C-section deliveries are a common medical procedure globally. For individuals who have experienced a previous C-section, the decision of how to deliver a subsequent baby involves specific choices. The default path often involves planning a surgical delivery, formally known as a repeat cesarean. Understanding this scheduled procedure and the available alternatives is important for making an informed decision.
Defining Repeat Cesarean Delivery
A repeat cesarean delivery refers to the surgical birth of a baby after a person has previously delivered one or more babies via C-section. When this procedure is planned in advance, it is often called an Elective Repeat Cesarean Delivery (ERCD). This planned approach offers the predictability of knowing the date and time of the birth.
Healthcare providers typically schedule an ERCD around 39 weeks of gestation. This timing is selected to reduce the risk of the baby being born prematurely, while also minimizing the chance of labor beginning spontaneously before the scheduled surgery. Scheduling the procedure avoids the unpredictable onset of contractions. The repeat surgery typically involves making an incision over the location of the previous scar.
The Primary Alternative: VBAC
The main alternative to a planned repeat C-section is attempting a vaginal birth, a process known as a Trial of Labor After Cesarean (TOLAC). If the TOLAC is successful, the outcome is a Vaginal Birth After Cesarean (VBAC). This approach allows the birthing person to experience a vaginal delivery, which generally has a shorter recovery period than major abdominal surgery.
A successful VBAC is associated with reduced risks of future placental problems, such as placenta accreta, which can increase with each subsequent C-section. The immediate recovery is often faster, allowing for a shorter hospital stay. For individuals hoping for a larger family, avoiding multiple major surgeries can be medically beneficial in the long term. The decision to attempt a TOLAC rests on a careful evaluation of the specific medical history of the patient.
Key Considerations for Delivery Choice
The choice between an ERCD and a TOLAC relies on an assessment of individual patient history and current pregnancy factors. The primary factor is the type of incision made on the uterus during the previous C-section, not the external skin incision. A low transverse uterine incision, which is a horizontal cut across the lower, thinner part of the uterus, is generally the safest for a TOLAC attempt.
A classical or vertical uterine incision carries a higher risk of uterine rupture during labor, making a repeat C-section the recommended delivery method. The reason for the first C-section is also important. If it was for a non-recurrent issue, such as a temporary fetal positioning problem, the chance of a successful VBAC is higher. Conversely, if the previous C-section was due to a non-progressing labor, the success rate for TOLAC is lower.
The primary risk associated with a TOLAC is uterine rupture, where the scar from the previous C-section tears open during labor. While this is a rare event, occurring in less than 1% of TOLAC attempts, it can be life-threatening for both the mother and the baby. Every additional C-section also increases the risk of serious placental complications in future pregnancies, such as placenta previa and placenta accreta. These conditions involve the placenta implanting abnormally close to or into the uterine wall, which can lead to severe hemorrhage and the potential need for a hysterectomy.
Preparing for a Repeat Cesarean
Once a repeat cesarean is scheduled, patients will receive specific instructions to prepare for the surgical day. Pre-operative instructions typically include fasting, meaning no food or non-clear liquids for at least eight hours before the surgery. Many facilities allow clear liquids, such as water or apple juice, up to two hours prior to the scheduled procedure.
Patients are often instructed to use a special antiseptic wash, such as a Chlorhexidine Gluconate (CHG) solution, to shower the night before and the morning of the surgery to reduce the risk of surgical site infection. The procedure is usually performed under regional anesthesia, such as a spinal block, which allows the mother to be awake and alert for the birth. The surgeon will typically make the incision through the same scar line from the previous surgery.
The actual surgical time for a repeat C-section is often shorter than the initial procedure. The presence of adhesions, which are bands of scar tissue that form internally from the previous surgery, can sometimes make the process of accessing the uterus more complex. Recovery involves a hospital stay that usually lasts between two and four days, and patients are encouraged to walk soon after the procedure to aid circulation and healing. Full recovery from a repeat C-section generally takes about six weeks, and patients are advised to avoid lifting anything heavier than the baby for this period.