Vaginal Delivery After C-Section Possible

Women often assume if they've had one caesarean section, they are destined to never have a vaginal birth. While this is sometimes the case, it doesn't have to be.

A recent Australian review finds that cervical ripening agents, private health insurance, induction of labor, local trends and individual practice preferences affect the possibility of vaginal delivery after having a cesarean section (VBAC).

Having a vaginal delivery after having a prior c-section is possible.

Lead author Christine Catling-Paull from Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney, New South Wales, Australia reports that numerous women who have had a previous cesarean section choose to repeat that procedure in following pregnancies. One of the reasons cesarean sections have increased dramatically in the past 20 years is due to these women opting for a repeat c-section.

Research shows that only 33 per cent of women in the UK will have a VBAC and in Australia the rate is even lower at just under 17 per cent. Interestingly, a different study from the U.S. indicates that 73 percent of women have a VBAC.

Caitling-Paull and the team of researchers, after reviewing 34 papers published between 1984 and 2007, found these important nonclinical factors impacting VBAC :

• There is spotty evidence that private health insurance providers don't support VBAC.
• If women receive more education about c-sections and VBAC they are impacted by the evidence and if affects their decision.
• Individual ob/gyn's attitudes and preferences have an impact on VBAC rates.
• Local guidelines and practice standards drive women in the direction of their local trend.

The researchers also reviewed 27 papers published from 1989 to 2008 evaluating clinical reasons that impact VBAC and found these factors:

• Scoring systems that are supposed to be predictive of VBAC success are for the most part unhelpful.
• Cervical ripening agents seem to have a low VBAC success rate compared with spontaneous labor.
• Inducing labor by several methods including the physician breaking the membranes tend to lead to lower the possibility of VBAC.
• Women who have received X-ray pelvimetry have higher c-section rates.

These two reviews are published in the August 2011 issue of the Journal of Advanced Nursing.