Natural birth after cesarean section in the previous pregnancy

Natural birth after cesarean section in the previous pregnancy

It is known that the rate of caesarean section births has increased recently worldwide due to:

** Increasing the use of continuous fetal monitoring during natural birth, which leads to increased detection of changes in the fetal heartbeat that require emergency caesarean sections.

**Increasing the rate of obesity, which leads to difficulty in natural childbirth (labor dystocia).

**increased maternal age at conception and childbirth due to women’s preference to delay marriage and pregnancy for reasons of career and education.

**Increase in the percentage of maternal requests for an elective caesarean section due to the mother’s fear of pain during natural childbirth.

Therefore, the percentage of pregnant women who have had a previous cesarean delivery is high, and most of these women are looking for a natural birth in subsequent pregnancies.

In what cases do we allow natural birth after a previous caesarean section?

- There must be only one previous caesarean section.

- The fetus’s head should be facing downward in this pregnancy (cephalic presentation).

- The gestational age must be 37 weeks or more (term pregnancy).

- There should be no contraindications to natural birth in general (a low lying placenta, a breech fetus, the fetus’s condition does not allow for a natural birth, that is, the fetus’s condition is unstable and the birth must take place quickly, the mother’s condition does not allow for a natural birth, that is, the mother’s condition is unstable and must give birth quickly)

What are the contraindications for natural birth after a cesarean section?

- The uterine incision in the previous cesarean section is located in the upper part of the uterus (classical incision)

- The previous uterine cesarean incision was atypical (J-shaped or T-shaped).

- There is a previous history of uterine rupture during previous natural births.

- Some types of previous uterine surgeries, such as performing a procedure to remove uterine fibroids and breaching the uterine cavity.

What are the signs that increase the success rate of natural birth in subsequent pregnancies after a previous cesarean section?

- Having a natural birth in a previous pregnancy, this raises the success rate of a natural birth to 90 percent.

- The birth should be spontaneous (uterine contractions begin spontaneously), as the need to induce labor reduces the chances of a successful natural birth in general.

- The reason for performing a cesarean section in the previous pregnancy was fetal distress or fetal malpresentation. If the previous cesarean section was due to failure to progress, this reduces the chances of a successful natural birth in the subsequent pregnancy.

-increased maternal height, the BMI must be less than 30, and the mother must be less than 40 years old.

-The estimated weight of the fetus should be less than 4 kg and the gestational age should be less than 40 weeks.

What are the concerns of vaginal birth after a previous cesarean section?

 rupture of the uterus during natural birth, which poses a risk to the mother’s life (bleeding and the need for a hysterectomy) and poses a risk to the fetus’s life (hypoxia or death).

How is the natural birth monitored for a woman who has had a previous caesarean section?

- Monitoring the fetus through continuous fetal heart monitoring throughout the birth process

- Monitoring the symptoms of the mother (severe abdominal pain that does not respond to painkillers, abdominal pain other than during uterine contractions)

- Monitoring the mother’s vital signs during childbirth

- Monitor the progress of cervical dilatation and descent of the fetal head into the pelvis as expected

What are the signs of uterine rupture during natural birth?

- abnormalities in fetal heart rate

- Severe pain in the mother’s abdomen that does not respond to painkillers and is present at times other than uterine contractions.

- Vaginal bleeding

- hematuria

- The mother’s blood pressure drops, her heart rate increases, and she goes into shock

- The fetal parts are palpable on the external abdominal examination

- Loss of uterine contractions that were previously present

Is it possible to induce labor for women who have had a previous caesarean section?

Yes, but the use of medications (suppositories or oxytocin) increases the incidence of uterine rupture, and therefore it is recommended to use mechanical methods of stimulation (Hegar cervical dilators, Foleys catheter).

What is the success rate of natural birth after a previous caesarean section?

72-75 percent

Is a natural birth possible after more than one previous caesarean section?

Yes, it is possible, but the incidence of uterine rupture during natural birth is higher with the increase in the number of previous cesarean deliveries.

What is the incidence of uterine rupture during natural birth after a previous cesarean section?

0.5 percent

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist