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There are plenty of reasons your first birth may have been a C-section. If you’re planning a second or third birth, you may have heard that must be a C-section, too.
For a time, that was close to the truth.
But in recent years, medical restrictions on giving birth vaginally after a C-section have eased. Florida Hospital for Women is invested in supporting women who want to attempt a vaginal delivery for their next child.
“The pendulum has swung toward attempting a vaginal birth after C-section, and we advocate giving women the facts around their options and supporting them, whatever they choose,” says Lori Boardman, MD, chief medical officer and executive medical director of the Florida Hospital for Women.
It’s called a “trial of labor,” and it’s a “safe and suitable choice for most women who have had a prior cesarean delivery,” according to the American Congress of Obstetricians and Gynecologists.
Some hospitals and doctors do not accommodate trials of labor, due in part to the need to have an obstetrician available at all times. At Florida Hospital, obstetricians are always available so that surgical delivery is not your only option.
Each mother’s story of labor and delivery is different, and the journey of birth is ultimately a personal one. Our goal is to give you the information and support to make the informed choice that’s right for you and your baby.
Who is VBAC for?
Many women can choose to attempt a vaginal birth after a C-section, or VBAC, for their next pregnancy. A discussion with your doctor is the best way to learn whether you qualify, but women who are the best candidates for a successful VBAC generally:
- Have had no more than 1 to 2 previous C-sections
- Had a prior successful vaginal delivery after a C-section
- Had the most common type of incision used for prior C-section which is called a low transverse incision
Each woman’s situation — her medical history, personal risk factors and goals for delivery — is different, so a discussion with your doctor is the best way to determine if you’re a good fit for a trial of labor.
It’s also important to note that a trial of labor is not a guarantee labor will proceed naturally. Nationwide, between 60 percent and 80 percent of women who attempt a trial of labor will achieve a natural birth.
Those odds don’t necessarily hold for each patient, though. Depending on your circumstances, your attempt at a VBAC may be more or less likely to be successful, and that may weigh in to your decision to attempt a trial of labor.
Why consider VBAC?
While women typically have a choice about how they deliver, there are advantages to vaginal delivery. These include:
- Shortened recovery after birth
- Reduced risks that come with major surgery, like heavy blood loss or infection
- Decreased risk of requiring a hysterectomy
That said, there are risks of attempting a VBAC.
The greatest risk of a vaginal birth after a C-section is the higher risk of a rupture of the uterus, usually at the site of the scar from a previous C-section. This is a serious complication, and a major reason home birth is not recommended for women who’ve already given birth by C-section.
But even the heightened risk of uterine rupture is still low, occurring in less than 1 in 100 women who undergo a trial of labor. This risk can differ based on a woman’s prior obstetric history, so you should ask how these risks apply in your case. Finally, at Florida Hospital for Women, the clinical team closely monitors for signs of a uterine rupture. Doctors are always on hand to respond in the unlikely event one occurs.
Dr. Boardman believes each woman should be able to decide which delivery method is best for her based on discussions she has with her healthcare provider. Understanding the immediate and long-term risks and benefits both to her and her baby is critical to decision-making.
“For women who are good candidates for a trial of labor, I lay out the case for both options. Ultimately, however, the decision really lies in the woman’s hands,” she says, adding “It’s important to me that women feel they’re in control of their birth process.”
Dr. Boardman also makes a point to tell her patients they can change their mind. These discussions are best had in the months before delivery, as goals can change as the anticipated date nears.
Dr. Boardman’s philosophy on offering patients control whenever possible is part of Florida Hospital’s wider value system. Exercising choice through decision making leads to improved health and longevity.
Thanks to our deep pool of expertise, we’re ready to adapt if plans change and it becomes necessary to perform a C-section. Our goal is for mothers to be confident about their choice, because, in the birthing room as elsewhere, a positive attitude can strengthen the health of your mind, body and spirit.