Randomized controlled trials of methods of induction of labor for women
with a previous cesarean delivery are underpowered to detect clinically relevant differences for many outcomes (112).
• How should second - trimester preterm delivery or delivery after a fetal death be accomplished in women
with a previous cesarean delivery?
For example, among three large studies investigating prostaglandins for induction of labor in women
with a previous cesarean delivery, one found an increased risk of uterine rupture (89), another reported no increased rupture risk (5), and a third found no increased risk of rupture when prostaglandins were used alone (with no subsequent oxytocin)(6).
Rates of cesarean section for multiparous women, when women
with previous cesarean sections were excluded, were not different (p value cut - off for statistical significance after the Bonferroni correction 0.002).
They also urged that current VBAC guidelines be revisited, malpractice concerns be addressed, and additional research undertaken to better understand the medical and non-medical factors that influence decision making for women
with previous cesarean deliveries.
Improved algorithms are needed to more precisely estimate the likelihood that a patient
with a previous cesarean will have a successful vaginal delivery.
We excluded women
with a previous cesarean scar and known gross fetal anomaly.
Moms who are determined to go forward with an elective cesarean section or who have not come to terms
with a previous cesarean section may find certain sections upsetting.
Unlike
with my previous Cesarean, which I didn't know would happen in advance, this time I was lucky to be able to process the emotions surrounding it beforehand.
As for the insurance companies charging more (or denying coverage)... their expenses for a woman
with a previous cesarean are higher than for a woman with previous vaginal birth — and it's not just if she births again.
Not exact matches
Meanwhile, VBAC has been shown to be safe for most women who have had a
previous cesarean birth,
with a few exceptions.
Studies also show that
with a history of
previous cesarean, seven out of ten women or more who are allowed to labor without undue restrictions will give birth vaginally, thus ending their exposure to the dangers of
cesarean section.13
Some common triggers, according to the Birth Trauma Association, are: lengthy labor or short and very painful labor, induction, poor pain relief, feelings of loss of control, high levels of medical intervention, traumatic or emergency deliveries (e.g. emergency
cesarean section), impersonal treatment or problems
with staff attitudes, not being listened to, lack of information or explanation, lack of privacy and dignity, fear for baby's safety, stillbirth, birth injuries to the baby, NICU stay, poor postpartum care,
previous trauma (such as sexual abuse, domestic violence, trauma
with a
previous birth).
Data regarding the risk for women attempting TOLAC
with more than two
previous cesarean deliveries are limited (76).
Additionally, retrospective cohort data have suggested that the likelihood of achieving VBAC appears to be similar for women
with one
previous cesarean delivery and women
with more than one
previous cesarean delivery.
Women
with one
previous cesarean delivery
with a low - transverse incision, who are otherwise appropriate candidates for twin vaginal delivery, are considered candidates for TOLAC.
Similar to that of women
with one
cesarean, the calculated predicted probability of a VBAC can be obtained using a web - based calculator that has been validated in women
with two
previous cesarean deliveries (75).
Most women
with one
previous cesarean delivery
with a low - transverse incision are candidates for and should be counseled about and offered TOLAC.
Women
with one
previous cesarean delivery
with an unknown uterine scar type may be candidates for TOLAC, unless there is a high clinical suspicion of a
previous classical uterine incision such as cesar - ean delivery performed at an extremely preterm gestation age.
They offer the statistics of uterine rupture
with two
previous cesareans as 1.36 %, and ultimately state that provided the woman is fully informed of the increased risk and has undergone an individual risk assessment
with her provider, then planned VBAC may be supported in women
with two or more
previous lower segment
cesarean deliveries (NICE, 2015).
NICE (2015) discusses a study by Landon et al (2006) that showed no significant difference in the rates of uterine rupture in VBAC
with two or more
previous cesarean births compared
with a single
previous cesarean birth, and states that these findings are consistent
with «other observational studies,» (p 7).
Zealot et al. (2000) demonstrated this risk may decease by as much as 40 % when women
with multiple
cesareans have had a
previous vaginal birth.
- There has only been one
previous cesarean delivery and it was done
with a low transverse horizontal incision (bikini scar).
There is also a package that includes a one - on - one consultation
with me, which you may find so helpful, as women who have had
previous cesarean planning to birth vaginally benefit tremendously from some extra personalized counseling and guidance.
According to the American College of Obstetricians and Gynecologists (ACOG), if you had a
previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is.2 to 1.5 %, which is approximately 1 chance in 5001.
Recently, ACOG stated that VBAC is safer than a repeat
cesarean, and VBAC
with more than one
previous cesarean does not pose any increased risk.2
I say if you've had a
previous cesarean, definitely speak
with your doctor and share your desire for VBAC.
No association between vaginal delivery and interference
with daily life was observed after 6 weeks, which supports a
previous study.22 Additionally, the prevalence of moderate or severe UI in the vaginal delivery group was higher than that in the
cesarean delivery group at 3 — 5 days, perhaps because pelvic floor muscle strength is significantly reduced at 3 — 8 days after vaginal delivery, but this is not the case after
cesarean delivery.6
The risk of uterine rupture
with a
previous low transverse (sideways)
cesarean delivery is less than 1percent.
The article goes on to state things that are probably not surprising to most: in women who are low risk, and even some who in the past have been deemed moderate risk (like over 35 years of age, have had a
previous cesarean), can have favorable outcomes
with a home birth.