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Natural birth after a C-section: Can it work for you?

Posted 12/1/2016 by KATHERINE AUSTINSON, CNM
Certified Nurse Midwife, UH MacDonald Women’s Hospital
Clinical Assistant Professor, Case Western Reserve University School of Medicine

Katherine Austinson

Katherine Austinson, CNM

Just because you delivered one baby via cesarean section doesn’t mean you can’t try a vaginal birth for your next child. “Vaginal birth after cesarean, or VBAC, is recommended as a safe delivery option for most women,” says Katherine Austinson, a certified nurse midwife at University Hospitals MacDonald Women’s Hospital.

VBAC may be an option if you meet the following criteria:

  1. Your health provider supports VBAC.
    Not every facility offers VBAC. Your medical team will have to monitor you closely and be ready to perform another C-section if needed. And they’ll need to be prepared to treat rare but serious complications, such as uterine rupture.
    “UH MacDonald Women’s Hospital uses the latest evidence-based practices to provide the best labor and birth outcomes for moms and babies, including VBAC outcomes that are better than the national average,” says Austinson.
  2. You have no other health problems.
    “Some pregnancy-related complications or other conditions make VBAC more dangerous,” says Austinson. “This includes diabetes, obesity, heart disease and placenta previa, a condition that occurs when the placenta covers part of your cervix.”
  3. Your incision is in the proper location.
    Some types of uterine incisions are more likely to cause rupture of the uterus than others. Low transverse (side to side) incisions carry the least chance of rupture. Women who have had one or two previous C-section deliveries with this type of incision can try VBAC. However, VBAC is not recommended for women who have high vertical (up and down) uterine incisions.
  4. Your baby is in the correct position.
    Babies in the head-down position have an easier time passing through the vaginal canal. If your baby is breech or transverse, meaning the feet or shoulders are down and the head is up or to the side, you may need another C-section.
  5. The reasons you had a C-section the first time aren’t a factor.
    Some women end up having a C-section for medical reasons specific to that pregnancy. This includes breech births, multiples, and babies with certain birth defects or problems during labor.

If the same issues don’t affect your current pregnancy, VBAC may be a safe choice for you. But that wouldn’t be the case for women who had a C-section because of a chronic health problem or past surgery on the uterus.

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“The first step in deciding if VBAC is right for you is to have a discussion with your obstetrician or nurse midwife,” says Austinson. “Be prepared to talk about any medical problems, prior deliveries, and personal factors that may affect your ability or desire to deliver vaginally, including pain management options and your support system.”

In addition to the counsel that your obstetrician or nurse midwife provides, UH MacDonald Women’s Hospital offers a childbirth education class to help you prepare for vaginal birth after a C-section.

To request an appointment with a UH obstetrician or nurse midwife, call 1-866-UH4-CARE (866-844-2273) or visit UHhospitals.org. Learn more about childbirth education classes at UHhospitals.org/BirthClass.

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