One of the more common questions that women asked when they come up to my clinic is that whether they could have a vaginal delivery after a Cesarean section. The answer of this question is not entirely straightforward as one need to take into consideration of a few factors, including what has happened in previous pregnancies, how things are with this pregnancy, and your own feelings about how you want to give birth to this baby. Therefore it is important that you, your doctor and midwife to discuss the advantages and disadvantages to you as an individual.\r\nThe general Cesarean rate of this country is about 20-25%. However, the rate may be increasing over the next few years with increasing safety of Caesarean sections and more evidence showing that Caesarean section may be beneficial in certain cases.\r\n\r\nIf you have had a Caesarean delivery for one birth and become pregnant again, you have two options:\r\n\r\n \tAim for a vaginal delivery. About 60-80% of women who choose this will be successful in giving birth to their babies vaginally. About 20-40% will need to have a further Caesarean section\r\n \tThe second option is to have a planned (elective) Caesarean section\r\n\r\nWho are not suitable for a trial of vaginal birth after a Caesarean section?\r\nAbout 90% of women who have had a Caesarean birth are suitable for a trial of vaginal birth. Factors which put a woman at high risk for trial of vaginal birth in this circumstance include:\r\n\r\n \tWomen who had a vertical uterine scar (classical incision) instead of low transverse (almost 95% of incisions are low transverse, therefore it is important that your obstetrician have a copy of your previous Caesarean delivery to be sure which type of incision was made on your uterus. Please note that the incision on your skin is not reflective of the type of incision on your uterus).\r\n\r\n\r\n \tWomen who have had more than 2 Caesarean deliveries are considered unsuitable for a trial of vaginal birth as the risk of uterine rupture is high. However, it is common that the obstetrician advise women with 2 previous Caesarean sections against a trial of vaginal birth.\r\n\r\n\r\n \tWomen with previous history of uterine rupture as the risk of recurrent rupture is unknown\r\n\r\nIn most studies, it has been shown that about 60-80% of women who have a previous Caesarean delivery can successfully give birth vaginally. Women who had previous vaginal births particularly those who have had delivered vaginally after a Caesarean delivery are known to be most likely to succeed (87-90%).\r\n\r\nWhat are the risks if I aim for a vaginal delivery?\r\n\r\n \tIn the case of unsuccessful trial of vaginal birth due to slow cervical dilatation or your baby become distress during the process of labour, you will end up with an emergency Caesarean section. We know that there is a slightly higher chance of complications with an emergency Caesarean section compared to a planned (elective) Caesarean section.\r\n \tOne of the major concerns for women who have had a previous Caesarean birth is the risk of the scar on the womb opens up (uterine rupture) during a trial of vaginal birth. If you had a previous Caesarean section with low transverse incision, the risk is around 0.5%. This is if you go into labour on your own. If you required oxytocin to help to kick start your labour or make your contractions stronger, then the risk is quoted to be 0.8%. The risk of uterine rupture increases to 2.5% if your required prostaglandin to start off your labour.