Repeat cesarean section — the risks 

Now that we have found out what can go wrong during a vaginal birth after c-section, it is time to examine the risks of a repeat cesarean section. Infections, hemorrhage and the need for blood transfusion, complications from the anesthetic received, and maternal death are two to four times more likely to occur as the result of a c-section. Psychological problems are also associated with c-sections.  

Babies born by c-section are more likely to be born prematurely, and have an increased risk of breathing difficulties right after birth and asthma later in life. Breastfeeding difficulties are another risk associated with c-section. 

Having a repeat cesarean section is a trade-off — you may lower the risk of uterine rupture in this pregnancy, but if you get pregnant again, a subsequent pregnancy is more likely to experience complications. Babies developing in a scarred uterus are more likely to have a low birth weight, to be born prematurely, and to be stillborn. Placenta previa and placenta accreta are placental complications in which the placenta covers the cervix or is embedded in the uterus more deeply than it should, respectively. These two are also more likely to happen in a scarred uterus. 

Scientific research shows that a VBAC is generally more safe than a planned repeat cesarean section, but also that a trial of labor turned emergency c-section carries the highest risk of the complications we just mentioned. The researchers (see source list at the bottom of this article) came up with a list of factors that to asses the likelyhood of emergency c-section after trial of labor: 

• No previous vaginal delivery.

• Increased maternal age.

• Lower maternal weight and height.

• Induction of labor.

• Labor after the 40-week mark. 

If You Want A VBAC, But Your Doctor Doesn't Agree

Some hospitals have no-VBAC policies, and some individual doctors are opposed to giving women a trial of labor after they have had a cesarean section. If this happens to you, it is important to find out what the underlying reason for your medical team's refusal to assist you with a VBAC is. 

It is possible that you are simply not a good candidate for a trial of labor. Did you have a classical or T-shaped incision during your previous c-section, perhaps? Or does your pregnancy have other risk factors that contraindicate a trial of labor, like breech or a low-lying placenta? In that case, accepting that a repeat cesarean section is the safest choice for you is probably the only option you have. 

If, on the other hand, your doctor or hospital has a blanket policy against vaginal birth after c-section, there are several things you can do. Pointing out the ACOG guidelines on VBAC may help, as will showing your medical records to reassure the doctor that your type or incision and sutures are combatiple with a trial of labor. You could also ask what would happen if you simply refused to undergo the surgery unless there is a clear medical reason. 

Do these questions result in a hostile attitude and more refusal? Then, your best bet is to search for a hospital or doctor that is supportive of VBAC. Searching the internet may be really helpful if you are trying to locate such a doctor, but you could also seek out local organizations where other moms are likely to have this information. The La Leche League, babywearing support groups, or even c-section support groups (they exist!) are all good places to start looking.