Many people in our country have the idea that once delivered by Caesarean section, Caesarean section is required in every subsequent pregnancy. .According to the American Pregnancy Association, 90% of mothers are eligible for a normal vaginal delivery after a cesarean delivery. Of these, 60-70% of mothers have a successful normal vaginal delivery without any problems. .But before giving a delivery trial, some mothers have to see if they are suitable for this delivery. For this we need to take some information about the previous Caesar.Â
Number of previous Caesars:
Those who have had a caesarean section before will only be able to have a vaginal delivery trial later.
What caused Caesar?
Caesarean section is due to some factors that are less likely to recur, such as Caesarean section due to abnormal position of the baby or Caesarean section due to some problem of the baby or mother which is absent in the current pregnancy.
How strong is Caesar’s position before:
Lower uterine caessarean section or LUCS (stitches in the lower part of the uterus) is the only chance to have a subsequent vaginal delivery trial, with a 0.5 to 1.5% chance of rupture of the previous stitches. .On the other hand, in case of classical caesarean section, the rate of sewing cracking is 4 to 9%.
There should be a gap of at least two years between the two pregnancies, as the previous stitching space becomes stronger.
Having a placenta previa in an earlier pregnancy or an infection after a caesarean section weakens the stitches which increases the risk of rupture later.
Also, if the mother has any other complications during the current pregnancy such as high blood pressure or diabetes, she is not considered suitable for a normal vaginal delivery trial.
A prerequisite for vaginal delivery is that the baby weighs less than 4 kg and the delivery road is wide enough.
If all goes well, mothers and guardians should be informed about the advantages and disadvantages of this delivery. .Delivery must be made to a hospital where an emergency caesarean section can be arranged quickly. Intensive monitoring of the baby and the mother is important in this case. .In developed countries, CTG (cardio-tocograph) machines are used to monitor the child during labor.
In 20 to 50 percent of cases, vaginal delivery is not possible and an emergency caesarean section is needed.Without proper monitoring during this delivery, maternal and child complications increase. On the other hand, through successful vaginal delivery, extra arms can be avoided.As the number of arms transplants in the body increases, so does the risk of tissue adhesion and tissue injury, and this delivery is free from all the risks of arms trafficking.
But this is not practiced in most of the hospitals in our country due to lack of skilled manpower, inadequate equipment required for mother and child monitoring and reluctance and fear of mothers in vaginal delivery.
Dr. Nusrat Jahan
Associate Consultant (Gaini-Obs), Imperial Hospital, Chittagong.
