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Can you have a natural birth after having two or more c-sections?


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2009-06-06 13:49:52
2009-06-06 13:49:52

Yes, you can, but it is something you should discuss with your obstetrician. First, you have to consider the reasons for the previous cesarian sections. If they were one time problems (breech presentation, placenta previa), then a vaginal birth is something to consider. If your previous cesarians were done for obstructed labor, a small pelvis, "CPD," dysfunctional labor, or other conditions which are likely to recur, it may not be a good idea. A uterus with a scar on it is much more likely to rupture (burst open) during labor, and this can cause fetal distress or death. However, even there is a less than 1% chance of this happening, it is still a possibility, and one with potentially catastrophic consequences. The type of scar is important. If you wish to attempt VBAC, you will want to make sure your previous surgeries were done with low-transverse incisions on the uterus. You cannot tell what sort of incision you had by looking at the scar on your belly--you need to consult the operative record or ask the doctor who performed it. A previous low transverse uterine incision does not cut into the body of the uterus, and is least like to rupture. A vertical, low vertical, or "classical" incision, which goes up and down on the uterus, and is performed for complicated presentation (transverse), prematurity (undeveloped lower uterine segment), unusual blood vessels, or scarring and/or adhesions from previous surgery, is much more likely to rupture, and is a contraindication to labor. Mind you, cesarean section also holds risks for the mother and baby. It is major abdominal surgery and has a maternal mortality rate 2 to 4 times that of vaginal birth. Cesarean births can lead to trouble bonding and breastfeeding. But, when compared to VBAC, the risks of maternal morbidity and mortality are similar. Most doctors will not induce someone with two previous cesarians (because of an even higher risk of rupture than natural labor), but will allow labor to proceed naturally in a hospital setting. If you wish to try and deliver vaginally after two cesarian sections, this should be done in a hospital (not birthing center) that can perform an immediate cesarian section in case of an emergency. If you've delivered vaginally prior to your cesarian section, this would increase the likelihood of a successful VBAC (vaginal birth after cesarian).

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