Once a C-Section, Always a C-Section?

By Maria Siu, DO, FACOG, Obstetrician/Gynecologist

Between 1970 and 2016, the Cesarean-section (C-section) rate in the United States increased from 5% to 31.9%. The belief in "once a C-section, always a C-section" is one of the reasons that the C-section rate has increased. However, in 2010, the National Institutes of Health recognized that trying vaginal birth after C-section was a reasonable option for many women with a previous C-section.

The benefits of a successful vaginal birth after C-section include avoiding a major abdominal surgery, lower risks of bleeding, infection, fewer complications for future pregnancies, and also a faster recovery compared to mothers who had an elective repeat C-section. Without C-section incision pain, patients can also take care of their little ones more comfortably.

It is important to remember that trying vaginal birth after C-section (VBAC) is not risk-free. The major concern for VBAC is uterine rupture or separation of a previous uterine scar. When uterine rupture happens, that can put the mother and the baby at risk. Emergent C-section is required at this time. Thankfully, the risk of uterine rupture is less than 1% overall.

So, how do you know if you should try VBAC?

Patients who have delivered vaginally before a C-section are good candidates for VBAC. As your body has successfully done a vaginal birth before, the labor process usually goes faster and is more likely to go into a successful VBAC. Patients who had a C-section because their baby did not come down during labor may not be the best candidates for VBAC.

There are many other factors to consider if you should try VBAC or not. Always discuss your options of trying VBAC versus having a repeat C-section with your doctor.

Does Pomona Valley Hospital Medical Center (PVHMC) support VBAC?

Yes! Not every hospital can perform VBACs. Hospitals that offer patients the option for VBAC are required to have an obstetrician, an anesthesiologist, a neonatology team, and nursing/surgical staff on-site 24/7. PVHMC meets these requirements and provides comprehensive care for patients who decide to try VBAC.

Should you decide that you want to try VBAC and come to PVHMC for labor, you and your baby will be monitored continuously to ensure there are no signs of uterine rupture. During the labor process, if you feel labor is not going as smoothly as you’d like, you can always talk to your doctor about having a repeat C-section procedure. After all, the safety of you and your baby, as well as your delivery experience, are our highest priorities.

Reference: Vaginal Birth After Cesarean Delivery. ACOG Practice Bulletin. Number 184, November 2017.

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