Can I have a 'normal delivery' after a C-section?

I am a 32 year old mother of two. I had an emergency cesarean section when delivering my son, 5 years ago, after I developed labour complications. I am now three months pregnant and I do not want to have another surgical procedure. My recovery after the C-section was prolonged and painful. I wish to have a ‘normal delivery’ just as I did with my first born. Is this possible? I plan to deliver in hospital so if there are any complications during labour my doctor can take me to theatre. What do you think is the best way forward?
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First, congratulations on your latest pregnancy. It is your blessing. Now, it is important to make an informed decision when it comes to deciding whether to undergo a trial of labour after a C-section. Several factors are considered before a woman attempts a vaginal delivery after a c-section:

Maternal factors

Baby spacing: Ideally, more than two years should have elapsed between the pregnancies.

Mother’s general health: ideally, the mother should be in good physical condition. Any health problem e.g. poorly controlled high blood pressure, can lead to life threatening complications during the trial of labour.

Uterine growths: The mother should not have growths in her womb that may hinder normal delivery. For example, a huge fibroid at the cervix can lead to obstructed labour.

Number of C-sections: Trial of vaginal delivery is safest in women who have had only one previous C-section.

Labour issues: Trial of vaginal delivery is best done in women who have spontaneous labour (as opposed to women who need medication to trigger labour). Labour should also progress normally.

Previous vaginal deliveries: Trial of labour after C-section is more successful in women who have had a vaginal delivery previously.

Baby factors

Number of babies: Ideally, it is safest to try vaginal delivery in women who are carrying one foetus as opposed to women carrying multiple babies.

Position of baby: The baby should ideally be in the head first position before onset of labour.

Location of placenta: The placenta should not be lying near or on top of the opening of the uterus. A placenta in these positions can lead to torrential bleeding during labour. The location of the placenta can be determined with the help of an ultrasound.

Large baby-small mother: Very large babies are not good candidates for trial of labour – especially if the mother has a small pelvis.

Previous pregnancy factors

Reason for C-section: The reason for the last C-section should be a once-off problem. For example, the baby was in the wrong position (just because that baby was malpositioned, it does not mean that this next baby will be in the wrong position).

Type of incision used by doctor in previous C-section: It is safest to try vaginal delivery in women whose womb had a low-lying cut from left to right as opposed to women whose cuts were made high in the womb or from top to bottom.
Although it is now standard procedure to make low-lying cuts, you can only confirm the type of cut made from your obstetrician (you cannot tell by looking at the scar on your belly).

Infection: If you had infection of the womb after your C-section delivery, there is a greater risk of complications developing during trial of vaginal delivery.

Risks of trial of labour

Uterine rupture: This is the greatest risk of trial of labour in women who have had a previous C-section. Although it is rare, it is important to know that it can happen. Uterine rupture often leads to torrential bleeding and can put both the mother and baby’s life at risk. A uterine tear can also lead to surgical removal of the womb (hysterectomy) to save the mother’s life.

Conversion to C-section

Trial of labour in women who have had a previous C-section must be done in a well-equipped hospital with the ability to take you to theatre immediately should complications arise.
The baby’s heart must be monitored throughout labour. You must always bear in mind that you could end up with a second C-section should your labour have any hiccups.

What should you do?

Start your antenatal clinics early. If you had a good experience with your obstetrician during your previous deliveries, use the same doctor. Get an ultrasound to determine how many babies you are carrying. It will also check for any growths in your uterus and the location of the placenta.

If you have any medical condition, get it under control. Inform your doctor about the health problem and the medication you are using for it.

Discuss, in-depth, with your doctor whether or not you are a good candidate for trial of labour. If you are not, then schedule an elective c-section.

Remember, the birth of a healthy baby with minimal health risks to you is the goal of pregnancy. The mode of delivery is secondary to that.