Have you had a baby in the past and now want to consider a natural (vaginal) birth? Natural birth after cesarean section (hereinafter referred to as ER after CS) can be a good solution for many women. Every woman and every birth is unique. And the following information will help you and your doctor or midwife decide whether ER after a C-section is a good option for you and your baby.
From 60 to 80% of American women who decided to have EP after a CS successfully gave birth to babies naturally. For the remaining 20-40%, the birth took place by caesarean section already during labor. For example, if labor does not progress or the baby’s condition worsens, a CS will most likely be performed.
You have a choice
When you start discussing your baby's upcoming birth with your doctor or midwife, you'll likely want to discuss your options.
So what can you choose:
- Try to give birth naturally after a CS;
- Scheduled CS.
Quality medical care
ER after CS should only occur in a hospital staffed by well-trained medical personnel who specialize in this category of birth.
Is ER after CS suitable for you?
There are many factors that you will need to think about. It is better to discuss everything with your doctor or midwife in advance, because this way you will have enough time to make the right decision for both you and the baby.
Why choose EP after CS?
In what cases should you choose a repeat CS?
- Uterine rupture: if you experienced such a complication during a previous birth, you cannot be a candidate for ER after a CS;
- Pregnancy with complications: If you have certain problems during pregnancy or the situation is such that ER may be risky, you most likely will not be a candidate for ER after a c-section.
There are certain risks
During EP after a CS, a complication may occur such as rupture of the suture of the abdominal cavity and uterus, which happens quite rarely. As a rule, this does not cause significant complications for the mother or child. However, very rarely such a rupture can cause serious harm to both mother and baby. Your doctor will tell you if you are at high risk of rupture. If you are at risk, EP after CS is not recommended for you.
You are a good candidate for EP after CS under the following conditions:
- Previous EPs: you have had a vaginal birth in the past;
- Spontaneous contractions: your contractions begin on their own, without the need for stimulation with medications or other means;
- Non-recurring reasons for a previous CS: During your previous birth, you had a CS for a reason that most likely will not happen again (for example, breech presentation).
You may still be a candidate for EP after CS in the following cases:
You may not be a candidate for EP after CS if the following factors exist:
Be prepared to change your birth plan
The birth of a child can never be completely planned. Therefore, it is important to be prepared to reconsider your birth plan if circumstances change during labor.
Where is ER practiced after CS in the USA?
There are very few hospitals and doctors in the USA who undertake VBACK. By the way, this is what natural childbirth after a cesarean section is called. Can be deciphered as vaginal back. According to American requirements, during vback, an anesthesiologist, a doctor and other personnel must be constantly near the ward. In a normal case, there will also be medical staff near you, but the anesthesiologist will not sit at the door, he will be called in advance for epidural anesthesia and after the procedure he will return to his office, and the doctor will come only when the dilation is 8-10 cm. With vback, everyone should be prepared for an emergency caesarean section. Many hospitals cannot afford this financially, and doctors refuse to accept such births, and even if you find a hospital that practices ER after CS, the second step will be to find an affiliated doctor in it who will agree to this option. There are only 3 places in Houston where you can try to give birth naturally - The Woman's Hospital of Houston, Texas Children's Hospital, Katy Memorial Hermann Hospital.
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One of the most exciting questions for many pregnant women is whether it is possible to give birth on their own with a scar on the uterus, that is, after a cesarean section (CS). In more rare cases, a scar may remain after a conservative myomectomy for benign uterine tumors or after perforation of the uterus during a medical abortion.
The answer is yes. But you need to approach this very responsibly. A woman must understand: how the ER will go after a cesarean section largely depends on the professionalism of the obstetricians and the capabilities of the maternity hospital. That is why it is recommended to give birth with a uterine scar only in well-equipped modern maternity hospitals.
