If you've had a cesarean section (C-section) before, will you have a normal delivery this time? Let's talk about VBAC!

If your first baby was delivered by cesarean section (C-section), you may be wondering, "Will I have a normal, vaginal birth this time?" This is a question that many mothers have high hopes for, but sometimes comes with a little fear. So today, let's talk about this clearly and in a way that you can understand.

Then and now: Has the way you think about childbirth changed after a cesarean section?

You may remember, back in your mother's day, many people thought that if you had a C-section once, you would have to have another C-section for every baby after that. Even doctors at that time often referred to that. There were reasons for that.

But nowadays, medical science is very advanced . With new research and new knowledge, many things have changed. Now, doctors themselves say that many qualified mothers, even if they have previously had a cesarean section, can give birth vaginally (Vaginal Birth After Cesarean - VBAC) . In fact, this is now considered a safe option for many mothers and their babies.

Imagine, you can go home sooner after having a normal baby. There is less discomfort and you can recover faster. These are some of the biggest advantages of a VBAC.

So, can I also do (VBAC)? What determines that?

This is the most important question. Not everyone is the same. There are several factors that determine whether you can have a VBAC or not. Let's look at each one individually.

1. What was the reason for your first cesarean section (C-section)?

Sometimes the first operation may be done because of an emergency with the baby, or because of an issue like the mother's blood pressure. There are some reasons, if that reason is likely to be relevant in this pregnancy, it may be risky to have a VBAC. But there are also some reasons, if it is something that only affected that time. For example, if you had a cesarean section because of something like a breech position, if the baby is in the correct position this time, you may be more likely to try a VBAC. Your doctor or midwife will explain this to you in detail.

2. Type of Uterine Incision - This is the most important thing!

Here's something to be very careful about. The shape of the incision in your uterus during your first cesarean section is crucial for a VBAC. This is not the incision visible on your skin, but the incision inside your uterus.

We are mainly talking about two types of cuts:

• Transverse incision:

Simply put, this is the most common type of incision performed, and the most favorable for a VBAC.. This incision is made in the lower, thinner part of the uterus, transversely. Think of it like a bikini line (not a skin incision, but an incision in the uterus). This incision is where the uterus is not under as much pressure when the baby is born (when it contracts to push the baby out). Therefore, a mother with this type of incision has a much higher chance of having a successful VBAC. Another name for this incision is (Low-transverse incision) .

• Vertical incision:

In this, the incision is made from the top of the uterus to the bottom, lengthwise. Because this incision goes through the muscles of the uterus, there is a high risk of the uterus tearing (uterine rupture) through the incision when the uterus contracts strongly during labor. This can be a very dangerous situation for both the mother and the baby. Therefore, doctors generally do not advise a VBAC if there is a vertical incision (especially a classical incision made in the upper part of the uterus).

Important: Even if your skin incision is horizontal, sometimes the incision inside your uterus can be vertical. Therefore, it is important to review your surgical notes from your first cesarean section to find out exactly what the incision looks like. Talk to your doctor about this.

3. How many cesarean sections have you had before?

Although VBAC is usually considered after one cesarean section, if you have had two or more cesarean sections, having a VBAC can be a little more risky. The risk of uterine rupture can be even higher due to the increased scar tissue in the uterus. However, in some special cases, even those who have had two previous cesarean sections may be allowed to try VBAC, with great care, at an appropriate facility. This depends entirely on your medical history, the type of uterine incision, and the decision of the doctor taking care of you.

4. Your current pregnancy status and other health concerns

If you have conditions like diabetes mellitus, high blood pressure, a growth problem with your baby, or a baby that appears to be very large (macrosomia) during this pregnancy, your doctor may think twice about going for a VBAC. Also, if you have any problems with the shape of your uterus (e.g. fibroids), that may also affect the decision to have a VBAC.

Isn't there no risk in (VBAC)?

Although a VBAC is a safe option for most mothers, it is not without risks . The main risk is uterine rupture . This is when the uterine wall tears at the site of a previous cesarean section. This is a very rare occurrence (less than 1% according to Sri Lankan statistics, especially for those who have had a horizontal incision), but if it does happen, it can be a life-threatening emergency for both mother and baby. That is why if you are trying for a VBAC,They say it should be done in a hospital that has all the facilities to perform an emergency cesarean section.

On the other hand, if you try a VBAC and it doesn't work, you may end up having to have an emergency cesarean section. This unplanned emergency surgery may be slightly more likely to cause minor complications than a scheduled cesarean section.

Don't be afraid! These risks are meant to educate you, not scare you. Most mothers successfully undergo VBAC without any problems. The most important thing is to talk to your doctor about whether it is right for your situation, what the risks are, and what the benefits are.

If I want a (VBAC), what should I do?

If you are considering a VBAC, follow these steps:

1. Talk to your doctor: This is the first and most important thing. Discuss all of your previous cesarean sections (especially the type of hysterectomy), your current health, and your specific health concerns with your doctor. Ask them about the pros and cons of a VBAC, and what specific risks you may have. Your doctor will examine you, review your records, and decide whether a VBAC is right for you.

2. Check with the hospital you choose to deliver your baby at: Not all hospitals have the same VBAC facilities or policies. Some hospitals are supportive of VBAC, with emergency rooms and operating rooms available 24/7. However, some hospitals, especially smaller ones, may not allow VBAC because they have limited resources to handle emergencies. Therefore, it is important to find out in advance what the VBAC policy is at the hospital you are planning to deliver your baby at.

3. Be prepared, but flexible: Even if you are prepared for a VBAC, sometimes things don't go as planned. If there are complications during labor, your doctor may decide to perform an emergency cesarean section. Remember, the ultimate goal is a healthy mother and a healthy baby. So, be prepared to follow your doctor's instructions.

Consider, if your chosen hospital doesn't allow VBAC, but you really want it and your doctor agrees, you may be able to transfer to another hospital that does. Talk to your doctor about this as well.

Shall we briefly recall what we talked about? (Take-Home Message)

Okay, so, from what we've talked about, these are the most important things you need to remember:

• Even if you have had a previous cesarean section (C-section), many mothers are able to have a vaginal birth (VBAC) . This is now a safe option.
• The main factor in determining whether or not you can have a VBAC is the type of uterine incision made during your first cesarean . A transverse incision is most likely to be the best option.
• This is affected by factors such as the reason for your first cesarean, the number of previous cesarean sections, and your current health condition.
• There may be some risks involved in a VBAC, but these risks can be minimized with good planning and a skilled medical team.
• The most important thing is to talk openly about this with your doctor. He or she will be the one who will advise you on what is best for your situation.
• Also, be aware of the VBAC policy of the hospital where you are going to deliver your baby.

Remember, every pregnancy and every birth is unique. I wish you the strength to choose what is safest and healthiest for both you and your baby!

` VBAC, Caesarean, Normal delivery, Hysterectomy, Childbirth, Maternal health, Medical advice