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Healthy Outlook

An expecting mom should consider natural childbirth, even with a C-section in her past

By Dr. Judy Bliss

Tuesday, May 21, 2013

Too many expectant mothers also expect surgery when they deliver their children. One myth I hear too often around the labor and delivery ward is that a woman who previously needed a C-section will always need one to have a baby.

I work hard to dispel that fallacy. In most cases, vaginal delivery is not only possible for mothers with previous cesarean deliveries — it's preferable.

The C-section should only become an option when vaginal delivery might pose an elevated risk to mother or child. Cesarean patients face elevated risk of complications, such as hernias, blood clots or infection. And, while mortality rates for mothers and newborns are low and falling across the board, they do remain slightly higher in cases of cesarean delivery.

Vaginal delivery, on the other hand, avoids many of those surgery risks. There's often less long-term pain and bleeding and there's less risk of future pregnancy or reproductive health problems. We also know that vaginal delivery makes for fewer breastfeeding complications.

Another challenge to the C-section is the fact that Cesarean patients are, in fact, more likely to need the same operation during subsequent pregnancies. But modern medicine has changed how we manage that risk.

Decades ago, that elevated risk of a mid-labor, emergency C-section made elective cesarean the safest option in the eyes of many doctors. That's because surgery leaves a scar on the uterine wall, a structural weak point that can (very rarely) rupture during vaginal childbirth. But these days we can predict the likelihood of complications much more accurately, and we are much better prepared to respond in case of emergency.

As a result, the average vaginal delivery rate for VBAC (Vaginal Birth After Cesarean) patients is close to 80% at Contra Costa Regional Medical Center, where I work. Our hospital decided several years ago to optimize our ability to support VBAC, in order to give expectant mothers as many safe options as possible as their due dates approach.

Our perinatal program uses a specific set of interventions, known as a "bundle," to ensure that our staff responds quickly and properly to any complications that might occur during labor or delivery. For mothers with previous cesareans, all levels of our staff are trained to immediately identify developing problems, and we have a surgery team specifically trained to assemble for an emergency C-section within minutes of a uterine rupture, at any hour of any day.

So are elective C-sections now a "bad" option? Not necessarily. Every patient is different, and some women definitely should consider cesarean delivery for health reasons. And medical opinions about elective C-sections clearly vary, as about one in every three children born in the U.S. is now a cesarean delivery, while we estimate that the procedure is medically necessary in only about 15% of all pregnancies.

The difference these days is the quality and quantity of information available to expecting mothers and their doctors. Decisions about your pregnancy rank among the most important in your life — don't base them on what was true when your mother was pregnant.

What we know now about pregnancy, and particularly your delivery options, may surprise you.

Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at theairdoctor@gmail.com. For more health information, go to www.cchealth.org.
About the Author

Dr. Bliss practices obstetrics and gynecology at the Contra Costa Regional Medical Center in Martinez.