Absolute contraindications to ER after CS:
Narrowed pelvis of a woman with a large fetus
Insolvent, that is, a thin scar on the uterus that can rupture at any time during childbirth
Post-term pregnancy
Two or more scars on the uterus
Two or more fruits
Relative contraindications to EU with a uterine scar:
Quite a large fruit. In this case, the obstetrician-gynecologist who is managing the pregnancy decides, based on the medical history and observation results, whether the pregnant woman can give birth herself. For example, if for the first time a woman was shown a CS due to weak labor or incoordination in the absence of other indications for cesarean, then in the second pregnancy the doctor may allow ER if there are no health problems.
Of course, now giving birth on your own after a CS is much safer than it was ten years ago. With proper monitoring of pregnancy and following all the rules, the likelihood that the scar will rip apart during childbirth is practically reduced to 0. This is also facilitated by high-quality suture materials that specialists use after a CS. However, the final decision is always made by the doctor, weighing the pros and cons in each case.
Does a pregnant woman need to prepare in any special way for ER after a CS?
Nothing depends on the woman herself, so no preparation is needed. Only constant monitoring of pregnancy is necessary.
Are ER different from ER after CS?
There is no difference for a pregnant woman. Childbirth with a scar on the uterus proceeds in the same way as ordinary natural ones. The pain does not become more noticeable. The only peculiarity of such births is the lack of stimulation.
Postpartum care after EP with a uterine scar
A manual examination is required to determine the integrity of the uterus. Otherwise, the observation is no different: the woman undergoes blood and urine tests and undergoes an ultrasound examination.
Advantages of the EMC maternity hospital:
Specialists who have completed internships in the best clinics in Europe
Doctors with extensive experience, including those specializing in the management of complex pregnancies, ER after CS and various cases of complicated childbirth.
Management of childbirth under powerful monitoring supervision.
Latest operating equipment
Intensive care unit equipped with the latest blood reinfusion devices, artificial lung ventilation, and anesthesia-respiratory devices.
Department of Neonatology
Constant monitoring of patients by medical staff
Today we will share the opinion of specialists and mothers from our forum on the topic of preparing for natural birth (NV) after cesarean section (CS).
Experts' opinions
Caesarean section is the most common abdominal operation worldwide, surpassing even appendectomy in frequency. The greatest danger is uterine rupture during repeated pregnancy and childbirth. The frequency of which is 69.5%. Rupture occurs only when the scar on the uterus is incompetent, its degenerative changes and/or chronic inflammation. Placenta accreta into the scar area is also dangerous. If the scar is strong, the pregnancy proceeds normally, without any complications, this percentage is no more than 4.Contraindications to vaginal delivery in women with a uterine scar are:
Anatomically narrow pelvis;
- attachment of the placenta in the scar area;
- breech presentation of the fetus;
- polyhydramnios;
- large fruit;
- complicated course of the previous operation;
- gestosis, preeclampsia, eclampsia;
- a scar on the uterus after conservative myomectomy, with entry into the uterine cavity, removal of multiple myomatous nodes.
When is vaginal delivery possible:In an uncomplicated previous pregnancy with a well-established uterine scar.
How to assess the health of a scar. The approach to assessment should be comprehensive, which includes taking an anamnesis:
When and for what reason was the CS performed, how did the postoperative period proceed?
- data on the study of the scar outside pregnancy, as well as during it;
- hysteroscopy outside pregnancy;
- the number of pregnancies between the CS and the real pregnancy is specified;
- you need to know about the course of this pregnancy;
- Ultrasound assessment of the uterine scar in dynamics;
- assessment of the consistency of the uterine scar according to ultrasound data. This criterion is by far the most important and reliable.
A postoperative scar with a thickness of 3 to 5 mm is considered to be consistent with a uniform echostructure. The scar is considered incompetent if the echostructure is heterogeneous, with hyperechoic inclusions, less than 3 mm thick.If the pregnancy is normal, the condition of the fetus is satisfactory and there are no signs of scar failure at 38 weeks, the patient should be hospitalized in the department of pathology of pregnant women of the maternity hospital. The maternity hospital must be highly equipped. There the question of the method of delivery will be decided.
