Delivery after cesarean section

Vaginal delivery after cesarean section is possible for many women who have had:

• one cesarean section;
• one or two caesarean sections followed by vaginal delivery.

Should you try to give birth to yourself after a cesarean section? Vaginal delivery after one cesarean section or one vaginal and two caesarean sections is in most cases safe for parturient women. Whether this is right for you depends on several factors, including:

• The cause of the previous caesarean section. If the cause is repeated (breech presentation), vaginal delivery is not recommended. Nevertheless, in many cases, a caesarean section is made as a result of complications in the process of vaginal delivery (rather than before birth), for example, when labor is terminated or fetal distress syndrome is observed. As a rule, there is no reason to worry that the previous state will be repeated again, although this can not be asserted with complete certainty.
• Number of previous cesarean sections. If you had one cesarean section, vaginal births can be quite safe. In the case of two - the safety of vaginal births depends on what kind of last birth you had. Attempts of vaginal delivery are not recommended for those women who had more than two operations. The more operations there were in the past, the higher the risk of a uterine rupture.
• The number of planned deliveries. The risk of developing complications during pregnancy depends on the number of scars from the caesarean section.
• Your personal beliefs. If there are no medical indicators of a cesarean section, the choice is yours. Women in similar situations follow intuition and experience.
• The clinic where you will give birth. If you decide on vaginal delivery after cesarean section, ask if there are any special equipment and qualified personnel in the clinic that can make a cesarean section if necessary. Risk factors for vaginal delivery after cesarean delivery
• Development of distress syndrome of the fetus, which requires prompt intervention for the safety of the mother and child. Fetal distress syndrome develops in 20-40% of women who are not at risk.
• Divergence of the edges of the seam, although usually does not cause problems and often heals by itself.
• A rash in the uterus, which is dangerous for the life of the mother and child, but it happens rarely. Women who try to give birth vaginally, but without success, are at greater risk of infection. It can be concluded that vaginal births expose a woman to a lesser risk of infection.
• Each delivery is unique, and one can not plan and provide for all the moments of labor and delivery. None of the doctors can guarantee the absence of complications.

Risk factors for cesarean delivery

• Infection
• The loss of blood and the need for transfusion
• Development of complications of the genito-urinary tract
• Thromboembolism
• Complications after anesthesia
• Fetal Injuries During Childbirth
• Long-term recovery

Further complications. With each surgical intervention on the uterus, more scar tissue is formed. If you plan to give birth to another child, you should take into account the number of stitches on the uterus. After two scars, each following increases the risk of developing placental problems with the next pregnancy, for example, placenta previa or augmentation. These complications are fraught not only with fetal injury, but also increase the risk of hysterectomy with heavy bleeding.

How long have women been recovering from cesarean delivery?

Most women are discharged home 3-5 days after the operation, but in the future it may take 4 weeks or more for a complete recovery. For comparison, women who gave birth vaginally, usually go home on day 2 after childbirth and lead a normal lifestyle in 1-2 weeks. Before discharge, the nurse will tell you how to care for the seam, what complications can occur and in which case you need to seek help from a doctor.

General recommendations after cesarean section:

• During the healing period, you should lead a quiet lifestyle. Do not lift weights, do not do intensive physical exercises and sudden movements. Ask family members or friends to help around the house, go shopping or make dinner.
• You may need pain medications for 1-2 weeks because of pain in the lower abdomen.
• There may be a slight vaginal bleeding for several weeks (use pads, not tampons).

Immediately seek medical help at the first sign of an inflammatory process, for example, fever, redness, or pus discharge from the suture line.

Should I give birth vaginally, if I had a cesarean section before?

In the past, a woman who had previously had a cesarean section had to do this surgery in subsequent pregnancies. To date, many women with a single suture after a cesarean section or experience of vaginal birth and two caesarean sutures can try to give birth naturally. This is called vaginal birth after cesarean section.

As with vaginal delivery, and in cesarean section there is a slight risk of serious complications. In general, the usual vaginal birth is considered less dangerous than the cesarean section. But the researchers concluded that pregnant women who had previously had a cesarean section increased the risk of rupture during labor. This is called a gust of the uterus.

Before deciding in favor of natural delivery after cesarean section, take into account the following recommendations:

• Even with a good chance of giving birth, there is still a chance of a re-cesarean section. 60-80% of pregnant women give birth vaginally after the previous cesarean section.
• If the cause of the previous caesarean section (breech presentation) is not repeated this time, it is likely that your birth will pass without complications.
• Vaginal delivery after caesarean section is considered safe for most women.
• With vaginal delivery after cesarean section, there is a risk of rupture of the uterine suture. This is called a gust of the uterus. The risk increases with each additional suture, and also in the case of the use of drugs that stimulate labor activity.
• If you have been given a caesarean section several times, but there is also the experience of subsequent vaginal birth, the risk of uterine rupture is reduced.
• If you are planning a pregnancy, be aware that with each additional suture on the uterus, the risk of complications increases. It is best to try to give birth vaginally and avoid subsequent stitches.

[1], [2], [3]