Mode of childbirth following cesarean section: Informing women’s decision-making
In this week’s PLoS Medicine, the PLoS Medicine editors discuss new research studies on the risks associated with mode of childbirth following caesarean section. In the first, Caroline Crowther and colleagues found that the risks of very severe outcomes - such as fetal or infant death - were lower among women who planned a repeat caesarean section than among women who planned a vaginal birth. In the second, Kathryn Fitzpatrick and colleagues showed that the risk of uterine rupture is higher among women who have had two or more previous caesarean sections, and if the time period since the last caesarean section is less than 12 months.
The editors comment: “The bigger issue raised by these findings relates to how clinicians and women can work together to make the best possible decision when so many questions remain unanswered…Together, these findings highlight the importance of pragmatic research studies, with the overall goal of improving care for future generations of mothers and babies.”
Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.
Competing Interests: The authors’ individual competing interests are at http://www.plosmedicine.org/static/editorsInterests.action. PLoS is funded partly through manuscript publication charges, but the PLoS Medicine Editors are paid a fixed salary (their salary is not linked to the number of papers published in the journal).
Citation: The PLoS Medicine Editors (2012) New Research on Childbirth Has the Potential to Empower Women’s Decision Making, but More Is Needed. PLoS Med 9(3): e1001197. doi:10.1371/journal.pmed.1001197
What would make me a good candidate for a VBAC (Vaginal birth after cesarean )?
According to the American College of Obstetricians and Gynecologists, you’re a good candidate for a vaginal birth after a c-section if you meet all of the following criteria:
- Your previous cesarean incision was a low-transverse uterine incision (which is horizontal) rather than a vertical incision in your upper uterus (known as a “classical” incision) or T-shaped, which would put you at higher risk for uterine rupture. (Note that the type of scar on your belly may not match the one on your uterus.)
- Your pelvis seems large enough to allow your baby to pass through safely. (While there’s no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)
- You’ve never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
- You’ve never had a uterine rupture.
- You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.
- There’s a physician on site who can monitor your labor and perform an emergency c-section if necessary.
- There’s an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.
Factors that would work against your having a successful VBAC include:
- Being an older mom
- Having a high body mass index (BMI)
- Having a baby with a high birth weight (over 4,000 grams, about 8.8 pounds)
- Having your pregnancy go beyond 40 weeks of gestation
- Having a short time between pregnancies (18 months or less)
Talk with your practitioner about your individual chance of success and carefully weigh the benefits and the risks.
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