Delivery after a previous Ceserean Section

Women who have had a previous Ceserean Section (CS) usually have concerns about subsequent pregnancies and delivery implications. The common view that “once a CS always a CS” is not true. Each woman must have their individual circumstances reviewed before making a specific recommendation for subsequent deliveries.There are several medical reasons why a CS delivery may be advised. Women preference also comes into play, and it is not unusual for some patients to request a CS delivery for any number of non-medical reasons. It is important to be aware that even though a CS is very safe nowadays, it is still a major surgical procedure with some associated risks.

Women who have had a single CS for a reason that is not recurrent can opt to try a vaginal birth in subsequent pregnancies. This is commonly referred to as Vaginal Birth After Ceserean (VBAC). The biggest risk during VBAC is uterine rupture. This occurs when the scar on the uterus from the previous CS gives way during uterine contractions, posing grave risks to the mother and the unborn baby. The risk of uterine rupture is however very low, and may be suspected during VBAC with adequate monitoring.

Before opting for a VBAC, the reasons for the first CS must be carefully reviewed with the attending Obstetrician. There must be no medical reasons for a CS in the current pregnancy. As soon as labor commences, the woman must go to a hospital facility capable of carefully monitoring the labor. The facility must also have the resources to do an emergency CS should that become necessary. The ideal monitoring is a one-to-one midwife, and continuous electronic monitoring of the fetus and uterine contractions. Any deviation from the normal progress of labor must be carefully assessed.

Most women trying a VBAC, about 2 out of every 3, will achieve a successful vaginal delivery. Reasons for converting an ongoing VBAC to an emergency CS depend on the progress of labor and any fetal or maternal concerns. Once a VBAC has been successful, there is a higher chance of successful vaginal deliveries in any subsequent pregnancies.

What about induction of labor after a previous CS? It’s normally best to await spontaneous labor, as women who go into labor spontaneously have more chance of a successful VBAC. If induction is contemplated, there is a slightly increased risk compared to women with no previous CS, hence a detailed discussion is warranted.

If a woman has had more than one previous CS (2 or more), VBAC is usually not advised as the risks are higher. A planned CS is usually carried out at 39 weeks, if done earlier, there may be a small risk of transient breathing problems in the baby.