Ask An Expert: What Are My Chances Of Having A Vaginal Birth After Two Caesarean Sections?

Our team of seasoned experts answer all your questions on pregnancy, delivery, children and women’s health, sexuality education and more.

Q: I have had two caesarean sections. I’m currently pregnant with my third baby and my doctor says I can have a vaginal birth. What are the likely risks? Need a second opinion.

Dr. Alex Kaoranu Molukwu (OB/GYN) says:

Your doctor is right – you can have a vaginal birth. This is also called vaginal birth after caesarian section (VBAC).

Your doctor is always on ground and has first-hand information about you and your pregnancy. It was commonly believed that for women with previous caesarean, ‘once a caesarian, always a caesarian,’ however, that medical practice has changed.

Your doctor knows that you are not 40 years old or above. He is confident that your baby is not malpositioned, and that you are not carrying twins.

Note that prematurity does not favour VBAC. Factors favouring VBAC include normal blood pressure, absence of diabetes mellitus, baby is of normal size, no major medical problems, and incisions of the previous caesarian sections were transverse incisions in the lower uterine segment and not T-shaped, inverted T or J-shaped.

The reason or indication for the previous caesarean section (for example obstructed labour) should also not be present in the current pregnancy. Women with previous uterine rupture, hysterotomy, myomectomy entering the uterine cavity, previous injury to the urinary bladder, bowel or ureter are not eligible for a VBAC because uterine rupture may be catastrophic or fatal.

VBAC should be attempted in hospitals or centres equipped to respond to emergencies with experienced physicians immediately available to respond or provide emergency care.

Please, you should get your doctor or obstetrician to discuss the risks and benefits of VBAC fully with you and your husband. I wish you the best.

Q: My husband and I got married 4 years ago, and I had IUCD inserted. We didn’t want a baby yet because neither of us had a decent job, and our son, whom we had during our courtship, was starting school. I stopped menstruating altogether and felt okay with it. I had the IUCD removed a couple of months back but I’m still not menstruating. What could be wrong?

Dr. Alex Kaoranu Molukwu (OB/GYN) says:

You forgot to tell me the exact type of intra uterine contraceptive (IUCD). Was it impregnated with female hormone to reduce pain and blood loss at menstruation?

IUCD is one of the most effective methods of contraception. It is often used in the management of amenorrhoea (cessation of period) due to contraceptive injectable or excessive curettage.

It is a recognized fact that IUCD does not prevent sexually transmitted diseases (STD), for example hepatitis and HIV infections. Tuberculosis is also endemic in our society. These infections can cause cessation of period directly or indirectly. A few people may also develop cervical stenosis with prolonged use of IUCD.

An intensive investigation or screening and appropriate medication will surely restore your cyclical menstruation and thereby your possible fertility.

Please do not forget to exclude a possible co-existing early pregnancy.