Birth of a healthy infant with vaginal birth has been the goal throughout centuries. The progress of medicine has and undoubtedly helped the concept of a perfect baby. Medical advances have brought about the safety of obstetrical procedures like a section cesarean. Cesarean delivery is a surgical procedure used to deliver an infant through an incision in the uterus.
The number of section, cesarean has reached epidemic proportions in some countries like Brazil 45,9%, Mexico, and Italy with 38%. Most of the country in Europe now has a cesarean section than 25%. One would expect that section, cesarean lead to reduce maternal and neonatal morbidity/mortality. But this is not a case.
Prevent the increase of section, a cesarean can be achieved through several steps: reaffirming the benefits of vaginal delivery to be, improved training of young residents and reintroduction of Vaginal birth after caesarean (VBAC). It appears that many women that previously have undergone a cesarean delivery can safely and successfully have a vaginal birth delivery. Current medical evidence indicates that 60-80% of women who attempt VBAC have a successful vaginal birth.When a literature review compared maternal mortality ratios by actual route of delivery, the rate in women who delivered by repeat cesarean was significantly higher than the rate in the woman who delivered vaginally (13.4versus 3.8% per 100000 births). We can conclude that vaginal birth after the previous cesarean should be encouraged with careful monitoring provided if there are not obstetric contraindications.
Vaginal Birth after Cesarean delivery versus Cesarean Section again
According to ACOG a trial to have a vaginal birth after cesarean delivery (TOLAC) to attempt VBAC compared with cesarean have some benefits but risks too.
Benefits of TOLAC include:
1.No surgery and some complications after it,
2.No additional blood loss (blood loss with cesarean is bigger compared with vaginal birth)
3.Lower risk of infections
Risks associated with a VBAC
- The main risk of TOLAC is a risk of uterine rupture. Don’t try TOLAC If you are at high risk of rupture of the uterus. According to the American College of Obstetricians and Gynecologists, the potential for uterine rupture during a vaginal birth after cesarean is one chance in 5000. Uterine rupture is associated with high vaginal bleeding and great pain between contractions as well as during them.
- In some cases, doctors use forceps or vacuum extraction to birth the baby. This may increase the risk of developing incontinenc
3. The incidence of episiotomy is usually associated with instrumental assistance for the birth (using forceps or vacuum extraction) and is 14%.
4. If problems develop during the labor, an emergency cesarean is needed. The risk of infection from an emergency cesarean is higher than from elective cesareans.
Risks associated with a repeat caesarean
- Blood loss with cesarean is bigger compared with vaginal birth. The cesarean requires a blood transfusion.
- The risk of accidental surgical damage to the bladder is always possible.
- There is the chance of an infection developing in the wound.
- The recovery time and the period spent in the hospital after cesarean is longer than the recovery time of vaginal birth.
- The risk of postnatal depression after cesarean is bigger than after vaginal birth.
The possibility of fetal death is minuscule with both VBAC and Cesarean delivery.