Planning a baby? Birth options after caesarean section

This article is for you if you had one caesarean section and is now looking for birth options for having another baby. This can also be helpful if you know someone in family or friends who would be in this situation. Caesarean sections also commonly known as C-Section (Due to the shape of the cut as “C”) are a very common one in five women give birth by C-Section currently, half of them are planned and the other half are unplanned or emergency cases. 

So, you had a previous C-section!

What are your Birthing options?

Broadly there are two options that you will have:

• VBAC (Vaginal Birth After Caesarean) or
• ERCS (Elective Repeat Caesarean Section)
  

Deciding factors for Birthing Options?

If you are generally fit and healthy than both VBAC and ERCS are safe options for you. The previous pregnancies and medical history are important factors to consider:

• Whether you have had previously given birth vaginally 
• Reason for previous C-Section
  
• Type of cut and place of cut that was made in your uterus
  
• Any complications at the time or during your recovery from a previous delivery
  
• Any complications during present pregnancy
  
• The thickness of the scar or cut at the time of delivery in present pregnancy
  
• How many more babies you are hoping to have in future. The risk increases with each C-Section so if you are planning to have more babies it would be advisable to avoid C-section if possible. 
  

Chances of successful VBAC

VBAC is giving birth vaginally after having had a caesarean section (C-section). Vaginal birth includes normal delivery or assisted delivery by forceps or vacuum cup. VBAC is common as presently three out of four women with normal pregnancy (without any complications) who go into labour naturally give birth vaginally. VBAC will be carried in the hospital only so that an emergency caesarean section can be carried out if needed.

There are a number of factors which increases the chances of successful VBAC:

• Your Body Mass Index (BMI) being less than 30 (BMI >30 is considered as obese)
• Your labour starting naturally
  
• Previous vaginal birth or previous VBAC. Having even 1 vaginal birth, either before or after C-section, increases your chances of next vaginal birth by 80%-90%.
  

Advantages of VBAC

Advantages of VBAC are more or less similar to the advantages of any vaginal birth which includes

• Shorter stay in hospital
• Faster recovery and getting back to everyday activities almost immediately
  
• Breastfeeding the newborn baby immediately after birth along with skin-to-skin contact
  
• Newer baby having fewer chances of breathing problems
  
• Greater chances of vaginal birth in future pregnancies
  
• Avoiding the risk associated with an operation 
  

Disadvantages of VBAC

• You may need to have an emergency C-Section during labour if your labour slows down or if there is any concern regarding the wellbeing of the baby.
•  An emergency C-Section carries more risk than planned C-Section.
• You have a slightly higher chance of needing a blood transfusion as compared to women choosing planned C-Section.
  
• There is a risk of scar separation or tear (rupture). This risk increase if labour is induced.
  
• You may need assisted vaginal birth using forceps or vacuum cup.
  
• You may experience a tear involving muscle that controls anus or rectum.
  
• The baby can have higher risk like that of brain injury or stillbirth than in cases of planned C-section. 
  

What happens if you do not go into labour when planning a VBAC

If the labour doesn't start by week 41, the physician might discuss the birth options again, which includes

• Continue to wait for the labour to start naturally
• Induction of labour; but this can increase the risk of scar rupture and lower chances of successful VBAC
  
• Plan for ERCS
  

What is ERCS

ERCS is Elective Repeat Caesarean Section (or Planned C-section). ERCS is sometimes an option that people can opt just out of their preference but in some cases, it is the only option available. Some of these situations are like:

• You have had three or more caesarean deliveries before.
• Your uterus has ruptured during a previous labour.
  
• The incision during previous delivery was on the upper part of the uterus or in other words, was ‘Classical’.
  
• The scar from previous delivery is not healed properly or the thickness of scar is less.
  
• The present pregnancy is not straightforward or you have complications that would need a planned caesarean section.

Advantages of ERCS

• There is a smaller risk of uterine scar rupture.
• It avoids the risk of labour and the rare risks to your baby.
  
• You will know the date of planned birth in most of the cases.
  

Disadvantages of ERCS

• The surgery will take a little longer than the first operation because of scar tissue. Scar tissues may also make surgery more difficult and can result in damage to your bowel or bladder.
• You can get a wound infection that can take several weeks to heal.
  
• You may need a blood transfusion.
  
• You may have longer recovery period post-delivery.
  
• You may have a higher risk of developing a blood clot (thrombosis) in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
  
• You may need a planned caesarean section (C-section) in future pregnancies as well.
  
• Breathing problems for your baby are quite common after C-section but usually will not last long.
  
• There are chances that the skin of the baby might cut during surgery but it usually heals without any further harm.
  

Key Take Away

• If one is fit and healthy, both VBAC and ERCS are safe choices with minimal risks.
• In 75-80% cases, the women with one caesarean section having a straightforward pregnancy and go into labour naturally will give birth vaginally.
  
• A history of even a single birth vaginally increases the chances of successful VBAC many folds.
  
• Giving birth vaginally have a lower risk for you and your baby and same follows in subsequent pregnancies.
  
• Having a caesarean section (C-Section) makes future births more complicated.
  
• Women opting for planned caesarean section recover well with heathy babies only thing is the recovery time post-delivery will be longer.
  

Whatever you choose for your second or subsequent pregnancies what is more important is that you make a conscious decision by knowing your medical condition, planning your present and future pregnancies, discussing and understanding options with your physician.

Happy Pregnancy!!