What is my chance of a natural birth after having a previous cesarean delivery?
Written by: Dr Haitham Badr
Edited by: Aya Diab
A cesarean delivery is a surgical birth that is performed by making an incision in the abdomen and removing the fetus from this incision. One in five women (20%) in the UK will have a cesarean delivery. Many women may have more than one caesarean section in their different pregnancies.
If you've had one or more caesareans before, you might consider how you will deliver your baby this time. If you choose to have a vaginal delivery or a cesarean section in your next childbirth, both options are safe with different risks and benefits for each.
In addition to the above, Dr. Haitham Badr, one of our leading consultants in the field of obstetrics and gynecology, talks in this article about the possibility of natural childbirth after a previous caesarean delivery and the benefits and risks of each....
How is the decision made in the current pregnancy after having a previous caesarean section?
To make a choice about how to give birth, your doctor will ask about your medical history and your previous births and pregnancies. In addition to the following:
- Why did you have a caesarean section in the previous birth and what happened during the delivery -was it an emergency or was it planned?
- The type and location of the incision made by the doctor in the uterus during the caesarean section.
- How was your experience in the previous delivery? And if you have any questions?
- How is your current pregnancy being monitored? And if there any problems or complications that you’re experiencing?
With the help of your doctor, decisions would be taken to increase the chances of a successful vaginal delivery in your next childbirth -taking into consideration; Your own choices and your future desires, if you’re planning to become pregnant again- when deciding to have a vaginal birth or a cesarean section.
What does a natural childbirth after a c-section means?
By this, we mean a woman giving birth vaginally after she had a cesarean delivery in her previous pregnancy. In this case, vaginal delivery may include giving birth using forceps or a suction device.
What is a planned caesarean delivery?
By that, we mean giving birth by performing the surgery at a predetermined date. This is done by setting a delivery date through the pregnancy follow-up clinic. This date is usually set within seven days before the due date -which is calculated through the ultrasound or the menstrual cycle, unless there is another reason to change this date and make it earlier due to a health condition of you or your fetus.
What are the benefits of a normal vaginal delivery?
Benefits of normal vaginal delivery include:
- Giving birth normally.
- Greater chance of a complication-free delivery to avoid any complications that happened previously.
- Faster recovery and less hospital stay.
- Less abdominal pain after childbirth.
- No scars
- You have not undergone surgery.
What increases the chance for a successful vaginal birth?
Three out of four women (75%) who have had a complication-free pregnancy and have started in the stages of childbirth; They’d give birth vaginally after they had a cesarean delivery in their previous pregnancy.
Also, if you deliver vaginally, before or after a caesarean section, the chance of a vaginal birth is very high. Whereas, nine out of ten women (90%) who went through the same conditions have had a natural birth.
What is my chance of having a normal vaginal delivery after I a previous cesarean delivery?
Here are some factors that reduce your chances of having a vaginal birth:
• You haven’t had a vaginal birth before.
• You need an induction for labor.
• Labor is progressing too slowly or not at all, and you need a cesarean section (usually due to the position of the fetus).
• Obesity, especially if IBM rate exceeds 30% at the beginning of your pregnancy.
What are the risks and constraints of a normal delivery after having a cesarean delivery?
Risks and constraints may include the following:
The need for an emergency caesarean section
Sometimes the condition requires an emergency caesarean section as you enter the early stages of labor. This happens to twenty-five (25%) women out of a hundred. And that percentage is lower if that was your first birth, so that at that time the percentage is twenty out of every hundred women (20%). The expected reason for a cesarean delivery is usually a slow progression of labor or the occurrence of a risk to the fetus.
The need for a blood transfusion or the occurrence of some complications such as an infection in the womb
Women who choose a natural delivery after a previous cesarean section may need a blood transfusion or may have complications such as an infection in the uterus, compared to those who choose a pre-determined caesarean section.
Weakness in the scar of the previous cesarean section or a ruptured uterus
In some cases, weakness in the previous cesarean section scar may develop, leading to its fissure. This could lead to serious complications for you and your unborn child. It only occurs in two to eight women out of a thousand (about 0.5%). This percentage increases if you are induced to give birth using medications. Therefore, in case the scar has splintered, an emergency caesarean section will be performed to deliver the fetus.
Risks to the fetus
The chance of a fetus having risks of death or brain injury - if you undergo a normal vaginal delivery after a cesarean delivery - is very small (happens to two out of every thousand babies, 0.2%).
Therefore, these risks must be compared to the risks involved in having a caesarean section.
These risks are more likely to occur for women who have an unsuccessful natural vaginal delivery experience.
When is a normal vaginal delivery not recommended after a previous cesarean delivery?
Sometimes a doctor does not recommend a normal delivery after a cesarean delivery. A cesarean delivery is the safest option in the following cases:
- A pregnant woman has undergone two or more caesarean sections before.
- Splitting of the previous c-section scar.
- Having a previous caesarean delivery through a high cut in the uterus.
- Complications in the current pregnancy that require caesarean section.
What are the benefits of having a planned c-section?
The benefits of having a planned caesarean section include:
- Avoid the risks of splitting the scar of the previous c-section.
- Avoid the risks of the beginning of labor, thus avoiding the risks that may affect the fetus like: death or cerebral defect because of oxygen lack during childbirth (this occurs in one in every thousand children, 0.1%).
- Choosing the day of delivery.
Despite setting the date of the c-section - usually seven days from the due date which is calculated through the menstrual cycle or the ultrasound - there is still a possibility that you will be entered into the labor stages before the scheduled date. This occurs in one in ten women (10%).
What are the risks of a planned cesarean delivery?
Risks of a planned caesarean section include the following:
A longer and more difficult cesarean delivery surgery
Due to repeated cesarean sections, the time for the second c-section is longer than the first operation due to the contiguous tissues. The contiguous tissues may also lead to some complications during surgery, including: tumor of the bladder or intestine, also there are scientifically mentioned cases of accidentally injuring the fetus during a cesarean section.
blood clotting
Thrombosis may occur in the lung. This stroke may pose a threat to the patient's life (death occurs to less than one patient out of every 1,000 patients who undergo a cesarean delivery).
Recovery time is longer than vaginal delivery
You may need more help at home, and your stay at the hospital may take longer than a natural birth.
Difficulty in breathing in your child
Difficulty in breathing may occur to the child after a c-section, but it lasts for a short time. Sometimes your baby may need intensive care for several days. Three or four children out of every hundred babies (3-4%) who are born by c-section have difficulty breathing compared to children born vaginally (2-3%).
Is your due date approaching and you still have many concerns and questions, you can book a consultation with Dr. Haitham Badr for a professional medical advice from here.