Jay Goldberg (Obstetrician/Gynecologist, Cedars-Sinai Medical Center) gives expert video advice on: If I've had a cesarean birth can I have a vaginal birth in the future? and more...
What is a "cesarean section"?
A cesarean delivery is a delivery in which an incision is made through the abdominal wall. Muscle is usually not cut during a ccaesarean section; the muscles are separated and you enter the various layers until you get to the uterus. You then make a small incision on the uterus and then deliver the baby through the abdominal wall, and that's a caearean section.
Why are cesarean sections performed?
Caesarean sections are performed for a number of reasons. If your baby is in an abnormal presentation (breach), or otherwise not head down, if you have twins, triplets or more, and the babies are not in an adequate presentation, a C-section is often recommended. If you have had a prior caesarean section, you have the option of having a caesarean section or you can try for a vaginal birth. However most times, or sometimes, patients are now opting to repeat a caesarean section. If you go into labour and it isn't progressing at an adequate or normal rate, and there are signs of distress in the baby, C-sections are performed for this reason as well.
What are the risks of a cesarean birth?
The risks of a c-section are like the risks of any surgery. C-section is a very commonly performed surgery, but it is still a major surgery. There are risks of infection, damaging nearby body parts like the bowel and the bladder. There's risks of anesthesia. Anytime you have surgery, there's always the risk of blood loss. Of course, with any surgery there's also the risk of death. Although we minimize these risks with sterile techniques, with experience to minimize blood loss and experience to minimize trauma to other areas, the risks do exist, even in cesarean section birth.
If I've had a cesarean birth can I have a vaginal birth in the future?
If you've had a caesarean section and you want to attempt a vaginal birth, there are some circumstances where that is safe, but you definitely need to consult your physician. There are not only physicians that don't feel comfortable delivering a vaginal birth after a caesarean section, but there are actually hospitals that do not allow it. There are hospitals in the United States that have a policy that they will not allow for a vaginal birth after a caesarean section. You may ask why, because there is a risk with a vaginal birth after a caesarean section of the uterus rupturing. The scar on the uterus from the caesarean section may have a weakened area in the uterus. And that area when you start to contract can break open and that can result in a complication such as a baby's body part coming through that incision, loss of fluid, excessive bleeding, and obviously nobody wants to assume that liability if they can avoid it. Now the risk of that happening is less than a percent. It's almost a percent, but it's less than a percent. But some people weigh the risks and benefits and find that that's just too risky. So you really need to consult your physician. Although it may be adequate and your physician may be comfortable, the hospital may not. But if you're in a circumstance where the hospital is comfortable and your physician is comfortable, then depending on your personal situation, it may be something that's doable.