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Once a Cesarean, Always a Cesarean?
- A woman's own experience
- The reason for the original C-section
- Her subsequent recovery
- Her overall health
- Her personal preference
- Her doctor's experience
Reducing the C-section Rate
Looking at VBAC
Examining the Reason for C-sections
- Fetal or maternal illness—This could make labor risky for mother and/or child.
- Fetal distress—This, too, can be controversial because fetal monitors can be misread and because normal readings are subjective.
- Labor that fails to progress—This means labor does not progress normally.
- Placenta previa —The placenta blocks the cervix and is at risk of detaching before the baby is born.
- Baby in breech position—When the baby's head will not come out first, it is safest to deliver the baby via cesarean section.
- Multiple pregnancy
- Cephalopelvic disproportion—This occurs when a baby's head is too large for the mother's pelvis. This is considered a controversial reason for C-section because the proportion is difficult to measure. Small pelvises do often accommodate large babies during labor.
- Infection in the mother
- Previous C-section
Getting the Experts' View
- Have had one or two previous cesarean with a low-transverse uterine incision—You cannot tell from the outside what type of incision you had in the uterus. You need to ask your surgeon. The low-transverse incision allows muscle tissue to knit a scar that is much stronger than the older types of incisions. However, it generally takes more time to do, so doctors are not always able to use this method in emergency situations. Women with a vertical incision should discuss whether a VBAC is appropriate, since data is mixed.
- Do not have any other uterine scars or ruptures, whether from previous cesareans or other surgeries
Making an Informed Decision
American Congress of Obstetricians and Gynecologists http://www.acog.org
The Canadian Women's Health Network http://www.cwhn.ca
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 115: Vaginal birth after previous Cesarean delivery. Obstet Gynecol. 2010 Aug;116(2 Pt 1):450-463.
Armstrong C. ACOG updates recommendations on vaginal birth after previous Cesarean delivery. Am Fam Physician. 2011 Jan 15;83(2):215-217.
Cesarean section. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 13, 2014. Accessed April 3, 2014.
Reasons for a Cesarean birth. American Pregnancy Association website. Available at: http://americanpregnancy.org/labornbirth/reasonsforacesarean.html. Updated January 2013. Accessed April 4, 2014.
Rossi AC, D'Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. Am J Obstet Gynecol. 2008 Sep;199(3):224-31.
SOGC Clinical Practice Guidelines. Int J Gynaecol Obstet. 2005;89:319-331.
Trial of labor after Cesarean (TOLAC), formerly trial of labor versus elective repeat cesarean section for the woman with a previous cesarean section. American Academy of Family Physicians website. Available at: http://www.aafp.org/dam/AAFP/documents/advocacy/workforce/scope/ES-TOLAC-0905.pdf. Published September 2005. Accessed April 3, 2014.
Trial of vaginal birth after cesarean (VBAC). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 17, 2014. Accessed April 3, 2014.
Vaginal birth after cesarean section. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq070.pdf. Updated August 2011. Accessed April 3, 2014.
VBAC: Vaginal birth after cesarean. American Pregnancy Association website. Available at: http://americanpregnancy.org/labornbirth/vbac.html. Accessed April 3, 2014.
- Reviewer: Michael Woods, MD
- Review Date: 04/2014
- Update Date: 04/03/2014