VBAC vs. Repeat C-Section: What to Consider for Your Second Pregnancy

If the first pregnancy was delivered via cesarean section, does the second pregnancy also require a cesarean section?

Hello, I am currently 29 weeks pregnant, and the fetal weight is 1800 grams.
The doctor mentioned that the fetus is a bit large, and since my first delivery was via cesarean section (due to abnormal fetal position), the doctor advised that if the fetal weight exceeds 3400 grams, a cesarean section would be safer.
What is your opinion on this? I really want to have a natural birth.
I have gained 9.2 kg so far; the doctor advised me to control my weight.
I am 163 cm tall and currently weigh 65.2 kg.
Is that considered overweight? Thank you for your response.

fion, 30~39 year old female. Ask Date: 2003/03/11

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello! 1.
Based on your height and weight, you currently have a standard weight and are not overweight.
2.
Generally, around 30 weeks of gestation, physicians in Taiwan estimate fetal weight using ultrasound to predict the future birth weight.
However, since ultrasound estimates can have inaccuracies, and considering individual variations in pelvic width and fetal head position during delivery, there are many variables involved.
During my training in the United States, they typically allow the mother to attempt vaginal delivery, resorting to cesarean section only in cases of obstructed labor.
Statistically, only about 5% of all pregnant women experience true obstructed labor.
3.
However, since you have a history of cesarean delivery, this may be the primary reason your physician recommends another cesarean section.
Attempting a vaginal delivery this time could carry a risk of uterine rupture, which is estimated to be around 20%.
Although the probability is low, the consequences can be severe, posing life-threatening risks to both the fetus and the mother.
Therefore, I personally recommend that you opt for another cesarean section.
Best wishes for your health from Dr.
Lu Li-Cheng, Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/03/11

More Info

When considering the options of Vaginal Birth After Cesarean (VBAC) versus a repeat Cesarean section (C-section), there are several important factors to take into account, especially in your case where you are currently 29 weeks pregnant and have a history of a C-section due to fetal malposition.
First, it’s essential to understand the risks and benefits associated with both delivery methods. VBAC can be a safe option for many women who have had a previous C-section, particularly if the reason for the initial C-section is not likely to recur. The benefits of VBAC include a shorter recovery time, less postoperative pain, and a lower risk of complications associated with major surgery. However, there are risks involved, including the potential for uterine rupture, which is a rare but serious complication.
On the other hand, a repeat C-section is often recommended when there are concerns about the size of the baby, particularly if the estimated fetal weight is projected to exceed 3400 grams (approximately 7.5 pounds). Larger babies can pose challenges during vaginal delivery, including increased risk of shoulder dystocia, which can lead to injury for both the baby and the mother. Additionally, since you have already had one C-section, the risk of complications during a subsequent C-section may be higher, but this is generally outweighed by the risks associated with attempting a VBAC if the conditions are not ideal.

Your doctor’s recommendation to consider a repeat C-section if the fetal weight exceeds 3400 grams is based on these considerations. It’s important to have open discussions with your healthcare provider about your desire for a natural birth and the specific risks associated with your situation. They can provide you with a detailed assessment of your health, the health of your baby, and the potential outcomes of both delivery methods.

Regarding your weight gain, it’s essential to monitor your weight during pregnancy, but it’s also important to focus on healthy eating and maintaining a balanced diet rather than solely on the numbers. At 163 cm tall and weighing 65.2 kg, your weight gain of 9.2 kg is within the recommended range for a woman of average weight. The total recommended weight gain during pregnancy varies depending on your pre-pregnancy weight and body mass index (BMI). For women with a normal BMI, the recommended weight gain is typically between 11.5 to 16 kg (25 to 35 pounds).
In conclusion, the decision between VBAC and a repeat C-section should be made collaboratively with your healthcare provider, taking into account your medical history, the current health of your pregnancy, and your personal preferences. It’s crucial to weigh the risks and benefits of each option carefully, and to ensure that you feel supported in your decision-making process. Regular prenatal check-ups will help monitor your baby’s growth and your health, allowing for timely interventions if necessary. Always prioritize open communication with your healthcare team to ensure the best possible outcomes for you and your baby.

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