Caesarean section
or C-section is a surgical procedure used to deliver a baby through an incision
made in the mother’s abdomen (laparotomy) and a second incision made in the
mother’s uterus (hysterotomy). Meanwhile, vaginal birth after caesarean section
or VBAC occurs when a woman having a vaginal delivery when she has had at least
one baby by caesarean section previously.
A woman underwent
a caesarean section for few reasons. It can be due to maternal indication, or
baby indication, or both. Maternal indications that lead to caesarean section
include previous history of caesarean section, obstruction of birth canal such
as tumor in the birth canal causing delivery to be obstructed, and pelvic
abnormalities such as small pelvis. Fetal indications include breech,
congenital malformation, compromised fetal condition, and so on.
Every procedure
will have its own complication. Same goes with C-section. Complication that may
arise from C-section include infection which can arise from the wound itself or
from other source such as urinary tract infection, thromboembolic disease such
as deep vein thrombosis, anesthetic complication, injury to adjacent organ of
the uterus such as bladder and bowel, uterine atony which the uterus unable to
contract well after delivery causing bleeding from the uterus and so on.
Maternal
complications increase with Caesarean delivery relatively compared to a vaginal
delivery. Thus VBAC may avoid some of the suitable candidate from encounter
complication of C-section. However, not all candidate is suitable for VBAC.
This is because there is risk for ‘uterine scar rupture’ for those who opted
for VBAC. Therefore, candidates with high risk for uterine scar rupture are not
suitable for this option, and they have to proceed with C-section.
There are few
criteria to be considered before making VBAC an option for delivery: 1) One
previous low transverse C-section. 2) Clinically adequate pelvis. 3) No other
uterine scar / previous uterine scar rupture. 4) A physician immediately
available throughout active labor who is capable of monitoring labor and
performing an emergency delivery (when indicated). 5) Availability of
anesthesia and personnel for emergency C-section.
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