About 25% of all babies in the United States are born by cesarean delivery, creating a situation where many women have to choose whether or not to have a repeat c-section, or to undergo an attempt at vaginal delivery for their next pregnancy.

What occurs during a c-section? Basically, an Ob doctor makes an incision into the skin of the abdomen, usually via a "bikini cut" but sometimes via an up-and-down cut called a vertical skin incision. He or she then cuts through each layer of tissue until reaching the uterus, which is essentially a large muscle. The area closest to the bladder, called the "lower uterine segment," heals better than the upper part of the uterus, so doctors make an incision in this lower area 90% of the time. The doctor makes a sideways cut, (going the same direction as the bikini cut), into this area, then reaches in, cups the baby in her or his hand, and delivers the baby through the incision. This sideways cut on the uterus is called a low transverse c-section, or LTCS for short. The uterine incision is sutured closed and heals over the next 2-6 weeks.

We know through medical research that uterine scar breakdowns (and especially uterine ruptures) are relatively uncommon events, occurring in 1/2 of 1% of low-transverse incisions. Uterine ruptures usually cause significant pain, so close observation by a patient's doctor and nurse, and perhaps the use of fetal monitoring, will often diagnose this condition.

Contrary to popular belief, a c-section is a *major* operation, not unlike a hysterectomy in it's complexity and potential complications! These complications may include infection, hemorrhage, scar tissue formation (which may produce lifelong abdominal or pelvic pain), anesthesia complications, opening of the skin incision leading to a very large scar, damage to the bladder or intestines, and the formation of blood clots within blood vessels or the lungs. These complications are usually much more common with c-sections than vaginal deliveries.

Since we know that vaginal deliveries are almost always safer for the mother, and usually as safe for the baby, and that VBAC attempts are successful in majority of cases, why do some women still choose to have a repeat c/section rather than try for a vaginal delivery? In some cases it is fear of pain during labor, in others it is a "fear of the unknown," while for some women there is a convenience in scheduling the exact date of their baby's birth, and there are women who do not wish to take the risk, no matter how rare, of uterine rupture.
Reference: D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology