Questionafter having c-cereans,what are my chances of finding a doctor who will let me have a vback delivery? even at the risk,is'nt the overall decision left up to me?
AnswerDear Shirley,
V-BACs (Vaginal Birth After Cesarean) do carry a certain amount of risk. Doctors usually assess each woman on a case by case basis. Depending on your particular circumstances, you may be a good candidate, but you will need to talk to your physician about it.
For example, a woman who has already had an easy vaginal delivery and then had a C-section when her next baby was breech is much more likely to have a successful VBAC than one who had a C-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)
According to the American College of Obstetricians and Gynecologists, you're a good candidate for a vaginal birth after a C-section if you meet all of the following criteria:
-You've had only one previous cesarean delivery and it was done with a low transverse (horizontal) incision. Having had more than one C-section or an incision in your upper uterus that was vertical - also known as "classical" - or T-shaped puts you at a greatly increased risk for uterine rupture. Note that the type of scar you have on your belly may not match the one on your uterus, so your practitioner will need to review a copy of your C-section report.
-Your pelvis seems large enough to allow your baby to pass through safely. (While there's no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)
-You've never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
-You've never had a uterine rupture.
-You have no medical condition or obstetric problem that would make a vaginal delivery risky.
-There's a physician on site who can monitor your labor and perform an emergency C-section if necessary.
-There's an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.
It's impossible to predict with any certainty which women will achieve a vaginal delivery and which will end up with a repeat C-section. Overall, about 60-80% of women who attempt a VBAC will successfully deliver vaginally.
Even if you're a good candidate for a VBAC, there's a small risk (about 1 in 100) that your uterus will rupture at the site of your C-section incision, resulting in severe blood loss for you and possibly oxygen deprivation for your baby. The risk of uterine rupture is somewhat higher if your labor needs to be induced or augmented.
Also, if you end up being unable to deliver vaginally, you could endure hours of labor only to have an unplanned C-section. And while a successful VBAC is less risky than a scheduled repeat C-section, an unsuccessful VBAC requiring a C-section after the onset of labor carries more risk than a scheduled C-section. With an unplanned C-section after laboring, you have a higher chance of surgical complications, such as excessive bleeding that could require a blood transfusion or a hysterectomy in rare cases and infections of the uterus and the incision. And the risk of complications is even higher if you end up needing an emergency cesarean.
Finally, there is the risk of the baby having a serious complication that could lead to long-term neurological damage or even death. While this risk is very small overall, it's higher in women who undergo labor before a C-section.
There are advantages to a vaginal delivery, but after you have had a C-Section, it does make it a more complicated situation. It is being done more often but doctors are pretty much obligated to follow the guidelines set by various national organizations like the AMA and ACOG to protect themselves as well as their patients.
I hope this information has helped you and answered your questions. I wish you well.
Brenda
