Health Take-Away: Vaginal birth after a cesarean section?

With a low-risk pregnancy and the appropriate care, a vaginal birth after c-section (VBAC) is relatively safe.

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All parents hope for the perfect childbirth experience. Yet, nature sometimes interferes and a cesarean section becomes necessary to ensure the safety of the mother or infant. A generation ago, women who had one c-section were told that all future births would necessarily be by c-section — not great news for mothers who faced major surgery with each new baby.

Today, the outlook is much more optimistic. With a low-risk pregnancy and the appropriate care, a vaginal birth after c-section (VBAC) is relatively safe. In fact, more than 70 percent of women with previous c-sections successfully delivered their next babies vaginally. Good candidates to attempt a trial of labor after a cesarean include women who've had one c-section or those who have had a vaginal birth followed by a c-section. The risk increases for women with multiple c-sections because the area along the incision lines of their previous surgeries is weaker.

In addition to their own medical history, women who hope to avoid another c-section have other important factors to consider. Top on the list is their obstetrician. Not all physicians will offer prenatal care and delivery for mothers who want the choice and will refer these patients to obstetricians with VBAC experience. And not all hospitals allow a woman to attempt labor after a cesarean because they can't guarantee that the right physicians and operating room teams are always available if an emergency c-section becomes necessary.

None of these barriers to a successful VBAC exist in our community. The physicians at Berkshire OB-GYN of BMC have both the expertise and the will to provide care for women who want the opportunity to try for a vaginal birth after a cesarean. And the operating rooms at Berkshire Medical Center function around-the-clock with all necessary medical specialties. At 25 percent, our c-section rates are lower than the national average of 31.9 percent — a point of great pride for physicians and staff at BMC's Mother Baby Unit.

That's because providing the care needed for a VBAC helps these mothers avoid the risks of abdominal surgery that can include scarring, bleeding, infection or injury to other organs located near the surgery. Recovering from a c-section can take from six to 10 weeks and include severe pain, no lifting or driving and all of the complications involved in trying to care for a newborn while recovering from a major surgical procedure. And with each subsequent c-section, recovery becomes more and more difficult.

Yet c-sections for low-risk deliveries remain alarmingly high worldwide. One out of every three babies is born by c-section — often unnecessarily. Studies indicate that at least half of these could have been avoided if mothers had received the kind of support and interventions that enabled them to labor a little longer.

These are among the many reasons why major medical organizations that oversee labor and delivery in the U.S. have mounted national campaigns that seek to lower the rate of primary c-sections, and provide awareness about the success of VBAC for most women.

And above all, the vast majority of mothers hope for an uncomplicated vaginal birth, even after a previous c-section. As obstetricians, our goal is to always do our best to help them achieve it.

Lauren B. Slater is a physician at OB-GYN of BMC.


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