by Katherine S. Puls, Certified Nurse Midwife/Advanced Nurse Practitioner
The number of C-sections is increasing in the United States due to the changing medical and legal climate, so you maybe part of the 33% of women who have experienced a Cesarean birth. When it is time to consider how to deliver your next baby, you should consider delivering vaginally. Vaginal birth after a C-section can happen safely and successfully approximately 75% of the time. Complications such as rupturing of the old uterine scar happen rarely (0.5%) but can be life threatening to both mother and baby.
When couples desire a vaginal birth after a C-section, I do a detailed history of the previous birth asking why the surgery was done. We want to determine if these events will influence the next labor and birth. I also encourage couples to prepare for childbirth by participating in a childbirth education class. It is also very helpful to discuss their feelings about the previous birth and how these feelings can influence future births. Fear of another Cesarean birth, fear of “failure”, fear of pain, fear for the mother’s well being, fear for the baby’s well being can all influence the progress and outcome of a birth. I encourage women and their partners to focus on just this labor and birth, listen to and trust the woman’s body, utilize the resources available to cope with labor and then “go with the flow”.
All of the variables surrounding labor and birth can not be controlled but we can use tools and techniques that promote vaginal delivery. Women need to stay well hydrated during their labors, women need to eat (nibble) small amounts frequently especially in early labor. Promoting walking, using a rocking chair, stair climbing, pelvic rocking and swaying, being on all fours all facilitate the baby settling into the birth canal in the proper position. Even with continuous external fetal monitoring women can walk around, use the shower, and use a labor pool. If pain relief is needed, postponing it until a women is in very active labor helps to decrease the risk it will influence the route of delivery of the baby. Judicious use of pitocin can also be helpful when it is determined that the labor has stalled and isn’t just progressing slowly.
The decision to have vaginal delivery after a cesarean birth is based on many factors; medical, emotional, availability of a supportive environment and supportive personnel, and the availability of emergency interventions if they are needed. But if you have had a cesarean birth, it is definitely worth considering having your next baby vaginally.
Kathy Puls, Certified Nurse Midwife, was in private practice in Evanston Northwestern for many years. She is now retired and lives in the beautiful southwest.