Giving birth vaginally after a C-section – what are the risks?

Shanghai Living

Giving birth has quite literally existed since the beginning of humanity—and even though health care has improved—things can still go wrong. In situations like these, women often have no choice but to undergo a cesarean section (C-section).

Natural is best

After a C-section, however, the story is far from done. After a C-section, a woman’s body changes in ways that make vaginal delivery risky. Should a mother have vaginal birth after a cesarean (otherwise known as VBAC)? What is the process even like?

To find answers, I put my questions to Dr. Sam Liu, chairman of the obstetrician and gynecology department at Beijing United Hospital. From the very beginning of the interview it’s evident Dr. Liu is a big supporter of natural, vaginal birth. When I ask a question he sits, thinks, and then answers slowly and authoritatively. I can tell by his calm and cool that he has delivered a few thousand babies in his time. He knows his stuff.

Dr. Liu explains that there are some clear differences between a C-section and vaginal birth. Vaginal birth is painful and time-consuming during labor, but after the delivery there is no additional pain, the female body can recover fast and the hospital stay is short. Also, with the modern anesthetic medicine and epidural technique, the labor process is easier and less painful than before. Vaginal delivery also means less risk of an infection, less risk that the baby will have breathing problems and a lower chance that the woman will require a blood transfusion. Also, a woman can give birth vaginally several times without any problems. Cesarean sections, on the other hand, have longer-lasting effects on a mother’s body. Mothers may experience pain after the surgery and need to stay at the hospital for a longer period of time. Also, there is a higher risk of infection, bleeding, anesthesia, vascular injuries, organ injuries and more.

Weighing these two options, vaginal birth seems to be an obvious choice for a mother who is having her second child. However, if your first child was conceived through a cesarean section, it’s important to know what risks there are.

During a cesarean, the woman’s uterus is cut to retrieve the baby. Because of this cut there is a small risk that during VBAC a rupture may happen in the uterus during vaginal delivery (at Beijing United Family hospital the risk is 0.58 percent, in the U.S. it’s 0.8 percent). If a tear occurs, risks include blood loss, bladder damage, infection, blood clots and sometimes a blood transfusion or hysterectomy may be necessary. With these risks in mind, hospitals set up comprehensive consultations with mothers who have had cesareans to make sure that they are aware what the risks are with VBAC. If the mother chooses to go through with vaginal birth, the process of TOLAC begins (or Trial of Labor After Cesarean), where the pregnant mother is monitored carefully to make sure that the uterus remains strong and healthy during pregnancy.

When a mother chooses VBAC, ultrasounds and comprehensive tests are done all the way up until labor. If the worst were to happen and it appears that the uterus is about to rupture, a cesarean section is the last resort.

Dr. Liu was clear on one thing though: just because VBAC has risks, doesn’t mean that several cesarean sections in a row is risk-free either. It is a common misconception that a mother who has had a C-section must continue to have C-sections. In fact, mothers who have several cesareans are at higher risk of having their uterus rupture. Dr. Liu shows me a scary ultrasound of a mother in the U.S. who had five cesareans. During her sixth pregnancy, the baby managed to kick through the weak uterus and it’s leg lay in the mother’s abdomen. Although the story ended well—both the mother and child survived—the disturbing picture made Dr. Liu’s message clear.

After vaginal birth, the body’s ability to heal is amazing. In fact, after a successful VBAC, your uterus is stronger and your next vaginal birth is even more likely to be a success. Compare this with C-sections where each additional cesarean becomes riskier.

Dr. Liu is adamant that mothers should trust natural birth more than anything else. Of course, if anything were to happen it is good to have doctors, nurses, computers, and medicine to help. But if everything seems to be going smoothly, vaginal birth is the best way to bring a child into the world.

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