The reasons for needing a caesarean section will vary, however they are more likely to occur during labour for women in their first pregnancy. This may be due to a number of things such as ‘foetal distress’ or ‘dystocia of labour’ where your labour stalls completely. For others, caesarean sections will be planned antenatally for reasons such as a breech position, placental problems or having a previous caesarean section.
Whatever the reason for your caesarean section it is safe in most cases to plan for a vaginal birth with your next pregnancy. Your consultant obstetrician or consultant midwife will be able to discuss this with you further. If you gave birth by caesarean section previously then your chance of having a vaginal birth this time is seventy to ninety percent. If you have had a vaginal birth previously as well as a caesarean section then your chance increases to ninety percent.
The benefit of an elective caesarean section is that you can plan when your surgery will be and have some level of control over it. However, there is always the possibility that your labour could start before that date and you would then require an emergency caesarean section.
There are however many risks associated with caesarean sections and with each subsequent surgery that risk rises again. Because of the scar tissue from your previous surgery you are at increased risk of bleeding, that may require a blood transfusion and sustaining damage to internal organs such as your bladder and bowel. As with any surgery your risk of developing blood clots also increases. Additionally, your baby will not have experienced the stress of labour and due to this his lungs may not have fully initiated the transition to breathing outside. He may then go on to develop difficulty breathing which may require closer monitoring and treatment on the neonatal unit.
Having a scar on your uterus will also affect the area into which your baby implants. As your baby embeds into your uterus he is more likely to do this onto the lower part of your uterus and over your previous scar resulting in a placenta praevia. This condition will rule out the choice of a vaginal delivery due to the potentially catastrophic blood loss that may occur whilst giving birth. If your placenta has implanted over your previous caesarean section scar then the surgery itself also becomes extremely complicated. You may be required to attend the radiology department immediately prior to your surgery in an effort to limit the blood supply to your uterus and you will be at a far higher risk of requiring a blood transfusion. These factors should be considered if you are planning on a large family.
By opting for a vaginal birth after a caesarean section you are more likely to breastfeed successfully and the recovery time is also much quicker. In order to be successful with a vaginal birth after caesarean section, like any labour you need good support from birth partners and to remain as mobile as possible. Essentially you should aim to keep any intervention to a minimum as this will again reduce your chances of being successful.
The risks involved with a vaginal birth after caesarean section are that for one in four hundred women the scar from their previous caesarean section will open. This may then cause extreme blood loss for you, put your baby at risk and will require immediate emergency surgery. Choosing a vaginal birth or a caesarean section carries different risks and benefits but overall any risk is extremely small and either choice, providing either option is advised is safe.
If you do decide to opt for a vaginal birth after caesarean section there are some things you can do to increase your chances of being successful. You may wish to avoid an epidural as they can slow your labour down and make another caesarean section more likely. There are plenty of techniques that you can use from earlier chapters and remember if you had an emergency caesarean section before then this labour should be quicker. When you do think that your labour has begun try to avoid the temptation of going into hospital too early. Like any other labour it is more likely to be slower in hospital and you are more likely to use strong pain relief earlier. You should aim to wait until your surges are coming regularly and every five minutes and that they last for one minute. You should however inform your hospital if you have any of the following:
Bleeding from your vagina.
If your waters break.
Any abdominal pain not connected to your surges.
When you do arrive in labour your midwife will assess your stage of labour by vaginal examination. This is important as it will give her a baseline to observe that your labour is progressing normally and not becoming too slow. A labour that is progressing slowly may be a sign that things are not altogether normal and intervention may be necessary at that point. If you are in active labour she will also wish to commence a continuous heart trace to monitor your baby. You will normally have a cannula sited in your hand and may have baseline bloods tests taken in case you require another caesarean section. This will avoid any delay should this need to be done quickly.
The reason that your baby needs to be monitored in labour is to pick up any signs that he maybe distressed as this could be an indication that your scar has opened or that you uterus has ‘ruptured’. If this is the case then you would require an emergency caesarean section but this is rare. If your labour is progressing more slowly than normal the hormone drip may be used to speed it up however this will always be used with caution in order to prevent unnecessary pressure on your previous caesarean section scar. Occasionally your obstetrician may feel that the risks of starting the hormone drip are less than the risks of another caesarean section.
Most hospitals at present do not offer water births to women who have had a previous caesarean section as there is not enough evidence to show that this is safe. Equally, there is no evidence to suggest that it is unsafe especially as it reduces the need for epidurals. Many hospitals nowadays have heart trace monitors that are able to be used in water. If this is an option that you are considering bear in mind that, although small there are still risks with a vaginal birth after caesarean section. Most labour wards will be able to arrange a meeting with a consultant midwife or supervisor of midwives to discuss this further and help you plan the birth of your choice.
It is most likely however that you will achieve a vaginal birth with minimal intervention. Once you have given birth, you will have the same options as normal for delivering your placenta providing you have avoided the hormone drip. Following this, providing the rest of your labour ran smoothly and your baby is well, there is no stipulation on how long you should stay in hospital and for some women this may be as little as a few hours.