Can I have a normal delivery after Caesarean section?

Childbearing is the joy of every expectant mother as they bring forth new beings into the world.

Women have the right to choose their preferred mode of delivery and are better placed in making the right decision once they are well informed by their gynaecologists.

Dr Felix Oindi answers the common questions most women wishing to go for vaginal delivery after caesarean section have;

Is it possible to have a normal delivery after Caesarean section?

Yes, it is possible. after an initial Caesarean section. It is also possible after two C-sections though the risks are much higher. The success rate of vaginal birth after C-section, also known as VBAC, is about 70 per cent and this increases to about 90 percent in those with a previous normal delivery especially if it was a successful VBAC.

Can I decide to have a vaginal birth or I have to consult a doctor?

First, you need to decide before consulting the doctor. The doctor will then assess your suitability. A motivated mum will usually have better outcomes overall.

What are the benefits of having a normal delivery?

Normal delivery is associated with a quicker recovery. The need for pain relief medication is also much less compared to C-section. Moreover, successful VBAC increases the chance of future normal deliveries.

What are the risks?

The main complication associated with VBAC is the uterus giving way, otherwise known as uterine rupture. This occurs in one in 200 women following a single previous C-section and about one in 50 women following two previous C-sections. This can be detected early and managed with no bad outcome for the mother or baby.

How do I know I can undergo vaginal delivery?

When you are expecting a single baby, who is presenting with the head down (cephalic presentation) with a history of a single caesarean delivery at term.

You are also a good candidate if the Caesarean section was due to an abnormal presentation of the baby such as ‘bottoms down’ (also known as breech presentation) or if it was due to the baby ‘getting tired’ (otherwise referred to as foetal distress).

Does that mean I can be a bad VBAC candidate?

Yes. You are not suitable for a planned VBAC if you have had a uterine rupture in a past pregnancy or if vaginal delivery is deemed too dangerous for you. This could be due to a low lying placenta covering the cervix (otherwise known as major placenta praevia) or if you have undergone many operations on the uterus.

Normal delivery will also be too risky if the baby is in an abnormal position (such as breech or transverse), in presence of features of a compromised or growth-restricted baby and if the baby has some abnormalities which can be detected by an ultrasound. In this case, a caesarean section will be the preferred mode of delivery.

What if I’m expecting twins?

It is possible to have a normal delivery especially if the first twin is head down (or in the cephalic presentation). However, you will require a very high level of monitoring due to high risks. This is why most mothers expecting twins will opt for planned caesarean delivery.

Having undergone a C-section before, how can I prepare for a VBAC?

First, identify a good hospital to have your delivery done safely. The hospital should have the ability to perform emergency caesarean delivery and should readily access blood and blood products in the event of a uterine rupture. It should also be able to continuously monitor the baby during labour. This will help in the early detection of uterine rupture before the baby gets compromised.

What are the risks likely to occur in case of an emergency delivery at home?

You should come to the hospital as soon as you start experiencing low abdominal pains or labour. This is to enable close monitoring and preparation in the event emergency care is needed. The complications to the baby and mother are more when you delay accessing emergency Caesarean section services.

Dr Oindi is a consultant obstetrician gynaecologist in the Department of Obstetrics and Gynaecology at Aga Khan University Hospital Nairobi