Birth after caesarian

How long should we wait before the next baby?
While your body superficially heals after about six weeks following most caesarians, rebuilding your body's strength, particularly that of the scar area in the womb, can take as long as a year. That doesn't necessarily mean that you should wait a year before trying to conceive following a c-section, although that used to be the advice usually given. These days doctors recognise that the healing process can vary significantly from woman to woman, and that has an impact on how long she should wait.

Three months is considered the absolute minimum time you should leave between pregnancies following a caesarian, but doctors usually recommend that you wait at least nine months to lessen the chance of a uterine rupture in your next pregnancy. This is particularly important if you would prefer to have a natural birth for your next baby, as the longer your womb has had to heal, the greater your chances of it being able to support a natural birth. Even following a natural birth doctors recommend that you wait several months to give your body the best chance to recover and recoop strength for the next time. If you particularly want to conceive before nine months have elapsed then talk to your doctor about your own situation and health post c-section to get the most appropriate advice for you.

What are the chances of a vaginal birth next time around?
Your chances for being among the 30% of women who manage a vaginal birth after a caesarian, commonly referred to as VBAC, depend on the circumstances of your c-section, your gynaecological history and how your next pregnancy and labour progress.

If the reason you needed a c-section last time still stands, for example you have an ongoing medical condition that renders labour dangerous, your womb is an unusual shape or your pelvis is particularly narrow, then your chances of a vaginal birth are relatively low and you may well be advised to opt for another c-section in advance. If the particular circumstances of your last pregnancy made a planned c-section necessary, such as placenta praevia or pre-eclampsia, then your chances will depend largely on whether you develop the condition again: If your next pregnancy is straightforward then there is usually a good chance of you having a vaginal birth.

Several reasons for having an emergency c-section are likely to be particular to your last pregnancy or labour. For example, if the position of your baby or a failure for labour to progress necessitated an emergency section last time, then there's no reason to believe that this will happen again, and you have a good chance of a natural labour and birth. Women with the highest chance of giving birth vaginally next time around are those who had successfully given birth vaginally prior to their c-section - having managed it once shows that their bodies are capable of delivering vaginally and inspires confidence in both the mother and medical team.

Is there are risk of uterine rupture during VBAC?
A uterine rupture occurs when the walls of the uterus tear open into the abdominal cavity endangering both mother and baby and making an emergency c-section delivery essential. Following a rupture the womb may be repairable, but in the future caesarian sections will be the only birthing option. There is also a chance that a hysterectomy may be necessary.

There is always an extremely low risk of uterine rupture from pregnancy and birth, the risk is higher if you have had a previous caesarian but is still very low, at less than one per cent. After two or more caesarian sections the risk of a rupture increases. Of the uterine ruptures that do occur, most happen along a previous c-section scar during labour when the uterus is put under the most strain from contractions. Research has shown that vertical incisions for a c-section (sometimes necessary but nowadays far less widely used) carry a far higher subsequent risk than the horizontal bikini cuts. Because of this, if you had a vertical incision you will be recommended to elect for a c-section next time around.

If you had a bikini incision and have healed well then the low risk of rupture shouldn't be a major cause for concern: If you are attempting a VBAC then you and your baby will be closely monitored for signs of a possible rupture and your delivery team will be prepared in the unlikely event that it does happen.

How is birth after a caesarian planned?
During your next pregnancy you and your doctor and/or obstetrician will discuss the circumstances of your last c-section and the progress of the current pregnancy. If the reason for the last c-section still holds, or if there is a low chance of you having a successful vaginal birth, then you will most likely be advised to have a planned c-section with this birth.

If there is a good chance of you having a vaginal birth then you and the delivery team can plan for what is called a 'trial of labour', in which case you are given the chance to deliver naturally with very close monitoring.

Of course there are many grey shades of chances for a natural birth and you and the doctors will have to discuss the options in light of your particular circumstances. If your chances of needing a c-section are relatively high you may still be able to have a trial of labour if you are desperate for a chance to give birth vaginally, but you'll need to weigh this up against the possibility of going through a long and arduous labour and then needing an emergency c-section, as opposed to the calmer and more secure circumstances of opting for a planned section.

Is there a limit on how many babies I can have by caesarian?
It used to be thought that after a caesarian a subsequent birth should always be by caesarian, and women were usually recommended to have no more than two caesarian births. This was due largely to the reasons for which c-sections were most often performed and the higher risks of subsequent uterine rupture with repeated use of the classical vertical incision previously used.
These days the majority of c-sections are carried out with a horizontal bikini cut which is far safer as it generally heals better and is in the lower part of the womb which comes under less strain during labour. The risk of uterine rupture does, however, rise with the more caesarians you have, as scar tissue can accumulate and weaken the womb.
Some doctors will recommend that you have no more than three sections but you'll need to discuss your own particular circumstances with your doctor in order to decide what is safe for you in terms of future pregnancies.