about your birth options when having another baby.
What are my choices for birth after one caesarian section?
If you have had a caesarian section , you may be thinking about how to give birth next time. Planning for a vaginal birth after caesarian (VBAC)or choosing an elective repeat caesarian section(ERCS)have different benefits and risks.
In considering your options, your previous pregnancies and medical history are important factors to take into account, including:
-the reason you had your caesarian section
-whether you have had a previous vaginal birth
-whether there were any complications at the time or during you recovery
-the type or cut that was made in your uterus(womb)
-how you felt about your previous birth
-whether your current pregnancy has been straightforward or whether there have been any problems or complications
-how may more babies you are hoping to have in future; the risks increase with each caesarian section, so if you plan to have more babies it may be better to try to avoid another caesarian section if possible.
What is VBAC?
VBAC stands for ‘’vaginal birth after caesarian’’. It is the term used when a woman gives birth vaginally ,having had a caesarian section in the past. Vaginal birth includes normal delivery and birth assisted by forceps or ventouse(vacuum cup).
What is ERCS?
ERCS stands for ‘’elective(planned)repeat caesarian section’’. You will usually have the operation after 39 weeks of pregnancy. This is because babies born after caesarian section earlier than this are more likely to need to be admitted to the special care baby unit for help with their breathing.(Of course ,if you have any complications during your pregnancy your doctor may need to do the c/s earlier)
What are my chances of a successful VBAC?
After one caesarian section ,about three out of four women with a straigthforward pregnancy who go into labour naturally give birth vaginally.
A number of factors make a successful vaginal birth more likely, including:
-previous vaginal birth, particularly if you have had previous successful  VBAC; If you have had a vaginal brth ,either before or after your caesarian section, about 8-9 out of 10 women can have another vaginal birth
-your labour staring naturally
-your body mass index(BMI)at booking is less than 30.
What are the disadvantages of VBAC?
-You may need to have emergency caesarian section during labour. This happens in 25 out of 100 women. An emergency caesarian section carries more risks than a planned caesarian section. The most common reasons for an emergency caesarian section are if your labour slows or if there is a concern for the wellbeing of you baby.
-You have a slightly higher chance of needing blood transfusion compared   with women who choose a planned second caesarian section.
-The scar on your uterus may separate and /or tear(rupture).This can occur in 1 in 200 women. The risk increases by 2 to 3 times if your labour is induced. If there are warning signs of these complications, your baby will be delivered by emergency caesarian section. Serious consequences for you and your baby are rare.
-You may need an assisted vaginal birth using ventouse or forceps.
-You may experience a tear involving the muscle that controls the anus or rectum(third or fourth degree tear)
When is VBAC not advisable?
-you have 2 and more previous caesarian deliveries
-your uterus has ruptured during a previous labour
-your previous caesarian was ‘’classical’’,i.e the incision involved the upper part of the uterus.
-you have other pregnancy complications that require a planned caesarian section
What are the advantages of ERCS?
-There is a smaller risk of uterine rupture(i in 1000)
-It avoids the risks of labour and the rare serious risks to your baby(2 in 1000)
-You will know the date of planned birth.
What are the disadvantages of ERCS?
-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 are more likely to need  a planned caesarian section in future pregnancies. More scar tissue occurs with each caesarian section. This increases the possibility of the  placenta growing into the scar ,making it difficult to remove during any future deliveries (placenta accreta or percreta).This can result in bleeding and may require a hysterectomy. All serious risks increase with every caesarian section you have.
What happens when I go into labour if I’m planning a VBAC?
Once you start having regular contractions  you will be advised  to have your baby’s heartbeat monitored continuously during labour. This is to ensure you baby’s wellbeing,since changes in the heartbeat pattern can be an early sign of problems with your previous caesarian scar. You can choose various options for pain relief, including an epidural.
What happens if I do not go into labour when planning a VBAC?
-If labour does not start by 40 weeks consider ERCS,after discussion with your doctor.
-I understood the risks of VBAC and the risks of ERCS,  if my doctor will have to perform it.
-I agree with the procedure as it was explained to me
-The doctor
-The patient
-The witness
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