$Unique_ID{BRK02129} $Pretitle{} $Title{Considering VBAC or Vaginal Birth After Caesarean} $Subject{caesarean childbirth delivery uterus uterine contractions transverse incision Pfannenstiel incision bikini-cut natural childbirth twins triplets breech presentation fetal abnormality fetal abnormalities} $Volume{} $Log{} Copyright (c) 1993 Tribune Media Services, Inc. Considering VBAC or Vaginal Birth After Caesarean ------------------------------------------------------------------------------ QUESTION: I accompanied my wife to her doctor the other day. She is expecting with our second child. After a long wait she was taken in for her examination, while I remained in the waiting room. I overheard the nurses speaking, and they mentioned that my wife was a "veeback". There were other things said as well, but I couldn't make them put. When I questioned my wife about her visit, she told me that all was in order and she was fine. All I got from her doctor was a nod of his head. Does what I heard mean that anything is wrong with my wife or baby? I am afraid to bring it up with her for fear of disturbing her. Can you help me, please? ------------------------------------------------------------------------------ ANSWER: If your first child was born by cesarean section delivery, than the rest of this answer will help clear away your doubts and anxieties. If not, you had best get the doctor on the telephone, for I can not tell you what the nurses were discussing from the information you have provided. By translating your word "veeback" into the initials "VBAC" I can begin to provide you with an explanation. VBAC stands for "vaginal birth after cesarean" and means that your next child is to be born by the normal vaginal route. Your wife most certainly understands this, for it requires her permission, and she has probably already discussed it with you. In the past, most women who had their first child by cesarean section, delivered all subsequent babies in the same fashion. This followed a now faded golden rule of obstetrical practice, "Once a cesarean, always a cesarean." It was felt that the scar resulting from the incision through the wall of the uterus made during a cesarean section, and through which the baby was delivered, wasn't strong enough to bear the pressures created by uterine contractions during a vaginal delivery. And that weakness could lead to the rupture of the uterus during labor. This was more probable in the days when the incision was made high in the midline of the uterus (or the classic cesarean incision). However, for the past 20 years or so, a low, transverse incision has been used for cesarean delivery, which is placed low on the uterus. And this type of incision is less likely to rupture. A similar incision to the skin that overlies the uterus is known as the Pfannenstiel incision, and commonly called the bikini-cut by many women. Today, a woman has an alternative to a repeat cesarean, and can deliver normally with a fine chance of complete success. There are many advantages to vaginal delivery. It results in a shorter hospital stay, allows the mother to recover more rapidly, costs less, and is less prone to infection. It also allows a woman to experience natural childbirth. A cesarean can always be performed if the delivery does not progress as it should. Thus more physicians these days advise their patients to attempt a normal delivery with the second child. In such cases, a consent form is signed that stipulates "VBAC with possible emergency cesarean". It may have been this consent form the nurses were discussing. There are some situations in which VBAC is not considered. They include cases where the woman does not consent, where the previous cesarean was conducted with the old form of incision and these are absolute contraindications. Individual evaluation is necessary in cases where there is more than one baby developing in the uterus, as in the case of twins or triplets, or where there is a breech presentation, or a fetal abnormality. The decision to have VBAC rests with you and your wife. A cesarean permits you to chose the birth date of your child, within certain restrictions, but, in many hospitals, denies you the chance to be with your wife during the actual delivery. And the outcome statistics show that VBAC is no more dangerous than a repeat cesarian. I hope your anxiety has disappeared with the mystery. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.