The following is information regarding vaginal birth after a cesarean section (VBAC). This information is provided to mothers so they can make an informed decision on how to proceed after a previous cesarean section. This information is important and should be carefully considered while consulting with your obstetrician. Once you have weighed your options please initial and sign on the option you choose.
All mothers who have had one previous low transverse cesarean section are offered an attempt at a vaginal delivery. Prior to your delivery we must review the operative report from your previous cesarean and any other uterine surgeries you may have had. Once the reports are reviewed and it shows medically reasonable we will offer the trial of labor for a vaginal birth.
There are risks with both cesarean section and vaginal birth after a previous cesarean section. The lowest risk to mother and baby after a previous cesarean is an uncomplicated vaginal birth; however, there is a 1% chance of risk that the previous cesarean scar will rupture during the attempt. In the case of uterine rupture or placental separation, an immediate cesarean section may be necessary. If this were to occur some of the risks to the mother are bleeding, blood transfusion, infection or the need for a hysterectomy. There could also be risks to the infant, such as, hypoxia (lack of oxygen) and blood loss, which could result in brain damage and possible fetal death. The success rate for those attempting a vaginal birth after cesarean section is 60 to 80%.
Risks are also associated with a repeat cesarean section and scar tissue may have formed from the previous surgery. Some of the risks include bleeding, blood transfusion, infection, and damage to other organs, such as, the bladder or bowel. There also may be a need for repair or future surgery. There could be a slight risk if a cesarean section is performed after an unsuccessful trial of labor. If you have had multiple cesarean sections trial of labor can still be an option; however, the risk of uterine rupture increases with each cesarean section. Also with multiple cesarean sections the risk of the placenta abnormally attaching to the uterus increases and the potential need for a hysterectomy during the cesarean rises. There is little data supporting vaginal or cesarean after three or more prior cesarean sections, but it is strongly suggested that another cesarean section should be considered.
Repeat cesarean sections are generally scheduled for 39 weeks estimated according to your gestational age. If you present in labor the rupture of membranes, prior to this time frame, a cesarean section will be performed.