Sunday, September 24th, 2017

Ask A Doc: Second Baby C-Section


by Dr. Tara Gellasch

I had a Cesarean Section with the birth of my first child. It was a pretty scary experience. During my labor my daughter’s heart rate dropped and an emergency C-section was done. Fortunately my daughter did well and is now a thriving two year old! I am pregnant and my husband and I are not sure if we want to plan another C-section or try for a vaginal delivery. I know that not all hospitals or doctors will allow you to try for a vaginal delivery after a C-section. How do I know if it is a good idea for me to try to have my baby vaginally?

Congratulations on your pregnancy! This is an excellent question. A Cesarean section can be a necessary life saving procedure for both the baby and the Mom.

Across the country, the rate of C-sections has increased from 21% in 1996 to 32% in 2013. Many factors contribute to this increase including the rise in numbers of women having other health issues that increase their risk of Cesarean such as obesity, hypertension, and gestational diabetes. The medical legal environment also encourages physicians to perform Cesarean sections to avoid a perceived risk of malpractice.

Despite the obvious benefits of a C-section in the case of emergency, a C-section increases the mother’s risk of serious injury or even death. Unfortunately, the steep rise in C-section rates has not resulted in a significant improvement in the birth outcomes for babies and Moms.

For these reasons, the American College of Obstetrics and Gynecology strongly supports decreasing the rates of Cesarean sections. Because it is unlikely to eliminate the need for emergency C-sections physicians have focused their efforts to decrease the number of elective repeat C-sections.

An elective repeat C-section is a when a women who has had a C-section avoids labor and plans a C-section on a scheduled date.

In the past it was thought that once a woman had one C-section that she would need a C-section with all future deliveries. However, studies show that 70% of women can successfully have a vaginal birth after cesarean section (VBAC). You can speak to your provider to determine if you are a candidate for a trial of labor after cesarean (TOLAC). Women who have a successful VBAC have a faster recovery than women having a scheduled repeat C-section. There are some risks to a TOLAC. Not all women will be able to have a successful vaginal delivery and will require a C-section. This comes with an increased risk of needing a blood transfusion, admission to an ICU or needing an emergency hysterectomy.

Another risk is the chance of uterine rupture which is when the scar on the uterus opens during the labor. The risk of uterine rupture is less than 1% but it can be a serious life threatening condition for both baby and Mom.

Due to the risks that come with a TOLAC, the American College of Obstetrics and Gynecology has established some guidelines for hospitals. A hospital should have the ability to perform an immediate C-section. This typically requires an Obstetrician and an Anesthesiologist to be in the hospital.

We are very fortunate to have the ability to safely offer TOLAC at Newark Wayne Community Hospital to women who are good candidates. We have seen a steady increase in the number of women choosing to have a TOLAC within our hospital since 2013. Additionally we are proud to have one of lowest overall rate of cesarean sections in the Finger Lakes Region.

I encourage you to consider a TOLAC. You need to discuss this with your OB provider to determine if you are a good candidate and if this is something that the hospital is able to offer