Having a vaginal birth after a caesarean
Modern medicine now makes it possible to attempt vaginal birth after a caesarean, which used to be out of the question due to the risk of rupturing the scar. Here is all you need to know

You may have set your heart on a natural (vaginal) birth but ended up having a caesarean instead. Now you're pregnant again – should you consider trying for a natual birth this time round?

According to the American College of Obstetricians and Gynaecologists (ACOG) the risk of uterine rupture in a vaginal delivery is about 1 in 500 for a previous caesarean with a low transverse incision (bikini cut).

A textbook for obstetricians and midwives called A Guide to Effective Care in Pregnancy and Childbirth says that vaginal birth in these circumstances may be less risky than repeat caesarean section.

Vaginal birth after caesarean (VBAC)

Prepare yourself

If you are considering VBAC (vaginal birth after caesarean), research it carefully and prepare yourself well. Make sure you have a competent, experienced and supportive caregiver. Keep your expectations realistic – VBAC should only be attempted under ideal conditions and a repeat caesar may become necessary if complications arise.

A woman with potential complications should be discouraged from pursuing a VBAC rather than being given false hope.

VBAC is not always possible. Vaginal birth the second time around should only be considered if:

  • The mom has only had one previous caesarean – and it was a bikini cut.
  • There is no indication that a repeat caesarean may be necessary.
  • The baby is a reasonable size and presenting head first.
  • The hospital is adequately equipped to cope with an emergency.
  • Staff allocation allows for a doctor or midwife to be in attendance all the time.

VBAC should only be performed under certain circumstances:

  • VBAC should not be a home birth.
  • The pregnancy should not continue beyond the due date.
  • Labour should begin spontaneously and progress steadily (1cm per hour). It should be carefully monitored and recorded.
  • Some doctors and midwives prefer not to use an epidural for pain relief because it could mask the pain of a ruptured scar.
  • A drip is necessary to keep an open line should there be complications.
  • Urine is tested for blood. Sometimes the bladder is catheterised for regular sampling.

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