Risk factors that make a repeat caesarean necessary
A trial of labour after a previous caesarean section is not recommended for women who have an increased risk of a previous caesarean scar tearing open (uterine rupture). Regardless of risk factors, no trial of labour is safe without the medical facilities and staff needed for an emergency caesarean.
Some health problems make a trial of labour more risky for you or for your baby. You may know about some of these problems early in your pregnancy or long enough before your due date that you can plan accordingly. Situations that make a vaginal birth after caesarean (VBAC) trial of labour more risky include:
- A vertical (classical) uterine incision that reaches above the lower uterus.
- Two or more caesarean scars and no previous vaginal delivery.1
- A caesarean delivery within the past 2 years.2
- A single-layer closure, rather than a double-layer closure, of your previous caesarean section.3
- Previous uterine surgery, such as removal of a uterine growth (fibroid) that has cut deeply into the uterus.
- A narrow (contracted) pelvis, as determined during your last delivery.
- Triplets or more during this pregnancy.
- A medical reason for caesarean in this pregnancy, such as active genital herpes or placenta previa.
Even if you plan a trial of labour, problems that require a repeat caesarean may develop as your due date nears or during labour. You may need a repeat caesarean if:
- Your labour does not begin spontaneously. One medicine used to start (induce) labour, such as misoprostol (Cytotec) has been linked to a higher risk of uterine rupture during VBAC. (If oxytocin is used sparingly to help a slow labour, it is less likely to increase uterine rupture risk.)1, 4 Some doctors will place a thin tube with a small balloon into the cervix. This can soften the cervix without raising the chance of uterine rupture.
- Placenta previa or placenta abruptio develops. These problems often require a caesarean delivery. However, if you had your first caesarean because of one of these problems, there is no reason to expect that it will happen again.
- The baby is in a breech position. For more information, see the topic Breech Position and Breech Birth.
- You have an active case of genital herpes, which may be transmitted to your infant during a vaginal delivery.
- Fetal monitoring during labour indicates that the baby may be in distress.
| Author: | Kathe Gallagher, MSW Carrie Henley | Last Updated: June 18, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology | |
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