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Contrary to a widely held idea, just because we gave birth by cesarean section for our first baby does not mean that it will be the same for the next ones. The figures prove it: 50% of women who have had a caesarean are offered a natural route attempt for their second childbirth. And for three quarters of them, it works! It is true that in the past doctors used to systematically perform a cesarean section on mothers who had already had one. Question of precaution: once the uterus has been cut, there is a risk of uterine rupture. During labor, the scar can indeed give way under the extent of the contractions. Especially since the elastic fibers of the skin are much less flexible in this area.
The rupture of the uterus causes hemorrhage and the consequences for the baby, deprived of his oxygen supply, can be irreversible. However, this complication is extremely rare (0,5%). Today, if not not a permanent medical reason (pelvis too narrow, hypertension …) which justified the first cesarean, there is no reason not to try the low route the next time. This question will be discussed with your doctor in particular during the 8th month consultation.
Giving birth vaginally after a cesarean: the 4 success factors
- You only had one cesarean section.
A vaginal birth is then quite possible.
- Work started spontaneously.
In this case, the risk of uterine rupture is 0,5%, while it is doubled if the birth is initiated. But again do not panic, it all depends on the product that is used. According to the National College of Obstetricians and Gynecologists, prostaglandins, like misoprostol, are associated with a significant increased risk of uterine rupture. In contrast, careful use of oxytocin is possible.
- The first cesarean was over a year old.
The uterus must be allowed time to heal well. The ideal is to start a pregnancy at least a year after the last childbirth.
- You have given birth naturally
Your first baby, for example, was born vaginally and the second by cesarean section.
The vagina after 2 cesarean sections
It should be noted that after two cesarean sections, the complication rate increases considerably. Whether one tries a vaginal birth or performs a cesarean section, the risk is equivalent: uterine rupture on one side, hemorrhage on the other. But generally, doctors prefer to resort to cesarean section.
Vaginal delivery after a caesarean: reinforced surveillance on D-day
A vaginal birth after a cesarean is closely monitored due to the risk of uterine rupture. This complication is manifested by various abnormalities during labor: an altered heart rate, bleeding, the presence of severe pain in the lower abdomen despite the epidural. Smaller, more irregular contractions should also attract attention. In some maternities, internal tocometry is used to monitor the intensity of contractions. This technique involves placing sensors in the uterus to measure contractions. If despite these precautions a uterine rupture occurs, it is necessary to perform an emergency cesarean section, stem the bleeding and then repair the wound.