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GREAT EXPECTATIONS By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital reprinted with permission from "Great Expectations by Today's Parents magazineI had a C-section during my first pregnancy due to bleeding at 32 weeks. After a three-year gap, will there be any risk involved if I choose a natural birth for my second pregnancy?The few studies available suggest that an interpregnancy interval shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes.There is emerging evidence that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous Caesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa). Hence, a three-year gap is an advantage.The main risk in attempting a vaginal delivery after a Lower Segment Caesarean Section (also called VBAC, or Vaginal Birth After Caesarean Section) is an increased risk of uterine rupture (tearing open of the uterine wall) during the delivery. The risk of rupture is 0.2 to 1.5 percent.The rate of foetal death is low with both VBAC and C-section. However, because the risk of foetal death increases with uterine rupture, foetal death occurs more frequently with VBAC than with repeat Caesarean delivery. Maternal death is rare with either type of delivery. VBAC is an acceptable option for women in the following situations:
* Does not have other conditions (as an example, placenta previa) that requires Caesarean delivery
* Has only one low transverse uterine incision from a past Caesarean delivery
* Has no other uterine scars (eg from a previous surgery for fi broid removal) and has never experienced a uterine rupture
* Does not have pelvic problems or abnormalities that prevent vaginal delivery
* The baby is in the proper position (head down)
In addition, VBAC should only be considered if facilities are available or an immediate Caesarean Section should it be necessary.
