For years, "once a cesarean, always a cesarean" was the rule. Elective repeat cesarean section has become the most common indication for doing a surgery in this country. Ob-Gyns in the past were concerned with the weakening of the uterus in the area of the scar and labor was considered dangerous because the uterus could burst.

Recently, this "dogma" has been challenged by academic studies which encouraged vaginal birth after cesarean section (VBAC). Women who had the surgery for reasons other than for a baby being too large for their pelvis are more likely to be successful. If you are a candidate for a VBAC with your next child you have statistically about a 65-70 percent chance of delivering vaginally, but there is a 1 in 200 risk of uterine rupture with the possibility of a dead or injured baby and maybe a hysterectomy. I have had one severe rupture with the baby and placenta extruded into the patient's abdomen. The baby did well because I was in the room when it happened, but if I were even just across the parking lot when it happened, I fear the baby would have been severely compromised. This changed my opinion on VBACs.

The patient must have a uterine scar that is transverse (cross wise). The scar you see on the abdominal skin has nothing to do with the way the incision was made on the womb itself. A vertical (up and down) scar on the uterus is thought to be much weaker and a VBAC is considered more inadvisable. There are some other individual factors you must discuss with your doctor. Your doctor will need to review your hospital delivery record before giving, you the OK. You must then make an educated decision because there are risks.

The scarred uterus is weaker than God made it to begin with. Labor requires close observation by physician and nursing staff. Additional monitoring devices to assure uterine stability must be used, and an operating room must be available in case a cesarean needs to be done. I do not encourage VBACs anymore. I feel VBACs are more dangerous to all involved than has been presented in the past. Frankly, in my mind, a cesarean is much safer, but currently I am still caring for VBACs in selected patients.