Is it possible to have a vaginal birth after a caesarean?

Although it’s often not recommended to have a vaginal birth a caesarean section, it’s very successfully performed in some cases.

What do the data show?

A caesarean section is the largest abdominal operation and requires two incisions. The first incision is made through the skin and the abdominal cavity and the second incision is made through the uterus to deliver a baby. Although it’s often a necessary procedure, in most cases to protect a mother, many women want to give a vaginal birth on their second pregnancy, if it’s possible. By 1988, only three per cent of women had a vaginal birth if their first delivery had been by a caesarean section. As 25% of babies in the USA were born by a caesarean section at that time, the National Health Institute and American gynaecologists started encouraging doctors to allow mothers to have a vaginal birth despite the fact that they already had a caesarean section. Today, there’s a well established practice according to which doctors allow every pregnant woman to give a vaginal birth under specific conditions, and if it becomes complicated, she has a repeat caesarean. 70% of women who delivered their baby by a caesarean section and want to give a vaginal birth the next time, have a successful second birth.

What influences doctor’s decision?

It depends on many factors whether or not a doctor will decide on a vaginal birth for a woman who previously had a caesarean section. If he largely had bad experiences in connection with this decision, he would probably recommend the mother not to have such a delivery. It’s very likely that a midwife and anaesthetist will also have to be present in an attempt of such a vaginal birth, as well as the personnel who are qualified to perform a caesarean section in case of any complications and despite the currently active course of delivery. Large hospitals always have qualified personnel available. As there might be complications, small hospitals and health care centres organise the required staff in advance. The doctor’s decision will also be influenced by the reason why the first delivery wasn’t a vaginal birth and thus a caesarean section was needed. Some women aren’t advised to have a vaginal birth because of the incision made during their first delivery. Namely, if the procedure also involved the upper part of the uterine muscles, a vaginal birth would increase the chances of expanding the scar on the uterus. That’s why it’s highly recommended that a woman consults in detail her doctor before giving birth because it can cause rupture of the uterus.

Rupture of the uterus

Rupture of the uterus is a rare, but very serious condition. It can cause hysterectomy, injuries to the urinary system, injuries to the brain of a baby in case of insufficient amount of oxygen, urgent transfusion, uterine infection or even the death of a mother or child. The cause of uterine rupture can be trauma, the child’s size or multiple pregnancies (twins, triplets, etc.). Women who want to give a vaginal birth and already had a caesarean are monitored closely during their delivery, and although it’s difficult to notice uterine rupture, sometimes a rapid heart rate can be the sign that the scar of the caesarean section has expanded. The method of delivery is always decided by a doctor after he examines the previous births of a woman and on that basis concludes what are her risks in case of that vaginal birth. It’s very likely that he’ll avoid using prostaglandins, that is, substances similar to hormones, which have many functions in the body and, among other, cause muscle tissue to contract and relax.

When is a vaginal birth successful?

A doctor will envisage that a vaginal birth will most probably be less successful for women who weigh more than 200 pounds (90kg) and women aged over 35 years. The success of a vaginal birth also depends on the size and weight of a child. A vaginal birth after having a caesarean section involves a higher risk and isn’t advisable if a child is big. The decision can also be influenced by the reason why the caesarean section was performed previously. If the position of a baby was incorrect during a delivery, that is, the baby was born with the buttocks and legs first, there are more chances to have a successful vaginal birth than in women who delivered every baby with a caesarean. If a woman had a vaginal birth previously, she has 89% chances to have another successful vaginal birth after a caesarean. If a caesarean section was followed by a vaginal birth, a woman has 93% chance to have another successful vaginal birth.