Why try for a vaginal delivery if you had a cesarean?

Once a cesarean, always a cesarean?

That used to be the rule of thumb. For years it was thought that if a woman had one baby by cesarean section, all of her other children would have to be born that way, too.

Today, many women who have had a cesarean can give birth vaginally in a later pregnancy. There's even a name for it: Vaginal Birth After Cesarean (VBAC). The American College of Obstetricians and Gynecologists (ACOG) estimates that of the women who try for a VBAC, between 60 and 80 percent succeed.

You may wonder why it matters. Actually, there are good reasons to consider a VBAC:

Having a baby delivered vaginally avoids major abdominal surgery, which is what a cesarean section is.
You won't have to spend as much time in the hospital.
There's a lower risk of infection and less need for blood transfusions and usually less pain.
You'll be up and on your feet quicker after you go home.

Weighing the benefits and the risks

Not all women are candidates for VBAC. As you consider whether to try for a VBAC, a major factor is what kind of incision was made in your uterus when you had the cesarean section. Certain types of incisions can put you at higher risk for a uterine rupture or tear. You can't tell about the scar on your uterus by looking at the scar on your tummy. Only your medical records will show what kind of incision you had. There are three types:

Low transverse. This is a horizontal cut across the lower, thinner part of the uterus.
Low vertical. This is an up-and-down cut made in the lower, thinner part of the uterus.
High vertical (classical). This is a vertical cut made in the upper part of the uterus. The high vertical incision puts you at higher risk for rupture during a vaginal delivery.

You may also be at increased risk of rupture if you have had more than one cesarean delivery. Other situations that might warn against VBAC include:

Small pelvis and a large baby
Signs that the baby may have problems during labor or vaginal delivery
Problems with the placenta
Certain medical conditions in the mother, such as high blood pressure, diabetes or active herpes infection
Problems progressing in labor
According to ACOG: "There is a higher risk for infection in the mother and baby in women who try VBAC and then give birth by cesarean."

If you do have a vaginal delivery, you can expect:

Your doctor to give you an exam to be sure your vagina, cervix and perineum look normal. If you had a tear, it will be repaired.
You will have your vital signs taken often. These include your blood pressure, pulse, and temperature. A nurse or other practitioner will massage your uterus, check for vaginal bleeding and signs of infection.

Whether or not you decide to try for VBAC is a question of weighing the risks and benefits. Your health care provider will be able to help you as you make up your mind.