Childbirth after cesarean section

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

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

Should you try to have a vaginal birth after a C-section? Vaginal birth after one C-section, or one vaginal and two C-sections, is safe for most mothers. Whether it's right for you depends on several factors, including:

• The reason for the previous caesarean section. If the reason is recurrent (breech presentation) vaginal delivery is not recommended. However, in many cases caesarean sections are performed as a result of complications during vaginal delivery (rather than before delivery), such as when labour stops or there is fetal distress. There is usually no reason to worry that the previous condition will reoccur, although this cannot be said with absolute certainty.
• Number of previous cesarean sections. If you have had one cesarean section, vaginal delivery may be quite safe. If you have had two, the safety of vaginal delivery depends on what type of birth you had last. Attempting vaginal delivery is not recommended for women who have had more than two surgeries. The more surgeries you have had in the past, the higher the risk of uterine rupture.
• Number of planned births. The risk of complications during pregnancy depends on the number of cesarean section scars.
• Your personal beliefs. If there are no medical indications for a cesarean section, the choice is yours. Women in similar situations follow their intuition and experience.
• The clinic where you will give birth. If you decide to have a vaginal birth after a cesarean section, ask if the clinic has the special equipment and qualified personnel who can perform a cesarean section if necessary. Risk factors for vaginal birth after cesarean section
• Development of fetal distress syndrome, which requires surgical intervention for the safety of mother and child. Fetal distress syndrome develops in 20-40% of women who are not at risk.
• Separation of the edges of the suture, although usually not a problem, often heals on its own.
• Uterine rupture, which is life-threatening for mother and baby, is rare. Women who try to give birth vaginally but fail are at greater risk of infection. It can be concluded that vaginal births put women at lower risk of infection.
• Every birth is unique, and it is impossible to plan and foresee all aspects of labor and the birth itself. No doctor can guarantee the absence of complications.

Risk factors for cesarean section

• Infection
• Blood loss and need for transfusion
• Development of complications of the genitourinary tract
• Thromboembolism
• Complications after anesthesia
• Fetal trauma during childbirth
• Long term recovery

Further complications. With each surgical intervention, more scar tissue forms on the uterus. If you are planning to have another child, you should take into account the number of stitches on the uterus. After two scars, each additional one increases the risk of developing placental problems in the next pregnancy, such as placenta previa or accreta. These complications are fraught with not only injury to the fetus, but also increase the risk of hysterectomy if there is heavy bleeding.

How long does it take for women to recover from a cesarean section?

Most women are discharged home 3-5 days after the procedure, but it may take 4 weeks or more to fully recover. In comparison, women who have had vaginal births are usually discharged home 2 days after delivery and resume their normal activities within 1-2 weeks. Before discharge, the nurse will explain how to care for the incision, what complications may arise, and when to seek medical help.

General recommendations after a cesarean section:

• During the healing period, you should lead a calm lifestyle. Do not lift heavy objects, do not do intense physical exercises or sudden movements. Ask family members or friends to help around the house, go shopping or cook dinner.
• You may need painkillers for 1 to 2 weeks due to lower abdominal pain.
• You may have some vaginal bleeding for a few weeks (use pads, not tampons).

Seek immediate medical attention at the first sign of inflammation, such as 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 a previous C-section would have to have the surgery again in subsequent pregnancies. Today, many women with one C-section scar or experience of vaginal birth and two C-section scars can attempt a vaginal birth. This is called vaginal birth after C-section.

There is a small risk of serious complications with both vaginal and cesarean sections. In general, vaginal births are considered less dangerous than cesarean sections. But scientists have found that pregnant women who have had previous cesarean sections have an increased risk of a ruptured uterine incision during labor. This is called a uterine rupture.

Before deciding to have a vaginal birth after a cesarean section, consider the following recommendations:

• Even if you have a good chance of having a vaginal birth, there is still a chance of having a repeat cesarean section. 60-80% of pregnant women give birth vaginally after a previous cesarean section.
• If the reason for the previous caesarean section (breech presentation) is not repeated this time, it is likely that your birth will be without complications.
• Vaginal birth after cesarean section is considered safe for most women.
• In vaginal birth after cesarean section, there is a risk of uterine suture rupture. This is called a uterine rupture. The risk increases with each additional suture, as well as in the case of the use of drugs that stimulate labor.
• If you have had several cesarean sections, but also have experience with subsequent vaginal births, the risk of uterine rupture is reduced.
• If you are planning a pregnancy, be aware that with each additional stitch on the uterus, the risk of complications increases. It is best to try to give birth vaginally and avoid further stitches.

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