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Vaginal Birth after Previous Cesarean Section Listen to a 4-Minute Audio Lecture (3 MB MP3 File) At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent:
For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70% successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1% in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for prompt intervention is wise.
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This information is provided by The Brookside Associates, a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates. The patients presented and discussed here are fictitious and are merely representative of clinical conditions. Any resemblence to real patients is purely coincidental and not intentional. For any clinical condition, many alternative diagnostic and therapeutic efforts may give satisfactory or superior results. The clinical approaches presented here are not intended to reflect and do not reflect the only way to provide good care for these patients. This information is provided solely for educational purposes. The practice of medicine and surgery is regulated by statute and restricted to licensed professionals and those in training under supervision. Performing medical procedures outside of that setting is a bad idea, is not recommended, and may be illegal. The presence of any advertising on these pages does not constitute an endorsement of that product or service by the Brookside Associates. C. 2010 All Rights Reserved |