As every Friday comes our section: Ask the midwife. In it, the midwife Marina Fernández every week will answer a question that our readers have left for her.
This week we have chosen a question that, for women who have had a C-section and are going to have a second child, is important, because we are going to value the possibility of vaginal delivery, its advantages and possible problems.
Marina Fernandez She is a midwife, specializing in home birth, a lactation consultant and an expert in complementary therapies. She is a member of the Professional Association Born at Home and a founding partner of Multilacta.Each week he will collaborate with Babies and more by answering a question from our readers. You can know her better on her Marina Matrona page.
The question we have selected is that of Nene-nenita, to which Marina previously answered in her first part, this is:
Two questions that worry me because I'm almost done: If you break the bag, do you go to the hospital immediately? I understand that if you do not go into labor within 12 hours, they will induce labor ... :( And another ... I have been told that I am at risk of uterine rupture because my previous pregnancy ended at 26 weeks in an emergency caesarean section. Natural, any advice, recommendation? How do I know if the breakage is occurring?
Midwife Marina Fernández answers the second question This week, which refers to a vaginal delivery after caesarean section:
"According to the 2010 Ministry of Health publication on" Assistance for the delivery of healthy women. Study of variability and systematic review. "Says:
“With the data of caesarean sections that it has, with 22.2% in publicly owned centers, Spain is well above the 15% of caesarean sections recommended by WHO, a percentage that is further increased if we take into account the caesarean sections performed in private centers so that it is established around 33% ”
Until very recently, a reason to indicate a C-section was that of a previous C-section. And unfortunately, in some hospitals it is still one of the criteria to recommend a C-section. For this reason, the Spanish Society of Obstetrics and Gynecology (SEGO) recommends that it is the woman, once informed, who decides if she wants to try a vaginal birth or not. This information should be clear, objective, and with scientific evidence in hand so that the woman is free to decide the best for her and her baby.
Given this situation we find that a high percentage of women have had a C-section and want to consider a vaginal delivery. When a cesarean section has been performed, there is a scar in the uterus that should be "pampered" as much as possible to minimize the risks of suffering from the dreaded "uterine rupture" during the birth process. The way to "pamper" a scar is to treat it carefully and gently, that is, not to force it at any time with inductions, oxytocin, forced postures, rush, fears, judgments, orders, etc. The way to take care of the process of the next delivery is to RESPECT the physiological conditions of the birth and the decisions of the woman who will give birth.
Published studies on the subject, give results of risk of uterine rupture between 0.2-1%, without induction of the next delivery. If this is done, the risk amounts to 6%. On the contrary, if the intervention is reduced, and other parameters are taken care of, such as free posture, sufficient waiting time for the body to do its work without haste, emotional environment appropriate to that woman's labor, etc. The risk decreases to 0.02%, of uterine rupture, at home births. Today, caesarean sections are performed with a horizontal incision, which carries a lower risk of scar dehiscence, than the vertical incisions that were previously made.
In the supposed case of happening, the risk for the mother is hemorrhage and, in very few cases, hysterectomy, but no associated associated mortality has been described, not being for the baby, who suffers risk of fetal death in a 5 '5% of uterine tears.
However, all studies conclude that the risk of a C-section is higher compared to the attempt at vaginal delivery after C-section. Caesarean section implies an associated risk of increased maternal morbidity and mortality, increased neonatal morbidity and mortality, greater complications for women's reproductive health, etc.
The success rates of attempted vaginal delivery after caesarean section are about 70-80% in a hospital delivery with little intervention and 90% of home births. This success rate is very similar to that of vaginal delivery without previous caesarean section, since we have previously commented on the percentage of caesarean section currently in Spain. We must also take into account the emotional issue, the success of seeing that your body is functioning properly, the satisfaction of giving birth without the need for outside help as female mammals that we are and are prepared to give birth.
For this success to be greater, we must take into account that it is convenient to wait at least 1 year until the beginning of the next pregnancy, so that the uterine contractions of the next delivery, occur after almost 24 months and the previous incision is well healed. In the case of occurring in pregnancy earlier than expected, nothing different should be done and the vaginal delivery option is still recommended in the first place.
If there are already two C-sections, the risk of uterine rupture does not increase significantly in studies, but the risk of a new scar in the uterus increases, with other major surgery, anesthesia, etc. So in all cases, the possibility of trying a vaginal delivery after a previous cesarean section should be assessed.
SEGO only contraindicates a vaginal delivery in the following cases:
- If the anterior caesarean section was made in the upper part of the uterus.
- If previously a uterine rupture occurred.
- If in an operation to remove a fibroid, the uterine cavity was opened.
- Without there are three or more C-sections.
You can get more information about these studies, and other articles related to the subject, as well as experiences of women who have had a PVDC in “Blog El Parto es Nuestro”, and in www.doctorsantos.com.
Finally, I would like to say that I also have a cesarean section during my first birth and then I have had two wonderful vaginal deliveries without any problems and therefore I encourage women who are in this situation to try. I have attended many births in these circumstances and above all the emotional satisfaction of being able to achieve it is immense. "
We hope that the response of midwife Marina Fernández be useful and serve to clear your doubts. Remember that every Friday we will choose a question so she can answer it, so if you are pregnant, you can leave your question here.
