May 13-19 is Women’s Health Week. Instead of trying to tackle a whole host of all-over-the-place issues, we thought we would focus on something we always we have questions about — the area down there. That includes the vagina and its parts, the uterus, and a few issues pertaining to our private parts that it never hurts to know more about. To educate ourselves, we sought out the insight of Dr. Wendy Goodall McDonald. She is a board-certified OB-GYN based in Chicago and author of the super informative and funny book, It Smells Just Like Popcorn: The Modern Woman’s A-V Guide to Her Vagina and Beyond. This women’s health expert gave us the rundown on what we should know about our sexual and reproductive anatomy, the right way to take care of it, and what it’s all capable of.
My mother had six children. When she had my eldest brother, she delivered him vaginally. But with the rest of us, she had C-sections. Way back in the day when she first started having kids, it was believed that after one C-section, you would need them for future deliveries. But things are different these days. Research has shown that risk of complications for women hoping to vaginally deliver their second child aren’t as high as perceived, and more and more women are trying, and hoping to try, a trial of labor after cesarean (TOLAC).
Studies have found that of those who do attempt a TOLAC, 60 to 80 percent are successful in having vaginal delivery. But the Centers for Disease Control (CDC) found that despite that good news, only about 20 percent of women attempt to give birth vaginally after having a C-section. Of that percentage, when they do, 30 percent end up needing a C-section.
Dr. Wendy says when you have a history of certain complications, the likelihood of requiring another C-section goes up and down.
“A lot of it has to do with why a person has to have a C-section,” she says. “For instance, I had a lady who was coming in to have her second baby, and with her first baby, she never made it past eight centimeters dilation. They tried and tried and tried all these things and it never happened. That woman is less likely to have a successful vaginal delivery after a C-section than somebody who had their C-section because they breached. If the baby’s head is not down, you didn’t even have a chance at labor. You can try and see if your labor will work this time, or if your baby will even tolerate labor. But that’s the person who is a better candidate for vaginal delivery after C-section.”
But aside from past complications, the main issue behind why some people who have had a C-section in the past might not be the best candidate for vaginal birth after cesarean (VBAC), is because of the scars from the first go-round.
“Anytime you try to deliver vaginally after a C-section, you have risks of the uterus opening where you cut before,” Dr. Wendy says. “We only want to take those risks when you have a pretty decent chance of having a vaginal delivery. Otherwise, it’s safer just doing a repeat C-section.”
If you are told that you need to forgo vaginal birth for a C-section, after two unsuccessful attempts, Dr. Wendy says, “You’re done.” You will likely require surgery from then on. The possible chance of the incision in the uterus opening again increases, and that can’t happen. If it does, both mother and child’s life could quickly be in danger.
“That’s a surgical emergency because not only at that point are you losing blood on the inside, the baby is losing blood,” she says. “So you both have only minutes before you have to emergently deliver that baby as opposed to, typically, if you had to do a C-section, you have a little bit of time to kind of prepare. But that’s an emergency and the baby can suffer pretty severe consequences. The chances of that happening, of the uterus rupturing after one C-section, is only about one percent or less, maybe a little bit more if you have to use Pitocin to help a person contract. But if you had two or more, that risk of rupture goes up pretty substantially. So it’s not worth the potential benefit of having a vaginal delivery at that point. You’re better off doing another C-section.”
With that being said, if you truly want to try VBAC, speak to your obstetrician about your possible risks, and if they’ll have the staff available (as well as an operating room) in case it’s found that giving birth vaginally won’t work. Clearly, it’s not meant for everybody, and many women don’t even bother inquiring to avoid unnecessary risks or for “convenience” (though any surgery isn’t convenient). However, the success rates are higher than most probably would expect. So don’t be afraid to do your research, ask questions and, overall, have a say in your birthing experience. You never know. You might be the perfect candidate.