Is normal delivery possible after caesarean? Yes, say doctors

HIGHLIGHTS
  • Vaginal Birth After Caesarean (VBAC) can be adopted by any mother.
  • Fear of labour pain, according to the experts, can be dispelled by timely counselling.
Pregnancy
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It is said that "once a caesarean, always a caesarean." It is commonly believed that a woman who has undergone a c-section delivery will have to opt for the same method while giving birth to her next child. But medical experts are trying to dispel this myth.

According to them, Vaginal Birth After Caesarean (VBAC) can be adopted by any mother for her second or third birth if she wishes to avoid the complications of c-section delivery.

"Any woman with a previous caesarean section can attempt a VBAC. The majority of women, despite having a c-sect delivery, often prefer a vaginal delivery. Women are showing more courage towards this. It is safe and the established hospitals are providing full support to mothers who plan to go for a vaginal delivery," Dr Mukta Kapila, director, Obstetrics and Gynaecology, at Fortis Gurgaon, said.

Dr Rinku Sengupta, who had been associated with the Sitaram Bhartia Institute of Science and Research as maternity programme head, said that in recent times two out of three women with a previous c-section deliveries attempt a VBAC and almost 90 per cent of them are successful.

"Only pregnant women above the age of 40 are more at risk for stillbirths and unsuccessful VBACs. Careful consideration should be given to the timing of delivery in these cases," Sengupta said.

Sengupta explained that obesity is also a factor that could potentially increase the risk of uterine rupture and this can be a limitation for VBAC. She also pointed to a study that 85 per cent of normal weight women (BMI 18.5-24.9) achieved successful VBAC, while only 61 per cent of morbidly obese (BMI 40 or more) women achieved VBAC.

Kapila said that before opting for a VBAC, the history of the previous delivery needed to be considered.

"Under which conditions and circumstances, a caesarean was conducted – in emergency or breach – first needs to be identified. The mother, planning for vaginal delivery, should at least maintain a minimum gap of two years before opting for the second or third child," she stated.

Often c-section delivery leaves a scar in the uterus, which, according to the medical experts, is a vital factor to be considered before they suggest a VBAC.

According to the American Congress of Obstetricians and Gynaecologists (ACOG), some uterine scars (such as vertical scars which are now rare) are more likely than others to cause a rupture during VBAC.

"Therefore, it is important to show medical records of prior caesarean delivery so that doctors can assess viability for a VBAC in case of increased risk of uterine rupture. Sometimes women are discouraged from trying for a VBAC because of a thin scar," Sengupta noted.

However, when it comes to vaginal delivery, the first thought that crosses most womens' minds is of the labour pain which develops a fear of the VBAC.

"Everyone knows that labour is painful and even an epidural injection cannot make labour 100 per cent pain-free. But with proper physical and emotional support, continuous one-on-one presence of a skilled care provider or birth partner, and use of natural methods like warm showers, massages and exercises, most mothers cope very well with labour pain," Sengupta explained.

Also, the fear of labour pain, according to the experts, can be dispelled by timely counselling and talking about the benefits and less risk involved in VBAC.

Yet, there is always the chance that a VBAC might be called off at the last moment even if the mother didn't face any complications during pregnancy.

"A doctor may suggest an emergency c-section if complications occur during labour. If the baby is not able to tolerate labour or the contractions aren't effective in moving the baby down the birth canal, then a caesarean may be the best way to deliver the baby," Sengupta explained. Kapila said that it is the patient's decision that gets greater priority.

"There is no point in pushing a mother for VBAC if she is not mentally prepared or feels scared or delivery complications arise at the last moment. Although the doctors will recommend vaginal birth, the patient's life cannot be put at risk," Kapila said.

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