Childbirth is a highly complex and painful process. Women who have initially undergone a cesarean for their first pregnancy are later presented with two choices for their next pregnancy delivery – cesarean or vaginal birth (VBAC).
When discussing the options, the doctors typically discuss the pros and cons of each of these procedures, highlighting the lifelong risks that are often imposed.
A recently conducted study published in the British Journal of Obstetrics and Gynaecology uncovered an often-neglected risk in vaginal birth after cesarean (VBAC) – extensive tear and damage around the vaginal area. It found that women undergoing VBAC have 21% increased chances of experiencing vaginal trauma instead of undergoing another cesarean delivery.
The injury to the perineum (the area between the vagina and the anus) in a woman affects the stability of several pelvic floor muscles responsible for controlling the bowels and bladder in the patients.
The study also recorded that the injury and damage extend to the anal sphincter, leading to bowel movements issues.
One of the main reasons behind the extent of the injury was recorded due to an existing mismatch between a uterus that has been birthed before and perineum that is entirely new to the natural birth and the risks that come with it. In such cases, with quick labor progression, the perineum doesn’t get enough time to stretch like it should, leading to extended tear and damage during VBAC.
Following the finding, the researchers also wanted to explore the lifelong complications of the third-degree perineal tear. The surgeon repairs any kind of minimal perineum tear right after childbirth. However, third-degree tears, despite expert care, third-degree tears affect the mother throughout their lives.
The research was done with data collected from 130,000 births over five years in Victoria. The reports and extent of the vaginal tear were recorded in the first-time mothers with the mothers who have previously undergone a cesarean and then opted for a vaginal birth.
Despite the rising risks associated, the choice is always left to the mother and the couple, considering their birth plan. The doctors can present them with a comprehensive outlook into the various options, following which the patients have to decide what they deem suitable for themselves.
The doctors typically offer a vaginal birth as a choice to would-be mothers is because of the quicker recovery and improved likelihood of breastfeeding for the mother. Considering and weighing in the pros and cons, some women opt to try for a vaginal birth. Other mothers who don’t want to experience the extent of the risks and permanent scarring opt for a repeat of cesarean birth.
1- Uebergang J, Hiscock R, Hastie R, Middleton A, Pritchard N, Walker S, Tong S, Lindquist A. Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: A state-wide cohort study. BJOG. 2021 Dec 16. doi: 10.1111/1471-0528.17063. Epub ahead of print. PMID: 34913246.