Q. Hi, I have 2 sons with which both i had emergency caesarean sections, i am pregnant again does this automatically mean i`ll have to have another section?

A. Unfortunately, there is very little research that has looked at women's success in having a vaginal birth after they've had two or more caesarean sections. From the studies that have been done, some suggest that the rate of successful vaginal birth after caesarean (VBAC) is no worse for women who have had two or more previous caesareans than those who've only had one. However, others have concluded that vaginal birth after two or more caesareans is less successful and is more risky. It also depends on the reasons why your two previous babies needed to be delivered by emergency caesarean and to what extent the neck of your womb (cervix) had opened (dilatated) during these labours. You might have been early on in labour, or close to being fully dilated. If your previous caesareans were performed because your cervix wasn't dilating as would normally be expected (called obstructed labour/failure to progress), or your baby was too large to pass through your pelvis (called cephalopelvic disproportion (CPD)) these difficulties are likely to recur, so attempting a vaginal birth may not be feasible.

However, you should not be discouraged from attempting VBAC if this is something you're keen to pursue. You will however, need to talk with your doctor who will be able to discuss the advantages and disadvantages, and may talk about aiming for a vaginal birth (called a ‘trial of labour'). This is where you start in labour and your progress and your baby's condition are monitored continuously, so that should any concerns arise, your baby can be delivered by caesarean.

Where you have had two previous caesarean births, the concern is that the scar tissue from these births can tear open (rupture) during labour. This is referred to as a ‘uterine rupture' and can result in severe bleeding (haemorrhage), which can be life-threatening for you and your baby. If each of your previous births was a lower segment caesarean section (LSCS), which involves a low ‘bikini line' cut/incision, these are least likely to rupture. However, if you had a different type of incision that was made higher up in the uterus because, for example, your babies were born too early (prematurely), or were lying in an unusual position inside the uterus, these are more likely to rupture and you may be advised against attempting vaginal birth.

A good starting point would be to talk with your midwife and doctor who will be able to discuss the safety of VBAC with you as it relates to your previous birth/obstetric history. If you wish to try for a vaginal birth, you will probably be advised that this should be undertaken in a hospital with the appropriate staff and facilities available. Both your and your baby's health and well-being can then be monitored closely, so that where concerns arise, a caesarean section can be performed immediately. I would also advise you to read MIDIRS Informed Choice leaflet, Caesarean section and subsequent births at www.choicesforbirth.org

Best regards

Vicky