[mariahames]

I had a csection April of 2013, I got pregnant again very soon when my daughter was 4 months old. I have had to opposite opinions on whether it would be a good Idea to have a vbac this pregnancy or not and would like another opinion..

[CravenMorhead]

I would go for vaginal because that isn't a major surgery. It also depends on how the C-Section was done. If it was a horizontal line by your pubic hair, then you can do both. If it was a vertical line from your bellow button down it will be troublesome to have a vaginal birth. In the end it will be up to the opinion of your doctor and your condition at the time.

[J_9]

Typically once a woman has a cesarean section, a vaginal delivery is no longer an option. This is because there is an increased risk of uterine rupture at the c/s incision site.

Considering that your c/s was fairly recent, your option of a vaginal delivery is severely limited. Most doctors say "once a cesarean section always a cesarean section." Very few doctors and/or hospitals do VBACs these days.

[CravenMorhead]

Odd. A lot of the literature we were given and told about stated that VBAC was common. It was all dependent on how it was done in the first place. The current method, being a cut at the bottom of the uterus, would be less likely to tear during labour while the older method, long cut perpendicular to the cervix, would be more likely to tear because you went across the grain of the muscle and not with it. Could just be our medical system in Alberta. We have some dodgy policies.

[J_9]

The current method, being a cut at the bottom of the uterus, would be less likely to tear during labour while the older method, long cut perpendicular to the cervix, would be more likely to tear because you went across the grain of the muscle and not with it.

That is absolutely correct in that the direction of the "cut" increases or decreases the risk. A lower abdominal transverse cut (side-to-side) decreases the risk of uterine rupture while a superior to inferior abdominal (top to bottom) "cut" increases the risk. However, the risk remains nonetheless.

A uterine rupture, no matter the direction of the cut, is a life and death risk to both mother and fetus. While some doctors will give an option of a labor attempt, many facilities have policies and procedures in place that do not allow this. A doctor's choice to allow it cannot overrule a facility's policies and procedures if the facility does not allow it. This is all thanks to the litigious nature of our society.

This is also dependent on the facility in question. In some facilities there is no surgical staff on the campus for a complete 24-hour period, sometimes only during "business hours," and surgery must be called in for sections, epidurals, etc. if it is a rural hospital. If it is a rural hospital then the lives of both mother and baby would be in jeopardy as it can take over an hour to get surgery in-house and delivery done via c/s if there is a rupture.

The current school of thought is "once a c-section, always a c-section."

In my years as a labor and delivery nurse in a rural hospital, I have only done one successful VBAC, and that was because the woman came in completely dilated.

[J_9]

I would also like to point out that the OP got pregnant 4 months after a delivery via c/s. That is not enough time to efficiently recover systemically, as well as physically, to attempt a VBAC. In this case delivery would be approximately 13 months post c/s. This would increase the risk of uterine rupture no matter the direction of the original incision.

[CravenMorhead]

Thanks for the info! Even though I didn't ask the question. I will file this away for future use. :-)