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Dr Bronwyn Moore (gynaecologist) answers:
It is possible to deliver vaginally –Vaginal Birth After Caesar (VBAC) – in certain circumstances after having had a caesar. There are certain situations were this is not advisable, and there is some risk associated with it. The biggest risk is scar rupture which is life threatening to both mother and baby. This risk can be minimised with appropriate care, but even with the best care problems can develop. To consider a VBAC you must only have had one previous uterine incision. The caesar cut on the uterus must have been in the lower segment –if your previous caesar was a classical caesar the risk of scar rupture is much higher and VBAC is not recommended. The reason for your caesar must be ‘non-recurring’, so perhaps it was for a breech presentation but this baby is head down. There must be no other obstetric complications in this pregnancy, no breech presentation, no twins, no placenta praevia in order to be able to safely conduct a VBAC, you need to deliver in a hospital where there is immediate access to a theatre, an anesthetist and a gynae to do the caesar. You need to have a drip up and a catheter inserted to monitor for blood in the urine – a warning sign of scar dehiscence. There must be access to emergency blood. Your labour must start spontaneously (no induction), and progress appropriately with no augmentation. If your gynae does not have access to the facilities above then VBAC should not be considered. Discuss with your doctor your preferences, and ask questions to establish whether or not a VBAC may be an option.
