Vaginal Birth After Caesarian & Uterine Rupture
Vaginal Birth After Caesarian (VBAC)
After one caesarian section, there is an option to have a vaginal birth in the second pregnancy. This is referred to as Vaginal Birth After Caesarian Section or VBAC.
VBAC is advisable when there are no contra-indications for vaginal birth and when the size of the baby is deemed to be able to pass through the mother’s pelvis. As ultrasound estimation of the size of baby is never accurate, a trial of labour, referred to as a Trial of VBAC, may be needed to assess if the baby’s head can deliver vaginally.
The following is what I will advice if VBAC is contemplated
❖ there must not be any contra-indication for a vaginal birth
❖ the labour must not be induced with medication
❖ caesarian section will be needed if there is no spontaneous labour after the expected date of delivery
❖ the Trial of VBAC should not be prolong, exceeding 10-12 hours
❖ caesarian section will be needed if delivery is not imminent after a reasonable Trial of VBAC
❖ caesarian section will be needed when there is a suspicion of uterine rupture
This is a dangerous condition where the womb actually tears and gives way. It can result in death of the baby as well as the mother losing the womb. It usually happens to women with previous caesarian sections or fibroid surgery. In very rare instances, it can happen to apparently healthy women in their first pregnancy. Although the vast majority of uterine rupture occurs during labour, a very small percentage may occur before labour, in the third trimester.
When uterine rupture occurs in labour, there can be severe pain with a lost of regular contractions and/or fetal movement. In some cases, abnormalities of the fetal heart beat tracing precedes the uterine rupture. The treatment is an emergency caesarian section.
The risk of uterine rupture after one caesarian section is 0.7%. This risk can increase to 1.4-2.5% if the labour is induced with Prostaglandins and/or Oxytocin. The risk of uterine rupture after two caesarian sections is 1.0-3.7% and most doctors will not recommend vaginal birth after two caesarian sections.