An obstetrician and gynaecologist with more than 13 years of experience, Dr. Chee Jing Jye is often asked this question by expectant mothers. Her current practice at The Obstetrics & Gynaecology Centre includes all areas of general obstetrics and gynaecology. She sub-specialises in Maternal Fetal Medicine with expertise in areas such as First Trimester Screening for Down Syndrome and high-risk pregnancy.
One mother in particular, AZ, went to see Dr. Chee recently with high hopes of being able to have a vaginal birth after caesarean (VBAC).
AZ is four months pregnant with her second child, just 18 months after having an emergency C-section with her first born daughter. AZ longs for the experience of holding her baby in her arms immediately after delivery. This was something she felt she had missed out on after giving birth to her daughter, having been under general anaesthesia for her C-section.
It really depends
Generally, there are a few factors to consider before deciding to go for a vaginal delivery after caesarean birth. VBAC may not be suitable for women who had to go through a caesarean birth due to a contracted pelvis. There may be a risk of uterine rupture if they chose to give birth vaginally. Uterine rupture can lead to life-threatening complications for both mother and baby, and may result in the need for surgical removal of the womb (hysterectomy).
AZ was asked whether she had any complications with her first C-section. The fact that it was an emergency surgery meant that there were some issues with the birth of her daughter. Women who have had a straightforward procedure and are not experiencing any complications in their current pregnancy are more suitable for a VBAC.
Dr. Chee examined AZ's scar to see what type of incision had been made. She would also need to have a look at the uterus to determine how it had been cut. If the uterus had a vertical incision, there would be a higher risk of uterine rupture.
Weigh the options
AZ's current pregnancy will need to be monitored for a low-lying placenta or the baby lying in an unusual position nearing delivery. She would also need to be aware of any medical issues such as high blood pressure and heart problems.
AZ looked doubtful but Dr. Chee reassured her that it is only for the safety of mother and baby that any recommendations against VBAC be made. In fact, based on her previous caesarean delivery that went on without any major complications, there is a 60-70% chance that she would have a successful vaginal delivery.
Dr. Chee also explained to AZ the several advantages of having a vaginal birth. AZ would be at a lower risk of infection and bleeding, and would normally recover faster with a shorter hospital stay.
In addition, a vaginal birth after caesarean does not bring any adverse side effects on the baby and is much less expensive than a C-section.
Trial vaginal birth
After weighing the situation with her gynaecologist, AZs plan was to opt for a trial vaginal delivery procedure when she is due next year. Her baby will be monitored closely in the labour ward. If labour does not go smoothly or there are signs of fetal distress, then an emergency C-section will be performed.
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