Dear Doctor,

I had my first child by C-section a year ago because of prolonged labour.  I plan to have another baby. But I would like to have a natural birth this time around. How long do I have to wait to be able to have a natural birth if there are no complications? Tina

Dear Tina,

A planned C-section or Caesarean section is usually done when there is some hindrance for vaginal delivery, like a short pelvis, bony deformity, and etcetera. It is done as an emergency procedure when there is some risk to the mother or baby. The risks include prolonged labour, umbilical cord prolapse, foetal distress, abnormal positions of the baby, severe hypertension during pregnancy, eclampsia of pregnancy, premature rupture of membranes, and etcetera.  Some have also advocated C-section for women who are too anxious or afraid of pain during a normal delivery.

World over, the prevalence of C-section has risen. This has been attributed to women marrying and conceiving at an older age, thus having increased risk of pregnancy related complications. C-section is a surgical procedure with all the potential risks associated with any surgery. These include risk of bleeding during or after surgery, infection at operation site, risk of clot formation in legs, trauma to adjacent organs like bladder, intestines, lacerations of uterus, and side effects of anaesthesia, to mention a few. Complications can occur later on in form of infertility due to post-operative adhesions or infection, hernia at site of incision, and uterine rupture in subsequent delivery.

A baby born via C-section has reduced immunity and is more vulnerable to develop asthma, diabetes in later life. It is also more expensive than a natural vaginal delivery and requires more post-operative care. Recovery takes longer than a vaginal delivery.

One can have a normal vaginal delivery after a C-section in a previous pregnancy, what is known as VBAC (vaginal birth after C-section). The only concern is that the issues or risk factors present during the first pregnancy should not be present this time. The chances of a successful subsequent vaginal delivery are higher in women who had a transverse low lying incision on the abdomen in a previous C-section, instead of the typical vertical one, in women where no other abdominal surgery has been performed and vagina is large enough.

It is impossible to predict whether one will deliver normally or would need a C-section for delivery in another pregnancy. The benefits and risks of each procedure have to be weighed in concern of risks to the mother and baby.  Regular antenatal check-ups can help decide that. If possibility of VBAC exists in second pregnancy, one should opt for a facility equipped with expertise for emergency C-section if needed around labour time.

 Dr. Rachna   Pande is a specialist in internal medicine.