Options for Delivering a Baby After a C-section

For nearly a generation, the majority of women who have had cesarean birth have been told by the medical establishment that any future births will also have to be C-sections. This advice was based primarily on the belief that a VBAC – vaginal birth after cesarean- might cause the scar from the previous cesarean to rupture. The American College of Obstetrics and Gynecology (ACOG) now says that statistics show there is less than a 1% chance of the scar rupturing, so more women should be allowed to choose a VBAC rather than opting for a scheduled cesarean. This statistical change may be related to the higher frequency of lower risk ‘low transverse’ incisions now performed rather than the previously popular higher risk ‘vertical’ incision.
Because a C-section is surgery, the medical risks to the mother and baby are higher than with a vaginal birth. However, the risks associated with an emergency C-section are higher than with a scheduled cesarean. The new ACOG guidelines estimate that between 60 and 80 percent of women who attempt a VBAC will be able to deliver the baby vaginally, and that the rest will still need a cesarean procedure.
To mitigate the problems that may occur with an emergency C-section, the ACOG guidelines recommend that women who opt to try a VBAC should only do so in hospitals that are equipped for immediate emergency C-sections. Opponents of this particular recommendation claim since many rural hospitals do not have those types of resources, smaller hospitals will be more likely to completely ban VBACs. ACOG responds by encouraging these hospitals to help women find care in a place that can more appropriately accommodate the potential risks associated with VBAC. This writer suggests that opponents’ claims are invalid and have no basis in fact. If a smaller hospital can accommodate a planned C-section then resources are likely available for attempting a VBAC.
Giving women as many choices as possible about how they want to handle childbirth is a good thing. Keeping mothers and babies safe is also key, and medical professionals and women considering a VBAC have to weigh the risks and benefits and decide what the best course of action is in each case. Keeping in mind ACOG’s intent in the guidelines of providing for the safety of the mother and the child in VBACs provides women important information when looking into options for a safe delivery.