There are many factors that go into determining if a patient who had a prior c-section should deliver the subsequent baby by vaginal delivery after c-section (VBAC) or whether they should have a repeat c-section.
In patients with multiple prior c-sections, prior myomectomy (surgical removal of a fibroid from the uterus), placenta previa, other placental abnormalities, and breech presentations, a repeat c-section without a trial of labor should be offered.
Otherwise, all clinical factors should be explored to determine a patient’s candidacy for TOLAC (trial of labor after c-section). Indication for prior c-section, fetal size and presentation and many other factors are examined. 60-80% of patients who had a prior c-section will succeed in avoiding major abdominal surgery and will VBAC.
The best candidates are those who had a prior indication for c-section that is non-recurrent (Placenta previa, breech baby, fetal distress), those who go into spontaneous labor, and patients who in the past have had at least one prior vaginal delivery. It is very important to speak with your doctor early on in the pregnancy about your particular situation and your desire to attempt a VBAC (if safe and indicated) versus having a repeat c-section.
The operative note from your prior c-section should be obtained for your doctor and a thorough discussion should be entertained regarding all options, risks, benefits and alternatives.
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