Long ago, the rule was: once a cesarean, always a cesarean. The belief was that labor after cesarean wasn't safe, that the uterus would be weak from the prior surgery, and burst open (rupture), leading to demise of the baby, and serious blood loss in the mother. In the 1970's, studies showed that women who'd had low transverse cesareans, in which the uterine incision runs crossways (not up and down), had a low complication rate from vaginal birth, less than a one percent chance of uterine rupture, and a 60-80 percent chance of success: the vaginal birth after cesarean (VBAC) movement was born.
In the 1990's, though, the pendulum swung back, as doctors saw occasional serious complications of VBAC. Even though the chance of uterine rupture was low, many doctors and parents felt it wasn't worth the risk. Family sizes were smaller, lawsuits larger, surgery safer; repeat cesarean didn't seem like such a bad idea.
The American College of Obstetrics and Gynecology currently supports the option of VBAC but recommends that labor after cesarean only be offered in hospitals in which a medical team is available for emergency cesarean at all times. This eliminates small hospitals that don't have an in-house anesthesiologist and is often interpreted to mean that the patient's doctor must be there throughout her labor. Currently, only about ten percent of births after cesarean are vaginal-the remainder are repeat c-sections.
Talk to your doctor. Find out if your doctor and your hospital offer VBAC at all. If yes, the type of incision you had on the uterus will determine if you are eligible for VBAC. Since the scar on the skin doesn’t reflect the direction of the incision on the uterus, your doctor will need to check the records to see that your first cesarean was the common low transverse type. You can then discuss the reasons for the original cesarean, and if that is likely to repeat itself. Lastly, you'll go through the pros and cons of vaginal birth versus repeat cesarean, and decide together what is right for you and your family.
