- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
- 2103390838
- 2421022988
Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Vaginal birth after cesarean delivery (VBAC) is becoming increasingly common. The long-held belief “once a cesarean, always a cesarean” no longer applies today. This viewpoint originated from a time when the uterine incision during cesarean delivery was typically made vertically. Since the early 1970s, with the routine use of a lower transverse uterine incision, the risk of uterine rupture has been minimized (less than 0.5%).
In most developed countries, a previous cesarean delivery is not an absolute indication for a repeat cesarean in the next pregnancy. The alternative option is VBAC — Vaginal Birth After Cesarean.
Many women who initially desired a vaginal delivery but ultimately required a cesarean wish to give birth vaginally to their second baby. However, certain criteria must be met for a VBAC to be considered safe. Most women with one prior cesarean and no additional risk factors are candidates for VBAC. A planned vaginal birth after a previous cesarean has a success rate of 60–80%, which is fully comparable to the success rate of vaginal deliveries in first-time mothers. If a woman has had a previous vaginal delivery before the cesarean, the success rate rises to 87–90%.
The main advantages and benefits of a vaginal birth after a cesarean section (VBAC) are that the mother recovers faster, her hospital stay is shorter, and she avoids infections, injuries (to the bowel, bladder, etc.), blood loss, thrombosis, and postoperative complications. The mother has a more active role in caring for the newborn during the first hours of its life. Finally, there is the possibility of many future pregnancies, since multiple cesarean sections carry risks related to uterine strength, injury to adjacent organs (bowel and bladder), and the position and texture of the placenta (risk of placenta previa and/or placenta accreta). There are also definite benefits for the baby, such as preventing iatrogenic prematurity and reducing the incidence of persistent pulmonary hypertension. Vaginal birth always prepares the baby for life outside the womb.
Certain requirements must be defined to ensure the successful outcome of a vaginal birth. Some of the basic prerequisites include selecting an obstetrician who has experience with similar cases, ensuring that the maternity hospital and delivery room are fully equipped, and confirming that there is the capability for an immediate cesarean section if and when needed.
Additionally, from the early early pregnancy until the last month, weekly fetal ultrasound examinations (and Doppler) are required. From the 32nd week of pregnancy, regular fetal monitoring with cardiotocography (NST) must be performed. Induction of labor with prostaglandins or oxytocin should be avoided, as it significantly increases the risk of uterine rupture. Finally, after the delivery of the placenta, the uterine cavity — especially the anterior wall — must be examined manually (digital inspection).
It is very important to know the exact reason for the previous cesarean section. If the previous cesarean was due to fetal malposition or breech presentation, the woman may attempt a vaginal birth with a high likelihood of success. The same applies when the reason for the cesarean section was fetal heart rate abnormalities due to umbilical cord compression. There are, of course, contraindications, mainly related to the type of the uterine incision, which must definitely be a low transverse incision. Any other type of uterine incision, a previous uterine rupture, or a previous myomectomy involving entry into the uterine cavity are significant contraindications. Also, at least one year must have passed since the last cesarean delivery so that the probability of a successful vaginal birth is not reduced. The labor must be planned around the 38th week of pregnancy. Epidural anesthesia significantly assists the entire process because it allows the woman to relax and also facilitates cervical dilation.
Attempting a Vaginal Birth After Cesarean (VBAC) is not unrealistic. If the above requirements are met, the probability of a successful vaginal delivery is around 60%. The main reason is the exceptionally strong feeling of satisfaction and accomplishment associated with achieving a vaginal birth after a cesarean section. The woman feels she has achieved what she originally wanted when she first became pregnant. It allows her to feel optimistic that future births may also be vaginal. Finally, it enables the husband to participate actively in the vaginal birth process alongside his partner and their doctor — something that strengthens the couple’s and the family’s sense of fulfillment.
