Sunday, January 12, 2020

3 tips to consider when planning to deliver after a cesarean section

If you’ve ever had a cesarean section and are pregnant again you may be wondering what your options are for your next pregnancy. Having a 
cesarean section for any of your births can cause a lot of moms to wonder if either their body can deliver vaginally or if they even have (or 
want) that option.

A c-section is major abdominal surgery and it shouldn’t be overlooked that your body has to recover in a different way than a vaginal birth. 
It’s understandable that you may question the feasibility and desire of vaginal delivery for subsequent pregnancies.

Most moms can deliver a baby after a cesarean it’s call a VBAC -vaginal birth after cesarean- the process to get there is called a TOLAC or 
trial of labor after cesarean. When moms choose a responsible, trustworthy provider and location well equipped to birth with the capability of 
performing emergency procedures a woman has the right to attempt a VBAC.

There is a caveat and of course the long response to such a heavy consideration REALLY depends on a number of things. I’ll break them 
down for you below:

  1. Why did you have a cesarean in the first place? Just having a C-section doesn’t exclude you or “risk you out” of a TOLAC but an honest 
    provider will consider your circumstances carefully before flatly denying or accepting your TOLAC request. There are a number of 
    reasons why you may have had a C-section and just saying “my baby wouldn’t come out” or “my body wouldn’t dilate” are pretty vague 
    and need further investigation.
  2.  Where do you want to deliver? Not all hospitals are able to labor a mother who has had a previous cesarean section. It isn’t that they 
    don’t want to its that they literally are unsafe for you in case of emergency. They don’t have the resources. Now, if you were to schedule 
    a C-section that same hospital may be perfectly fine. Why? Resources (i.e. operating room staff) are readily available.
  3. Who do you want as your OB provider? Put another way -are you attempting to deliver with a provider who has a reputation for not 
    supporting VBAC’s? Or is it someone who is really nice but hasn’t actually attended a VBAC since med school so they aren’t even sure 
    what to ask or what red flags to be aware of? Have you asked in your community about who has the reputation of supporting successful 
    TOLAC consents? Why is this important? Your provider plays a huge role in the outcome of your birth. If you stick with someone you 
    know has plainly refused to TOLAC  patient or everyone in your community has beautiful success stories with another provider you can 
    guess from at least your providers stand point what your outcome may be.

The biggest consideration to make, of course, is what do YOU want. If you’ve never experienced labor contractions before are you prepared 
for what they may feel like? This is especially important because your uterus will be contracting on a uterus that has a healed incision scar 
and is therefore more at risk for complications. Think about your pain tolerance. Be ready by taking a high quality childbirth class that will teach 
you what’s normal in labor and ways to manage that pain. Think about hiring a labor doula. There is research that supports the use of 
professionally trained labor support. 

If you have delivered vaginally before you have the perspective of how to manage the discomfort and length of of that discomfort in labor. Your 
choice will have some balance in that regard. But remember, every pregnancy and every labor is different. Again, hiring a doula will help direct 
you in finding a rhythm in pain relief. If the cesarean was traumatic in any way having a labor doula can ease fear.

So have a thoughtful and thorough conversation with yourself, partner and care providers. Be honest with yourself on what you want and 
whether its possible to obtain. Remember you can’t plan everything in labor but you can prepare for it. 

Until next time #tranquilpregnancyvibes

Monique Nicole, RN BSN
Pregnancy Wayfinder