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    Once a C, Always a C?

    To C or Not to C

    A time and place for each continued...

    But VBAC isn't for everyone, Randell warns. If a woman has a very narrow pelvis, any medical or obstetrical complication that precludes vaginal delivery, or has had a "classical" c-section where the uterus was cut up and down vs. side to side (note that the direction of the scar on the skin does not accurately predict the one on the uterus, and a review of the operative report is highly advisable to confirm such a detail), a VBAC is not recommended. Ultimately, the decision is based on weighing risks and benefits, says Randell, and each case is unique.

    Women considering VBAC also must acknowledge the possibility that despite the trial of labor, they may need to have another cesarean. For these women, Mozurkewich says, recovery may take longer and be associated with a higher risk of infection and other complications than with an elective C. "If she has the baby vaginally, her recovery will be shorter, but if she has a failed trial of labor, she will face the recovery of both the labor and the cesarean."

    Just as a woman has the right to choose VBAC if it is medically appropriate, she also has the right to refuse it, says Randell. Some women just aren't comfortable with the risks, Randell says. Others prefer to schedule the baby's arrival, fear vaginal childbirth, or have had a previous c-section and want to go with the known. Likewise, if a woman is not a good candidate for VBAC, her doctor can refuse. "The goal is to have a healthy baby and a safe delivery, by whatever method," says Hundley. "That's most important."

    A VBAC success

    When Cheryl went into labor with her second child, the thought did cross her mind that she might still need another cesarean. But after a short labor and 45 minutes of pushing, her daughter was born vaginally without any problems. "I would recommend VBAC to anyone who wants to try," she says. "I'd choose it again in a minute."

    Michele Bloomquist is a freelance writer based in Brush Prairie, Wash. She was born by elective c-section, in the days before VBAC.

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