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Sunday, April 3, 2011

Prior C-section Delivery Shouldn’t Limit Mom’s Future

Prior C-section Delivery Shouldn’t Limit Mom’s Future Options

Women who meet certain criteria can have a successful vaginal birth after cesarean (VBAC) delivery, but many don’t receive enough information to make that choice, says an obstetrician at UT Southwestern Medical Center.

According to statistical reports, the rate of C-section deliveries has increased in the U.S. from just 5 percent in 1970 to nearly a third of all births in 2008.

About a third of American hospitals and half of physicians do not even offer VBAC as an option, in part due to fear of potential litigation, says Dr. F. Gary Cunningham, a professor of obstetrics and gynecology at UT Southwestern who led a National Institutes of Health panel on the topic in 2010.

Since the panel’s findings were released in July 2010, the American College of Obstetricians and Gynecologists revised its recommendations to encourage clinicians and hospitals to improve women’s access to in-hospital VBAC.

“The latest recommendations released are much more permissive,” Dr. Cunningham says. “Women should be aware that in many cases vaginal birth is an option to be considered.”

A C-section, also called a cesarean section, is the delivery of a baby through a surgical opening in the lower belly area.


A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but numbed from the chest to the feet. This is done by giving her epidural or spinal anesthesia.

The surgeon make a cut across the belly just above the pubic area. The uterus and amniotic sac are opened, and the baby is delivered.

The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is clamped and cut. The pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable.

The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.

Why the Procedure is Performed

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman's past deliveries or medical history. Some reasons for having C-section instead of vaginal delivery are:

Reasons related to the baby:
Abnormal heart rate in the baby
Abnormal position of the baby in the uterus such as crosswise (transverse) or feet-first (breech)
Developmental problems such as hydrocephalus or spina bifida
Multiple babies in the uterus (triplet and some twin pregnancies)

Reasons related to the mother:
Active genital herpes infection
Large uterine fibroids low in the uterus near the cervix
HIV infection in the mother
Previous uterine surgery, including myomectomy and previous C-sections
Severe illness in the mother, including heart disease, toxemia, preeclampsia or eclampsia

Problems with labor or delivery:
Baby's head is too large to pass through mother's pelvis (cephalopelvic disproportion)
Prolonged or arrested labor
Very large baby (macrosomia)

Problems with the placenta or umbilical cord:
Placenta attaches in abnormal location (placenta previa)
Placenta prematurely separated from uterine wall (placenta abruptio)
Umbilical cord comes through the cervix before the baby (umbilical cord prolapse)

A C-section is a safe procedure. The rate of serious complications is extremely low. However, certain risks are higher after C-section than after vaginal delivery. These include:
Infection of the bladder or uterus
Injury to the urinary tract
Injury to the baby

A C-section may also cause problems in future pregnancies. This includes a higher risk for:
Placenta previa
Placenta growing into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta)
Uterine rupture

All surgeries carry risks. Risks due to anesthesia may include:
Reactions to medications
Problems breathing

Risks related to surgery in general may include:
Blood clots in the leg or pelvic veins
Outlook (Prognosis)

Most mothers and infants recover well, with few problems.

Women who have C-section deliveries can have a normal vaginal delivery with later pregnancies, depending on the type of C-section performed and the reason the C-section was performed.

Many women who attempt a vaginal birth after cesarean (VBAC) delivery are successful. However, there is a small risk of uterine rupture associated with VBAC attempts, which can endanger the mother and the baby. It is important to discuss the benefits and risks of VBAC with your obstetric health care provider.

The average hospital stay after C-section is 2 to 4 days. Recovery takes longer than it would from a natural birth. Walking is encouraged the day of surgery to speed recovery. Pain can be managed with medications taken by mouth.
Alternative Names

Abdominal delivery; Abdominal birth; Cesarean section
Landon MB. Cesarean delivery. In: Gabbe SG, Niebyl JR, Simpson JL, ed. Obstetrics: Normal and Problem Pregnancies. 5th ed. New York, NY: Churchill Livingstone; 2007: Chap.19.

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