Mount Auburn Hospital - Great Expectations

About 1 in 3 or 4 babies are born by cesarean birth in the United States today. In a cesarean birth, the baby is delivered by making surgical incisions through your abdominal wall and uterus. Cesarean births are considered major surgery requiring some type of anesthesia. Infection, bleeding, and wound complications occur more often with cesarean births.

CESAREAN BIRTH

Other factors that may support TOLAC/VBAC include: • Prior vaginal birth • Reason for past cesarean doesn’t happen again • You’re under age 40 • Labor starts naturally, not with medication or another method Factors that may not support this option include: • Multiple cesarean births in the past • Obesity • Additional medical complications • Pregnancy over 40 weeks • Baby estimated to weigh more than 9 pounds • Preeclampsia • Augmented or induced labor

There are a number of reasons for cesarean births. Some of these may be known before labor starts, but many only come up after labor begins and progresses. Any of the following conditions — or a combination — can lead to cesarean birth:

• You’ve had a previous cesarean birth • The baby is not tolerating labor well • The baby is in an abnormal position • The baby’s umbilical cord comes out first • The placenta separates too early • You have a specific medical condition

Recovering from a cesarean birth may cause you to stay a day or two longer in the hospital. You may also need to take it easy for several additional weeks before resuming normal physical activity. Before you leave the hospital, you will receive instructions on how to care for your incision. You will also receive instructions about how active you can be while you recover. VAGINAL BIRTH AFTER CESAREAN (VBAC) Common wisdom used to be that once you had a cesarean birth, any future babies should also be born by cesarean. But VBAC may be an option for some people. VBAC has been linked to a shorter hospital stay along with a speedier recovery and return to normal activities. Attempting a VBAC is sometimes referred to as a trial of labor after cesarean (TOLAC). According to the ACOG, as many as 8 out of 10 pregnant patients who plan a TOLAC are able to have a vaginal birth. IS TOLAC/VBAC AN OPTION? The first factor that your health care provider will look at when evaluating you for TOLAC/VBAC is the type of incision made in your uterus during your previous cesarean birth. People who had a low transverse uterine incision (also called a side-to-side or horizontal incision) are the most suitable candidates for TOLAC/VBAC. Why? Because this type of uterine incision is the least likely to rupture during labor or birth. This information can be found in your past medical records.

Uterine Rupture Risk

Although it is relatively rare, patients attempting a VBAC need to understand that they may be at risk for uterine rupture. Uterine rupture happens when the scar from your previous cesarean procedure tears or opens up in response to pressure from the baby moving through your birth canal. Carefully monitoring the baby’s heart rate, the shape of your abdomen, and your blood pressure can help your birth team detect a uterine rupture. If it happens, you will need to have an emergency cesarean birth to prevent excessive bleeding and distress to the baby, which can be life-threatening.

MAKING THE DECISION Many health care providers now offer TOLAC/VBAC as an option for their patients, although some do not. If you are interested, you’ll need to talk with your provider and decide together if this is a safe option for both you and your baby. Having a health care provider who supports this decision can improve your chances of having a VBAC. Other helpful tips include using a doula and writing both a VBAC birth plan and a cesarean birth plan. If you need to talk about your previous birth and work through your feelings, you may want to contact a counselor or trusted advisor early in your pregnancy.

Your Guide to A Healthy Pregnancy

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