If the CS happened, then the doctors had reasons for this. But in the next pregnancy, perhaps everything will turn out more favorably, and the expectant mother can discuss the EP option with the doctor. Remember, your desire is a serious component for EP. But first of all, you need to focus on the goal: the well-being of the child and mother after childbirth. And if there is even the slightest risk for one of the two, doctors will recommend a CS again.It must be admitted that doctors do not really like to give permission for ER after a CS, despite the fact that women often ask for it. As a rule, women in labor do not know all the obstetric nuances. The doctor evaluates the entire medical history and must weigh the pros and cons for the fetus and mother. Of course, if a woman decides to have EP, contrary to the advice of doctors, then no one can stop her. After all, the operation requires her written consent. Therefore, it is very important that doctors explain everything to you in great detail, so that it becomes clear whether there really is a risk in EP.
In addition, you need to know that in a situation where a woman in labor arrives at the maternity hospital with her “head in the pelvis” and there are 20-30 minutes left before the end of labor, a CS can no longer be performed. But such cases are extremely rare, and there is no need to specially provoke them.And another important component for natural childbirth after a caesarean section is preparation! Agree, if you need to prepare for a normal birth, then even more so in such a special case. These women will not only have to breathe, move, use different methods to deal with pain, they will have to do it all perfectly! No room for error! And if there is an assistant-partner next to them, then he should be well versed in the situation and take on part of the work himself.
I want to talk about giving birth with a uterine scar. For some reason, many people think that these are some other births. Let's figure it out. If it so happened that your first or second birth ended in a CS, by your will or according to indications, then this does not mean at all that you only need to do a cesarean section. It used to be like this, however. But now world standards have changed. Giving birth after a CS is no surprise to anyone now.What is important to understand and do:
It would be good to be 100% sure that you want to give birth naturally. When I hear even a hint of doubt, I don’t even undertake to lead such a woman;
- lead a healthy lifestyle. Swimming, yoga, nutrition, sauna. The body must also be confident;
- choose the right doctor who will not see the problem and persuade you to have a CS;
- visualization of your scar. I always do this test. I ask the woman to close her eyes and see her mark from the CS. Please describe. If you see a wound, torture, a black square, etc., then you need help in overcoming your fears. This must be done before giving birth, otherwise there will be a CS again.
There are features of labor management after a CS. It is better not to stimulate such labor. Plus, CTG during pushing should be mandatory. After childbirth, the doctor can examine the scar under IV anesthesia for integrity. This lasts 5-7 minutes. Russian practice. In Europe they simply do an ultrasound. Otherwise, it's a normal birth. By the way, as world practice shows, childbirth through ER is possible after two or three CS. Each woman has her own characteristics, it is better to consider them individually, taking into account the differences between pregnancies, ultrasound results and health status.
Maternity hospitals and doctors practicing ER after CS (according to the LV forum)
16 maternity hospital (all ER doctors are taken after CS)
- Filatova Marina Petrovna.
- Kleschelskaya Liliya Petrovna.
- Vartanyan Ruzanna Albertovna.
- Khamzalatova Aina Zalimkhanovna.
- Dolzhenkova Nina Leonidovna.
- Bobrova Galina Aleksnadrovna.
- Balykova Nadezhda Dmitrievna.
- Kulikova Natalya Alexandrovna.
- Filippova Irina Gennadievna.
- Poponina Taisiya Nikolaevna.
- Pirogov Vladimir Georgievich.
- Vakulenko Natalya Alekseevna.
- Alekseeva Elena Viktorovna.
17(11) maternity hospital
- Yankevich Yulia Vladislavovna.
- Shman Vera Valerievna.
Maternity hospital of Gatchina.
- Shuvalova Larisa Renatovna (Shkredik).
- Shubina Nadezhda Dmitrievna.
Maternity hospital on Furshtatskaya
- Dulikova Victoria Gennadievna.
- Pankova Larisa Borisovna.
