The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

VBAC info from an HMO! (circa 2001)

Check this out everyone.  I was totally surprised but maybe shouldn't be since it comes from a notoriously cheap HMO/hospital network in the Pacfic Northwest.  It's actually pretty great info. though it never states where they get all of there statistics.

More information about vaginal birth after cesarean section (VBCS) Common questions

Q:  I have had one cesarean section. Now my doctor wants me to have a vaginal
delivery. I'm confused... In the past women who had a cesarean section were automatically scheduled for a repeat cesarean. Why the change?

A:  It is confusing. However, medical recommendations have changed as new information has become available about the risks and benefits of a vaginal delivery after a cesarean section. In 1916 a doctor published an article that said "once a cesarean section, always a cesarean section." He wrote that recommendation without any scientific proof and at a time when obstetrical practice was much different than today. Over the past 20 years, many scientific papers have been published about deliveries following a cesarean section. That research shows that it is safer for the mother, and equally safe for the baby, to attempt a vaginal birth after a previous cesarean section.

Q:  Why the fuss about a repeat cesarean? I did just fine after my cesarean section.

A:  While the majority of women do well after a cesarean delivery, it is riskier than a vaginal delivery. The risk of infection, blood loss, and hysterectomy to treat a complication of delivery is greater with an elective repeat cesarean than with a trial of labor. Most women also recover more quickly

after a vaginal delivery and that may be important to you because you have another child at home. In addition, many women feel a vaginal delivery is a real accomplishment.

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Q:  I have heard my uterus could rupture during labor. I don't want to take any chances.

A:  The uterine scar opens or separates in fewer than two women out of 100 who have had a cesarean section. Many scar separations do not harm the mother or baby and don't need to be repaired.

Separations that cause trouble and need repair are called ruptures. Ruptures occur in about 1 woman out of 200 with a previous cesarean. However, you need to know that a repeat cesarean section does not entirely eliminate the risk of rupture. Rupture of the uterus can occur before labor and before a scheduled cesarean section. Scientific studies show that the risk of rupture is the same for women who plan a repeat cesarean section and women who have a trial of labor.

Q:  What is my chance of getting a rupture if I have had more than one cesarean section in the past?

A:  It is safe for women who have had two or even three cesarean sections to have a trial of labor. Less than 3 women out of 200 who have a trial of labor after two or three previous cesareans will rupture their uterus. But remember, uterine rupture may occur even if a cesarean delivery is planned. Also remember the benefits of vaginal delivery.

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Q:  What happens if my uterus ruptures?

A:  During labor you and your baby will be monitored closely. If there is any sign of uterine rupture, your doctor will do an emergency cesarean section to deliver your baby and repair the rupture.

Q:  What are the signs of uterine rupture?

A:  There is no sign that is present all the time. Pain is an unreliable sign because of the pain of labor that is already occurring. Sometimes vaginal
bleeding is a clue. The most reliable indicator is a change in the baby's heart rate pattern -- dips in the baby's heart rate called variable decelerations.

Q:  That sounds scary. I don't want anything bad to happen to my baby.

A:  Having your uterus rupture is scary. The members of your OB team will be working quickly to take good care of you and your baby should an emergency cesarean become necessary. However, the changes in the baby's heart rate that may occur with a uterine rupture frequently occur in labor. Your OB team is prepared to handle the situation and do the best for you and your baby. Variable decelerations will not harm the baby if the baby's heart rate doesn't go too low for too long. That's why the team will be working quickly to deliver your baby.

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Q:  Can the rupture in the uterus be fixed?

A:  Most of the time the rupture in the uterus can be repaired at the time of the cesarean delivery. On rare occasions a hysterectomy may be necessary.

However, you are more likely to need a hysterectomy to treat a complication of delivery if you have an elective repeat cesarean than if you have a trial of labor.

Q:  Can I have another baby if my uterus ruptures?

A:  If the uterus can be repaired you can have another baby. Since your uterus has ruptured once, your doctor will probably recommend a planned cesarean for the next delivery.

Q:  You keep mentioning "a trial of labor." What are my chances of delivering vaginally?

A:  Women who have had one previous cesarean section have an 82% chance of delivering vaginally. If your cesarean section was performed because you did not dilate completely or were unable to push the baby out, your chance of a vaginal delivery is still 67%.

Q:  I grow big babies. My last baby was big and I needed a cesarean to deliver her. I think this baby is big too. I can't possibly be a candidate for a trial of labor, can I?

A:  Yes, you can. Many women who had a cesarean delivery in the past because the baby was thought to be too big, actually deliver larger babies vaginally in their next pregnancy. The weight of the baby may not be the most important factor. Other factors -- positioning of the baby in the birth canal, shoulder size, or strength of the uterine contractions -- help determine whether the baby can be delivered vaginally.

Q:  I don't dilate. I only dilated to 3 cm after 24 hours of labor last time. I can't be a candidate for a trial of labor, can I?

A:  Yes, you can. How much a woman dilated before undergoing her first cesarean delivery does not predict whether she will be able to deliver vaginally in the next pregnancy.

Q:  What is my chance of a vaginal delivery if I have had two cesareans?

A:  If one of the cesareans did not follow a trial of labor, but was scheduled before labor or was done when labor began, your chance of a vaginal delivery is 75%. If both previous cesareans were done following a failed trial of labor, your chance of delivering vaginally is still 56%.

Q:  I think all this emphasis on a trial of labor and not having a scheduled cesarean section is just to save Group Health money.

A:  Group Health is always looking for ways in to make good use of your dues and not waste your money. However, our primary concern is your health and the health of your baby. Several fee-for-service hospitals have guidelines that require a trial of labor unless there is a clear medical reason for cesarean section. A repeat cesarean section carries more medical risk than a trial of labor without an improvement in outcome.

If you have any other questions or concerns, please talk to your doctor or midwife. They will be happy to answer your questions.