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Alternatives to VBAC

Clip Number: 21 of 40
Presentation: Women's Health -- Common Conditions, Tests, and Procedures
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Reviewed By: Arthur Schoenstadt, MD
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The only alternative to a cesarean section is a vaginal delivery, which can be done with the help of either forceps or vacuum, if necessary. With your condition, there are risks no matter how your baby is delivered. Let's discuss the risks of having a vaginal delivery.
You have a scar on your uterus from a previous cesarean delivery. The risks for this scar partially or completely separating during a vaginal birth, depend on where your scar is located on the uterus. Women with vertical or up and down scars on the upper part of the uterus have a significantly higher risk of serious complications than women who have a side-to-side, or transverse, scar on the lower part of the uterus.
The lower section of the uterus does not contract very much during labor. However, if you have a scar in this area, there is still a chance that it may separate or open up during labor, as the uterus stretches during a vaginal delivery. The scar opens up in about 2 out of 100 women who attempt a vaginal birth after a previous cesarean delivery, or VBAC. But, in most women who have a scar that separates in this area, the uterus does not rupture, and the problems are minor. Serious problems from complete separation of the scar, or uterine rupture, occur in only 1 to 4 out of every 500 women who have a low transverse scar and attempt a vaginal birth. A rupture in this location can seriously injure the baby.
Uterine rupture is more common during labor in women who have a scar on the upper part of the uterus. In fact, in about 12 out of 100 women who have this kind of scar and attempt a vaginal delivery, their uterus ruptures.
Rupture of the uterus in this area usually has serious consequences for both the mother and the baby. You may need to have a hysterectomy, and/or your baby may be seriously or fatally injured. It is also important to remember that, no matter where the scar from a previous c-section is located, uterine rupture can happen before labor even starts.
Not all attempts at VBAC are successful. If you attempt a vaginal delivery, but end up needing a cesarean delivery instead, you and your baby are at an increased risk for infection and possibly other complications.
So the decision to have or not have a c-section rests with you, but it is very important for you to discuss your scar and your situation with your doctor when making this decision.

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