When a woman has a Cesarean delivery (also called a C-section), her baby is delivered through an incision made in the mother's abdominal wall and uterus. The amniotic sac containing the baby and placenta is cut, and the baby is removed through the incisions. After the baby is delivered, the placenta is removed. The uterus is closed in layers with sutures that are absorbed (they don't have to be removed). The abdomen is then sewn together.
In 1965, only 4% of all deliveries were Cesarean. Today, about 20% of all deliveries are Cesarean deliveries. We believe the increase is related to better monitoring during labor and safer procedures for C-sections. Women are also having bigger babies. Another factor in this increase may be rising malpractice rates and the fear of litigation.
With most C-sections, the anesthesiologist will give you an epidural or a spinal anesthetic. You are awake with these.
Advantages and Disadvantages
The most important advantage of a Cesarean delivery is delivery of a healthy baby. On the other hand, this is major surgery and carries with it those risks. You will probably have to stay in the hospital 2 or 3 days.
Recovery at home takes longer with a Cesarean than it does with a vaginal delivery. The normal time for full recovery is 4 to 6 weeks.
How many C-sections?
Many doctors recommend no more than two or three, but this is evaluated at the time of each delivery. There is no exact,"safe" number of C-sections a woman may have. I have one patient on whom I recently performed her eighth C-section. This is unusual however.
Usually the doctor will use the same incision site. If you have a large scar, your doctor may cut out the old scar.
Vaginal Birth after Cesarean (VBAC)
In the past it was believed that once a woman had a C-section, all later deliveries would have to be Cesarean also. Today it is becoming more common for women who have had a C-section to deliver vaginally with later pregnancies. This is called vaginal birth after Cesarean (VBAC).
Various factors must be considered in the decision to have a VBAC. The type of incision done with the Cesarean delivery is important. If the incision on the uterus (not the woman's abdomen) is high, labor is not permitted in subsequent pregnancies. If the woman is small and the baby is large, it may cause problems. Multiple fetuses and medical complications, such as diabetes or high blood pressure, may require a repeat C-section.
The American College of Obstetricians and Gynecologists states a woman may have two Cesarean deliveries and still be a candidate for VBAC, other factors permitting. This is a very individual decision. Discuss it with your doctor.
Women who have the best chance of having a successful vaginal delivery after a C-section include women:
|whose original cause for a Cesarean delivery is not repeated with this pregnancy|
|who have no major medical problems|
|who had a low incision on the uterus with their previous C-section|
|who have a normal-size baby|
|whose babies are in the normal, head-down position|
If you want to try a vaginal delivery after a C-section, the most important thing to do is to discuss it with your doctor well in advance of labor so plans can be made. It may be helpful to get the records from your other delivery. Discuss the benefits and risks, and ask your doctor for his or her opinion as to your chances of a successful vaginal delivery. He or she knows your health and pregnancy history. Include your partner in this decision-making process.