VBACS IN GOVERNMENT HOSPITALS
You won’t be forced into a VBAC at a South African government hospital if you’d rather have another C-section. “You can book in for a repeat C-section,” Dr Moore says. (In some other parts of the world, such as the UK, you will labour after a caesar as a matter of course.) And if you’re HIV+, in state hospitals this is not considered an indication for a C-section. “If you’re taking ARVs and are fully suppressed, then delivering by C-section doesn’t further reduce your risk of motherto-child transmission,” Dr Moore says.
IF YOU’VE HAD A PREVIOUS SUCCESSFUL VAGINAL DELIVERY
“You’re a good candidate because we know you can deliver vaginally,” Dr Moore says.
IF YOUR C-SECTION WAS AT LEAST 18 MONTHS AGO
Your body reverts to “normal” in the six weeks postpartum as far as cardiovascular and renal functions are concerned, Dr Moore says.
“But the story is different with trauma such as an episiotomy or a caesarean scar. Scar tissue takes a long time to mature and stabilise, and labour puts strain on a scar. The closer your interval between births, the higher your risk of uterine rupture during labour.” For this reason, gynaecologists won’t attempt a VBAC if the gap between births is shorter than 18 months. “It’s also better if the patient has only had one previous C-section, and the uterus was cut bikinistyle instead of vertically, because that causes less damage to the muscle and reduces the chance of dehiscence during labour,” Dr Moore says.
IF YOU WANT MANY CHILDREN
“If you want a big family, think carefully about your birth choices early on,” advises Dr Moore. “With each C-section the risk of a placenta praevia and placenta accreta increases, and this risk increases exponentially after your third C-section.”
“The complications related to a fourth C-section are somewhat higher than the third, and a fifth C-section carries extremely high risk,” writes Dr Heather Rupe on the website WebMD. If you’re thinking about having more than three children, you should strongly consider a VBAC.”
On the whole, the more complicated your case and the more your situation deviates from the ideal VBAC candidate, the more you should discuss it with a doctor you trust. “We constantly try to balance benefit and risk,” says Dr Moore, “and we worry about scar dehiscence and scar rupture. The risk of that happening is between one and three percent, but when it does happen it is a catastrophic event. We can lose the baby, we can lose the uterus, and we can lose the mom. This is why we have rules and limits: you must labour with a drip and a catheter. That way we can monitor whether you have blood in your urine – one of the first signs of scar rupture.” If you’re not a good candidate for VBAC, consider a spontaneous labour caesarean (SLC) instead, suggests Dr Moore. This is where you wait to go into labour (conferring some of the benefits of a laboured baby onto your child) before your operation is started.