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Hey, guys, Welcome to another episode of four Vaginas only in this podcast episode we're gonna talk about C sections and the possibility of vaginal delivery after you've had a C section. So let's get right to it. And cue the music theme. Hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. Welcome. Welcome. His episode number 16 of four vaginas on Lee. I am your host, Dr Celestine. And on this episode, we're gonna talk a little bit about C sections, why they occur and who is possibly a good candidate for a vaginal birth after a C section. So let's just jump right into it. Okay, So what is a C section? It's kind of funny, because when I was in residency, we and even now obviously has a signed consent forms with patients before I do any type of procedure. And the consent form for a C section describes it as an incision in the abdomen and removal of a baby, which is so simple. I mean, that is what it is, but it is really simple. I mean, ah c section is not just your basic C or a little procedure to deliver a baby. A C section is a major surgery. We are going into your abdomen through the skin into your belly and delivering a baby. So it's a major abdominal surgery. 20 people out there think of it very lightly. Um, and I just wanted to put it out there in my own podcast that it is a major surgery. It takes a big recovery time, and it takes a lot out of you, Um, at least more so than a normal vaginal delivery. But anyway, that's just my little tidbit on C section, because I feel like not enough people understand that. But there are some instances where a C section is warranted or needed or preferred, so you know, if you do end up having a C section for whatever reason. And even though it is a major surgery, even though it's harder to recover from, you know, sometimes it just needs to be done for the benefit of mom and or baby. So let's talk about the how many C sections are done in the United States, so approximately 32% of all deliveries are performed via C section, which is a lot. I think it's, you know, it's been going up over the years and for multiple different reasons, and I found this little charts, which is interesting. It's a map of the United States, and it tells you the C section rate, actually in each state. So where I am in West Virginia, it's a little bit higher than the 32% average, and it's at 35.3% as of 2011. Actually, this charts a little old, but I don't know if they've made a new one since then. If you are in New Jersey, the state of my heart, you are about 38.8%. New York is 34.7% Florida, 37.8% Um, California, 33% you know, so majority of states, it's around 30%. That's why they got the average of about 32% of deliveries being performed via C section. So, you know, why is that? A lot of people come in and they always say that Oh, you know my mother, my sister, my friends have had a vaginal delivery. So, you know, I plan on having a vaginal delivery. They come in with their birth plan and they have a whole thing, but labor and delivery is not something that can be predicted. Um, I guess the way that I live my life when I'm running around on labor and delivery is expecting the best, but preparing for the worst. So I think it's great that people come in and they kind of have a plan off what they think is gonna happen. But I always try toe make sure that they're realistic, or at least that they understand that, you know, even the best laid plans don't go as we would like them too. So, on that Noah's well, a lot of people feel or express to me feelings of failure because they weren't able to have a vaginal delivery for whatever reason. And that is just simply not the case. So let's talk about some reasons why a C section is necessary and actually is more beneficial in cases of, you know, making the mother and the baby have a better outcome. So There are a lot of reasons why a C section might occur, and there's no possible way for me to go through all of them in a podcast episode. And sometimes C sections occur when you're not even expecting them. Um, I mean, it's great when it goes smoothly, but it doesn't always. And even though, as in O'Brien and you know, I'm still fairly new as an OBE joy in, um, attending only about 2.5 years in. But there's still some things that I haven't experienced or that are unexpected to me. So you can imagine that somebody that comes in expecting to have vaginal delivery without any other ideas of the possibility that things that can happen, how it can sometimes throw them for a loop when you have to tell them that a C section is the best route. So anyway, there are a few reasons why C sections occur, Um, but I will go through the top three reasons. The top three most common reasons. The very most common reason is arrest of labor. So that means that during the labor process, your cervix either stopped dilating and doesn't get fully to 10 centimetres, despite what we try to d'oh or the baby's head is unable to come down far enough for a vaginal delivery. Sometimes the baby's head just in the wrong position or the pelvis isn't the adequate shape or size, and that prevents the baby from coming down to deliver vaginally. So those that's the top reason why people end up having C sections. The second most common reason is some sort of some sort of abnormal fetal heart rate, which can allude to toe before fetal wellbeing. Um, that's as best I can say it. Poor fetal wellbeing. There's a whole thing that goes into it, but a zoo. Lot of people know when you come to the hospital, or even sometimes in the office, you get connected to a monitor two straps on your belly. One is for the baby's heart rate and the others for your contraction pattern in labor, sometimes even in natural labor or even in labor that we give medications to keep it going. No matter how you progress or maintain your labor, there can be the deceleration zor other abnormalities