VBAC has its own set of risks. The most serious complication that can occur is a separation of a previous uterine scar (a uterine rupture) that, in rare instances, can result in excessive bleeding, the need for a hysterectomy, and even the death of the baby. However, a large proportion of what have been termed uterine ruptures is asymptomatic - that is, they have no medical consequences. The risk of uterine rupture during an attempt at vaginal birth after one prior cesarean section with a lower uterine horizontal incision is about one in one hundred, and the risk increases with the number of previous cesarean sections. (Uterine rupture can occur in the absence of scars on the uterus from a previous cesarean. However, the single factor that increases the chance of uterine rupture dramatically is a prior cesarean.)
A Answers (4)
Boston Women's Health Book Collective, answered
There's a risk that the uterus could rupture during a vaginal birth after cesarean (VBAC) delivery, which could be fatal to the mom and the baby. So we need to take special precautions. If a woman has had a cesarean section and she would like to deliver vaginally, she needs to talk to her doctor and they need to review it and decide. Most women can do it.
Margaret McKenzie, Obstetrics & Gynecology, answered
There are many factors to consider before having a VBAC. Watch this video to learn the risks of choosing to have a vaginal birth after a caesarian.
New Guidelines from the American College of Obstetricians and Gynecologists remind clinicians that: most women with one previous low-transverse uterine (not skin) incision are candidates for a subsequent vaginal delivery and should receive counseling about this; regional anesthesia (epidural) may be used; and prostaglandin cervical ripening agents should not be used. These conclusions are based on “good and consistent scientific evidence.” “Limited or inconsistent scientific evidence (a little less secure therefore)” allows the following additional advice to be given: women with two previous low-transverse uterine incisions may be considered candidates; inductions (not cervical ripening) are not disallowed; and twin delivery in the face of one previous low-transverse uterine incision is not disallowed; women with other than previous low-transverse uterine incisions or any other condition that precludes a vaginal delivery are not good candidates. The American College of Obstetricians and Gynecologists also maintained a previous commitment to patient safety by stating that attempts at vaginal delivery should be undertaken only in hospitals capable of doing emergency deliveries. This may appear puzzling to some because patients may think that all hospitals that deliver babies are capable of doing emergency deliveries. This is not true and patients are advised to check with their local hospital. And, the American College of Obstetricians and Gynecologists made a specific demand, which I support and I am sure is in the highest interests of patient safety: the obstetrician must be IMMEDIATELY available. There is a universe of difference between the accepted standard of readily available (which means nearby) and immediately available (which means right there).
If your obstetrician and his/her group will not commit to being immediately available for your trial of labor after Cesarean delivery, the risk outweighs the benefit.