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Fact Sheet for Vaginal Delivery Following
Previous
Cesarean Section
 It
has been shown that patients who have had a previous cesarean section
may safely deliver vaginally in subsequent pregnancies. There may
be many reasons why a cesarean section was done in the previous
delivery, which may not exist in the current pregnancy. For example,
it may have been done for slow heart rate in the baby (fetal distress),
bleeding during pregnancy, unusual position (baby coming feet first-
breech), or hypertension (high blood pressure). If these conditions
are not present in the current pregnancy, the woman may be allowed
to go into labor and deliver safely vaginally.
The following considerations are important for patient
awareness:
1. There are no guarantees that once you go into labor
you will deliver vaginally, a cesarean section may be necessary
if complications develop during labor, either the mother or baby.
2. In approximately 1% of patients who attempt a vaginal
delivery after a cesarean the uterine scar may rupture or tear
and will require a repeat cesarean section, or a hysterectomy.
This risk is no greater than for patients who have never had a
cesarean section.
3. The type of incision on the uterus (not the skin)
made during the previous cesarean section affects the risk of uterine
rupture in the current pregnancy. There is an increased risk of
rupture with a vertical (up and down) incision on the uterus. Therefore
all patients with a previous vertical incision will not be allowed
to attempt a vaginal delivery.
Of those patients who will be allowed to go into labor, only 50%
to 75% will deliver vaginally and the remainder will need a repeat
cesarean section.
Factors that must be present for possible vaginal delivery:
*All factors must be present
1. Patient should understand the risk of abdominal
versus vaginal delivery.
2. Patient must accept the concept of vaginal delivery.
3. There are no medical, surgical or obstetrical complications
that prohibit labor or a vaginal delivery in the present pregnancy.
Factors that prevent a woman with a previous cesarean
section, from attempting a vaginal delivery:
1. Previous vertical or “T “incision on
the uterus.
2. A prior uterine rupture.
3. Medical or obstetrical complications that favor
a cesarean section.
4. Patient’s refusal to attempt a vaginal delivery
before the onset of labor.
Advantages of a vaginal delivery:
1. The length of stay is normally shorter for vaginal
delivery, averaging (2) two days as compared to (3) three to (4)
four-day cesarean section.
2. The recovery period is normally shorter with a
vaginal delivery.
3. Vaginal delivery carries less complications than
cesarean section such as: infection, excessive bleeding and although
very rare, death of either mother or baby.
Disadvantages or risks of a vaginal delivery:
Rupture of the low transverse scar may occur. It is a rare possibility,
but if rupture occurs the following complications can ensue: a-
loss of uterus (hysterectomy) b- damage to other internal organs
(bladder) c-fetal death or d- maternal death.
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