Vagina Delivery After Cesarean Section (By Showunmi Mary)

Showunmi Mary, is a Midwife, change agent, a counselor and a care giver who is concerned about helping mothers through out the conception period. She is particular about educating and giving out meaningful information about reproduction, delivery, antenatal, postnatal and child care to people, to mothers, and women in their reproductive age.

She is the founder and Lead Midwife at ANC with Nurse Showunmi. This is a platform comprised of a close Whatsapp group and an Instagram page dedicated to providing free consultation for women in the above categories.

Here is her session with us:

As you all know, I am a Registered Midwife. I have met Alot of mothers that don’t even know they have an option of trying out VAGINA DELIVERY AFTER CEASEAREAN SECTION hence this class. Everyone one should follow this class to the end and not just pick up on a paragraph and decide to bank on it.

First of all what are the types of birth methods:

We have different birth methods but we would be going through the first two

  • Vagina birth:

Vagina birth is a process in which the contraction and retraction of the uterus (womb) over a period of a time becomes strong enough to expel the products of conception (the baby, placenta and membranes) via the vagina

Usually the process is very painful but once the baby is out the woman is relived. It is believed to be the easiest method of birth as there are little risk of complications when compared to other methods.

  • Cesarean section:

Cesarean section can be described as the process of delivering the products of conception via incision into the abdominal and uterine wall. It is then stitched to leave a clean wound which is allowed to heal and dressed at appropriate intervals.
This methods carries a significant number of risk which can be higher or low compared to a vagina birth which is dependent on the situation surrounding the birth and pregnancy.

  • Assisted delivery (this is gradually facing out due to the numerous complications attached to it)

The least common of the three, is the assisted delivery, this is a type of vagina birth but is being completed by using forceps or vacuum to deliver the head of the baby. This is a very risky procedure and it is being faced out because of the risk attached to it.

What then does it mean to have a Vagina Birth After Caesarean Section? Also know as (VBAC)

VBAC is a situation whereby one who has had a Caesarean section agrees to and successfully delivers her next child via vaginal delivery. In Nigeria, not every mother knows that they have an option of VBAC, and not all hospitals support VBAC due to their policy or experience. Usually a VBAC occurs when a Trial of Labour After Caesarean (TOLAC) is successful, if not successful it would end in another Caesarean Section.

The joy of every Midwife and family is to have an healthy and alive baby and mother at the end of pregnancy. So regardless of any method offered this should be the goal

When considering having a VBAC, every one should be considered individually. This is where alot of mothers get it wrong because your sister had a successful Vbac does not mean you would have one too, or you would even be considered for one. For every mother, attempting a VBAC should understand or consider the following:

1) what methods of delivery suits you best:

I have seen mothers, who prefer to go for the C-section because they believe it is the best and most convenient for them. You have to psychologically accept whether or not you want a Trial of Labour. If you would like to consider having a vagina delivery after a C-section, you should be prepared to do so…And you have the right to back out at any point.

2) History of Previous C-section

Any one who is going to support a TOLAC must have a detailed history about your previous C-section. This is also particular to the type of incision made on your uterus. This is not the one you can see with your eyes, it is the one made in your womb. The lower incision is the best, as the classical incision puts women at risk of uterine rupture.
This can be demoted by taking history. Why Was The previous surgery performed. For example if it was placenta previa with placenta attaching to the anterior wall, the incision made on the uterus might be classical, which means one should not attempt a VBAC.

3) The Choice of birth place.

Your choice of birth place should be streamlined to one which has facility for Emergency Caesarean section. This is because sometimes things might not go as

planned, and it might end up in a Caesarean section.

I need to sound this again, because some women who desire to have a VBAC would run to traditional birth attendant or non-certified church clinic to expect a “miraculous delivery” VBAC. You are doing more harm than good to your self.

4) Previous and present Obstetric history

if one is the type of person that has an Android (male) pelvis, or has had recurrent still birth. One would like to be careful and not take chance with the present pregnancy.

In present pregnancy, when conditions like fetal distress, severe placenta Abruptio, pre-eclampsia. The safest option for the mother and child might be Caesarean section.

In addition to the above, both partners and their health professionals have to discuss extensively about their choices, options, birth plan and complication readiness.

The biggest risk associated to VBAC is uterine rupture

However, some of the following might increase the chances of having a successful VBAC

  • had previous vagina birth
  • had less than 2 C-section
  • healthy weight
  • at least 18 months since the last surgery
  • reason for the last section was non-recurring rather than recurring conditions

Advantages of VBAC

  1. it gives psychological reassurance to the woman (The feeling is reassuring for people who have always wanted one.
  2. It is less expensive
  3. Recovery is faster than that of C-section

Disadvantages

  1. It can lead to uterine rupture, if not monitored well
  2. One would have to wait for labour to start normally unlike C-section when one can choose to have the baby out anytime after 38 weeks
    if the TOLAC fails
    I. One might feel very disappointed if a TOLAC doesn’t lead to a V-bac.
    II. It might lead to double stress, you go through the process of labour and also the pain of healing from the incision.

Questions

Q: I didn’t fall into labor, it was at 42weeks that they induced me is it advisable to try Vbac?

Q: I have had two CS, the first one was due to oligohydramnios and baby still didn’t make it, the second was elective CS at 37 weeks? Would You advise a VBAC at all? My gynaecologist seem to believe CS is a safer birth method, What are your opinions?

Q: Is it possible for a CS spot to burst from inside

Yes, in cases of negligence. Like inducing labour after one has had a CS. Like trying out vaginal delivery within one year of previous CS


You can reach Showunmi Mary @ancwith.nurseShowunmi on Instagram. You can also connect to her on twitter @nurse_Showunmi or Whatsapp +2347060937274

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