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Are C-Sections Really Necessary The Second Time Around?

It’s become almost standard practice for OB/GYNs these days to tell patients that if they’ve had one C-Section they will absolutely have to have another C-Section for subsequent deliveries.   Vaginal Birth After Cesarean, or VBACs are highly discouraged at most hospitals mainly due to fear of malpractice suits.  I was one of the fortunate few who were told by my doctor that there was no reason I couldn’t try a VBAC for the birth of my daughter.  Not only was I successful but it was the shortest and easiest labor of all my children.

The rate of C-Sections has grown dramatically and is extremely troubling for many health care professionals.   Because C-Sections have become so common place many women forget that this is still a surgical procedure and bring with it the possibility of serious complications.  Studies show that women who have C-Sections versus vaginal births have a greater chance of ending up back in the hospital after delivery with complications such as bleeding and blood clots.

On July 21, the American College of Obstetrics and Gynecology (ACOG) issued new guidelines recommending that hospitals allow most mothers who desire a VBAC to attempt a trial of labor, including some mothers who are carrying twins or have had two prior C-sections.  ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed.

There are several factors that determine whether a woman would be a good candidate for a VBAC:

  • If the previous caesarean(s) involved a low transverse incision there is less risk of uterine rupture than if there was a low vertical incision, classical incision, T-shaped, inverted T-shaped, or J-shaped incision.
  • A previous successful vaginal delivery (before or after the caesarean section) increases the chances of a successful VBAC.
  • The reason for the previous caesarean section should not be present in the current pregnancy.
  • The more caesarean sections that a woman has had, the less likely she will be eligible for VBAC.
  • The presence of twins will decrease the likelihood of VBAC. Some doctors will still allow VBAC if the twins are positioned properly for birth.
  • VBAC may be ruled out if there are other medical complications (such as diabetes), if the mother is over 40, if she is past her due date, if the baby is in the wrong position, etc.
  • For women planning to have many children, VBAC may be a better option because repeat caesarean sections get increasingly complicated with each subsequent caesarean section operation.

Ultimately, every woman should be allowed to make the decision as to whether to attempt a VBAC for herself after being provided full disclosure by her doctor.  Sadly there have been cases where hospitals ban VBACs and prevent women from making the decision that’s best for her.

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