Guest Post by Village Obstetrics,

About 20% of first births in the United States are by Cesarean delivery. The American College of Obstetricians and Gynecologists advises women to consider a trial of labor after cesarean (TOLAC) for their next birth. However, the latest statistics reveal that 90% of US women with a previous cesarean delivery have a repeat cesarean rather than a VBAC.

There are several things to consider in deciding whether to have a TOLAC or a scheduled repeat cesarean delivery. The biggest concern for OB doctors and midwives is the risk of uterine rupture during labor. Uterine rupture is the opening up of the scar on the uterus where the Cesarean incision was placed in the previous delivery. Thankfully the risk of uterine rupture is only about 0.5%, however if it occurs it has major health concerns especially for the baby. In general, a woman is choosing a VBAC because the recovery is typically faster and easier after vaginal birth than after cesarean birth. In addition, women describe a feeling that they prefer a more natural birth approach which is both empowering to her but also may have additional health benefits for the baby as well. Finally, a VBAC means that the number of repeat cesareans will be reduced which is safer for women especially if three or more children are desired.

A scheduled repeat cesarean delivery minimizes the risk that a uterine rupture may occur. Some women like knowing when their baby will be born and avoiding the pain of labor. However, the surgical risks for the woman are important considerations and the risk of needing a blood transfusion or needing a life-saving removal of the uterus (hysterectomy) rise with each repeat cesarean section especially after the third cesarean.

Especially since there’s a lot of information to process its best to select an obstetrical provider who is experienced with both VBACs and repeat cesarean sections. It may help to ask questions to help you evaluate the best suitability of the practice for you:

• What is the Cesarean birth rate for the practice?
• Is the rate available for each doctor in the group?
• In the practice what percentage of patients with a prior cesarean try a TOLAC and how many end up with a vaginal birth?
• Does the practice decide who can have a TOLAC based on certain criteria such as gestational age, or fetal estimated weight?
• Does the practice offer induction of labor if indicated for any patients with a prior cesarean?
• What is the practice experience in dealing with complications such as uterine rupture?
• If a scheduled cesarean is selected, does the practice perform “Gentle of Family Centered” Cesarean births?

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Village Obstetrics – 1225 Park Avenue | New York, NY 10128 (tel) 212.741.2229 – please quote BabyDoesNYC upon inquiry.