Expert: Dorothy H, LCCE - 1/6/2010

Question
I have 4 children. My first three were born vaginally and without medication. After laboring to complete and having my water break my midwife discovered my fourth child coming elbow first, which turned into a c-section for me. A horizontal incision was made on my skin, but a vertical incision was made on my uterus. This was made because the bottom of my uterus wasn't stretched out enough for the horizontal cut. The doctor told me because of my vertical incision I could never have a vaginal birth again. My labors are short and relatively pain free. My question is can i have a safe VBAC if I ever decide to have more children.

Answer
Hi Christina,

If your vertical incision was a low vertical incision that doesn't extend to the upper uterus, it presents a 1-7% chance of uterine rupture.  You may possibly be able to find a care provider willing to consider a VBAC depending on the exact location of the scar. (in other words, if your scar is low and your doctor feels you are closer to the 1% risk,they may be willing to give you a trial of labor.  If the incision is higher up and they feel you are closer to the 7% risk, they won't chance it.

If your incision is a high vertical incision, which from what you described sounds more likely unfortunately, your chance of uterine rupture is 4-9%, and VBAC is not recommended, and I don't think you would find a doctor willing to allow a trial of labor.

I would suggest getting your surgical records and having a consultation with doctors in your area who are known to be VBAC friendly and discuss with them whether they feel you are a candidate for a VBAC.

I hope that helps!

Dorothy H, LCCE