Having a baby when you have had a Caesarean before
You have had a previous Caesarean section. This leaflet aims to give you information on your birth options in this pregnancy.
What are the chances of having a vaginal birth?
Many women who have had a Caesarean section can safely have a vaginal birth in a subsequent labour. This is known as Vaginal Birth after Caesarean section (VBAC). As long as there are no reasons not to, you will be offered and encouraged to try for a vaginal delivery. The evidence suggests that this is advantageous for you and has no significant adverse effect on your baby. Studies have shown that of those women who chose vaginal birth after Caesarean section, between 60 – 83% would be successful.
What are the risks of attempting a vaginal birth?
A mother who has had a previous Caesarean has a small risk of the womb (uterus) rupturing. This happens because the scar on the uterus tears open during the strain of labour; the risk of this happening is around 1 in 300 (0.35%). If your labour is induced the risk of scar rupture is higher at up to 2 – 3% (depending on the method used). However, you are more likely to need a Caesarean section for reasons other than scar rupture, e.g. the baby becoming distressed during labour or not making good progress.It is because of this small risk of scar rupture that you are advised to have your baby in hospital, with monitoring of your baby’s heart and facilities to perform an immediate repeat Caesarean if needed. If scar rupture occurs in the hospital setting the chances for you and your baby are excellent.The progress of your labour will be closely watched and if you are not making good progress a repeat Caesarean will be advised. You will be able to have an epidural during labour, if you wish.If you give birth vaginally you will have an even better chance of future vaginal births, avoiding the risks of a repeat Caesarean.
What are the risks of a repeat Caesarean section?
The evidence suggests that complications are more common after a repeat Caesarean section than following a vaginal birth. These include more blood loss, the need for a blood transfusion, infection of the uterus or wound, damage to bladder and bowel and clots in the veins of the legs (called deep vein thrombosis or DVT). The more Caesarean births you have the more difficult the operation becomes and the more likely it is that the placenta develops over the scar making it difficult to remove, resulting in excessive bleeding. Added to which there is the delayed recovery time following a repeat Caesarean. Rarely babies born by Caesarean may develop some difficulties with their breathing due to persistence of fluid on their lungs. This fluid would normally be squeezed out of the lungs during delivery through the vagina. It is for this reason that routine repeat Caesarean sections are not done until a week before your due date to try and ensure that the baby’s lungs are mature.There may be reasons to recommend a Caesarean section in this pregnancy, for instance a low lying placenta, a twin pregnancy, a baby coming bottom first (breech), a very difficult delivery last time or a cut on the upper part of the uterus instead of the usual lower part. It is accepted advice to perform a planned Caesarean if you have had two previous Caesareans.Both Caesarian and Vaginal birth have their advantages and disadvantages. These will be discussed with you and a birth plan will be made which is appropriate for your individual needs.Please feel free to seek further advice from and discuss any concerns with your midwife or obstetrician.
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