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Giving Birth After a Cesarean

In the minds of many a new mom, a C-section represents a failing mark in childbirth -- even more so if she has attempted to deliver vaginally after a previous surgical delivery, a practice called vaginal birth after Cesarean, or VBAC.

But it doesn't have to be that way. "I try to persuade women not to get caught up in the female version of machismo -- the idea that somehow she is something less of a woman if she can't deliver vaginally," says Michael F. Greene, M.D., director of maternal fetal medicine at Massachusetts General Hospital in Boston. "What is important is that both mother and baby are healthy."

In fact, although a vaginal delivery is often promoted as the ideal way to give birth, data show that, with women who've already had a c-section, a vaginal delivery is not always in the best interest of either mother or child. While VBACs can mean shorter recovery times and hospital stays, and a lower risk of infection, a growing body of research shows that they also up the risk for uterine rupture, a rare but potentially fatal complication. The latest study found that the chance of suffering this devastating complication is significantly higher among women whose labor is induced, as compared with those who have a repeat c-section. According to the research from the University of Washington in Seattle, the risk is a whopping 15 times greater if hormones called prostaglandins -- applied topically to ripen the cervix -- are used to trigger labor. (Oxytocin, the hormone given intravenously to induce contractions, boosted a woman's chance of uterine rupture five times.)

If you're thinking about attempting a VBAC, discuss the risks and benefits with your doctor and be sure that your hospital can perform an emergency c-section if the need arises. VBACs are best for women who have given birth vaginally before and who had a low transverse (horizontal) incision in the uterus. (Your medical records will have this information: The scar on your abdomen does not necessarily correspond to the incision in your uterus.) VBACs are safer when there has been more than 18 months between the c-section and the next delivery, according to a recent study from the Brigham and Women's Hospital in Boston. If you must have a repeat c-section, you can rest assured that it's probably for the best.

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