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VBAC (Vaginal Birth After Caesarean)
PHYSIOLOGICAL TOCKS AFTER A CASSARIAN TOMB : Truths and myths
It is a myth that, having a C-section in the history, all subsequent children will have to be born by C-section. We used to say "once a section, always a section".
This practice has changed over the years and every woman with a history of a caesarean section is given the choice of whether she wishes to have a normal birth (VBAC).
- Probability of success: 72-76 %, depending on the history of the previous birth.
- Το μεσοδιάστημα ανάμεσα στους δυο τοκετούς μπορεί να επηρεάσει τις πιθανότητες επιπλοκών: σε μεσοδιάστημα < 15 μηνών η πιθανότητα επιπλοκών αυξάνει κατά 3 φορές. Αυτό δεν σημαίνει ότι δεν έχει δικαίωμα ή απαγορεύεται να προσπαθήσει για vbac μία γυναίκα που μόλις γέννησε και ξαναέμεινε έγκυος.
- The estimated fetal weight affects the probability of success: it has been found that if the estimated fetal weight is >4 kg, the estimated success rate drops from 70% to about 50%.
Advantages of normal childbirth
- Rapid recovery and mobility of the mother
- The experience of the process of normal childbirth that the mother acquires
- Avoiding surgery with all that entails
Disadvantages of VBAC
- Risk of uterine incision disruption: the risk is as follows: 1/277 when the woman has her own contractions during delivery, 1/120 with the use of oxytocin (in the absence of identical contractions) and 1/77 with induction with vaginal suppositories.
- Fetal mortality: 9:10,000, which is higher than for caesarean section.
- Symptoms of incision opening: heart rhythm abnormalities on cardiotocography - pain under the incision - bleeding from the atrium.
- Maternal mortality: as well as the likelihood of venous thrombosis, vascular injury and total average blood loss in labour is lower in vbac than in repeat caesarean section.
Given that only 20-30% of women go into spontaneous labour before their probable date of delivery (DDP), it is clear that the more time a pregnant woman is given to wait to go into spontaneous labour, the fewer complications. The usual wait is up to 10 days after the PHT, a stage at which statistically 90% of pregnant women will have gone into labour on their own. Epidural anaesthesia may or may not be used, according to the needs and wishes of the pregnant woman.
It encourages the mobility of the pregnant woman and a change of posture, which favours the dilation and progress of the birth.
Oxytocin may be used, but for a limited time, at a slow rate and with caution.
The birth plan can be done and implemented as normal, just like any other pregnancy.
The mother can go home after one day.
Dr. Nikos Papanikolaou
Obstetric Surgeon Gynecologist, ATSM
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