\r\n\r\nTherefore, we need to take precaution steps to try to avoid it:\r\n\r\n \tWe would think carefully before inducing labour\u00a0in a women with a previous Caesarean section\r\n\r\n\r\n \tYou are strongly recommended to have a trial of vaginal birth in a hospital setting for emergency Caesarean section\r\n\r\n\r\n \tDuring labour, blood would be taken and a cannula inserted into your hand and arm so that we could quickly connect a drip if you need to go to the operating theatre quickly\r\n \tThe progress of your labour and the baby\u2019s condition would be monitored closely. It is recommended we continuously monitor your baby\u2019s heart rate with an electronic fetal monitoring machine following the onset of uterine contractions.\r\n\r\nComparing a Repeat Caesarean section to a VBAC (Vaginal Birth after Caesarean Section)\r\n\r\n\r\n\r\n\r\n\u00a0\u00a0 Repeat Caesarean Section\r\n\r\n\u00a0\u00a0 VBAC\r\n\r\n\r\n\r\n\u00a0\u00a0\u00a0 Risk of Caesarean section\r\n\u00a0\u00a0 (please refer to the topic what are\r\n\u00a0 \u00a0the risk\r\n\u00a0 \u00a0of\u00a0Caesarean section )\r\n\r\n\u00a0\u00a0\u00a0 0.5-1.0% risk of the scar on the\r\n\u00a0 \u00a0 womb\u00a0opening up\u00a0\u00a0(uterine\r\n\u00a0 \u00a0 rupture). If this occur,\r\n\u00a0 \u00a0 it can cause serious\u00a0internal\r\n\u00a0 \u00a0 bleeding and\u00a0can be dangerous\r\n\u00a0 \u00a0 for\u00a0both\r\n\r\n\r\n\r\n\u00a0\u00a0 Hospital stay of 2-3 days or even\r\n\u00a0 \u00a0longer\u00a0depending on the\r\n\u00a0 \u00a0circumstances of your\u00a0Caesarean\r\n\u00a0 \u00a0section\r\n\r\n\u00a0\u00a0 Hospital stay of approximately 1-2\r\n\u00a0 \u00a0days\r\n\r\n\r\n\r\n\u00a0\u00a0 Increased risk of infection to the\r\n\u00a0 \u00a0womb,\u00a0bladder and skin\r\n\r\n\u00a0\u00a0 Risk of infection is higher if you\r\n\u00a0 \u00a0ended up\u00a0with an\u00a0\u00a0emergency\r\n\u00a0 \u00a0Caesarean section\r\n\r\n\r\n\r\n\u00a0\u00a0 Injury to the internal organs such\r\n\u00a0 \u00a0as bladder,\u00a0bowel or\u00a0\u00a0adjacent\r\n\u00a0 \u00a0organs\r\n\r\n\u00a0\u00a0 Risk of an episiotomy if you need\r\n\u00a0 \u00a0one to\u00a0deliver your baby\r\n\r\n\r\n\r\n\u00a0\u00a0 Risk of blood clot formation in the\r\n\u00a0 \u00a0legs or\u00a0lungs\r\n\r\n\u00a0\u00a0 Lower risk of blood clot formation\r\n\u00a0 \u00a0in\u00a0the\u00a0legs or lungs\r\n\r\n\r\n\r\n\u00a0\u00a0 More pain relief required after the\r\n\u00a0 \u00a0procedure\r\n\r\n\u00a0\u00a0 Lower requirement of pain relief\r\n\r\n\r\n\r\n\u00a0 Risk of anaesthesia. However, with\r\n\u00a0 the\u00a0development of\u00a0\u00a0modern\r\n\u00a0 anaesthesia\u00a0technique such as\r\n\u00a0 epidural and spinal\u00a0anaesthesia, the\r\n\u00a0 risk has been reduced\u00a0remarkably\r\n\r\n\r\n\r\n\r\n\u00a0 On-going pain due to scar tissue\r\n\u00a0 formation in\u00a0abdomen\r\n\r\n\u00a0\u00a0 Short term pain and discomfort\r\n\u00a0 \u00a0around\u00a0vagina\r\n\r\n\r\n\r\n\u00a0 Longer recovery\r\n\r\n\u00a0\u00a0 Shorter recovery\r\n\r\n\r\n\r\n\u00a0 Higher cost\r\n\r\n\u00a0\u00a0 Lower cost\r\n\r\n\r\n\r\n\u00a0 If you plan to have many more\r\n\u00a0 children, you\u00a0need to take\u00a0\u00a0this into\r\n\u00a0 consideration as the\u00a0 risk of surgery\r\n\u00a0 increases with\u00a0\u00a0the number of\r\n\u00a0 surgery you have had. Therefore, a\r\n\u00a0 repeat\u00a0Caesarean section may limit\r\n\u00a0 the number of\u00a0children you\u00a0could\r\n\u00a0 have\r\n\r\n\r\n\r\n\r\n\u00a0 A small risk of baby having\r\n\u00a0 breathing\u00a0difficulties upon delivery\r\n\r\n\r\n\r\n\r\n\u00a0\r\n\u00a0Reference to Pitterpatter.com.my.