in the fetal heart rate tracing. We do the best that we can in order to try to resolve them and continue with the labor process. But sometimes, no matter what your physician or nurses may try, the baby's heart rate just does not want to get right. So in order to prevent a bad outcome of the baby, a C section is sometimes warranted. The third most common reason is MALP presentation, as we call it. This basically means the baby's not head down. So a lot of people know that your baby needs to be head down in order to have a vaginal delivery. Let me back up needs Maybe not always the case. Um, there are some instances where you can deliver a breech baby vaginally, but that's definitely up to you and your physician to talk about it. I mean, there's so many factors that go into that and the safety of that that you definitely discussed with your own doctor that knows your history, not just some doctor on the podcast. Um, anyway, so MALP recitation being the third most common reason a breech baby sometimes is like but down or feet down or trans verse in the belly, side to side. You know, these positions usually don't allow you to have a vaginal delivery, and then you end up getting scheduled for a C section, So those are the top three. Keep in mind there's many, many more, and there's many variations to even those top three, depending on each particular pregnancy. And every pregnancy is different. Even if you had a pregnant first baby, you know, and your pregnancy went fine and you're expecting that in your second baby. It's not always the case, literally. Every pregnancy, even in the same person, is different than the others. So, you know, I'm glad that I do what I do. I'm glad that I've learned as much as I have an experience as much as I have, so that can help Mom's along in this kind of unpredictable process. But it's just, you know, important to keep in mind that sometimes C sections are warranted. All right, so you're not a failure if it happens to you, you're not a failure. If you're mother, your sister, your friends all had vaginal deliveries, and you're the only one with the C section. That doesn't mean anything, you know, um, so just keep that in mind anywhere moving right along So, depending on the individual circumstances, um, you know, you have to have that conversation with your physician in order to determine what is gonna be the best route for you. But like I said, generally speaking, a C section is harder on the body than having a vaginal delivery In terms of recovery. A C section is also has major risk because it's a major abdominal surgery, there's a risk of injuring the bowel. There's risk of injuring the bladder, all these organs. It's funny because one time I had someone and I took pictures for a laproscopic surgery, and I showed her the inside of her abdomen, the uterus and everything. And even though I talked to her about the risk of injuring the bowel and the bladder and all that, and explained how close they are in the procedure, you don't really understand until you see it for yourself. So I remember her being so shocked when she saw exactly how close the bowel was to her uterus. I mean, the uterus is looted, really laying on top of your bowels, so you know those injuries can happen. And that's what makes a C section a little bit more risky than a normal vaginal delivery. So also why C section is usually reserved only for cases in which the benefits outweigh the risks. Now there's an old saying, once a C section, always a C section, darling, I don't know about the darling part. I probably just added that. But anyway, these days, that is kind of put to rest with the option of having a vaginal birth after cesarean delivery what we call a V back. Okay, so if you have had one, or sometimes even to C sections now the two is really depending on the position policies and hospital policies. But if you've had one or two C sections, there's a possibility that you can have the option of attempting a vaginal delivery. Now the majority of the time, Ah v back is successful. If your C section was for a reason that was not necessarily going to recur in your current pregnancy, such as if you had a breech baby the first time and you had to deliver, you had a C section. Now you're coming in, your baby's head down, everything's going well. You might be a candidate for a V back Also, if you've had the abnormal fetal heart tracing in your last pregnancy, that's not necessarily gonna happen in all of your subsequent pregnancies. So maybe in the current or next pregnancy, you could be a candidate for a vaginal delivery after cesarean section. So if you fall into the category of women who can attempt to have a V back, it is a great alternative to a repeat section because of the decreased risk of maternal and fetal. Um, well, really, maternal complications in future pregnancies sometimes feel as well. So keep in mind, though, that although Avi back is appropriate for many women, it's important for your own physician to assess the likelihood of a successful V back by taking into account all of the factors in your pregnancy to determine if you're a good candidate. The reason for that, and the reason why it's so important to pick good candidates, is because if you go into the hospital and let's say you're a poor or so so kind of candidate for Avi back and we still plan on doing Avi back and you go through the labor process, but something happens where you need to end up having that repeat C section anyway. There's actually a higher risk in that C section than if you had just scheduled one from the jump and decided not to try to have a vaginal delivery. Okay, so I don't want to scare people by saying that, you know, usually a physician to pick really good candidates Sometimes. Like I said, things are unpredictable and some things happen. But, um, if you go in and the plan is that you have a high likelihood of having a vaginal delivery, I would say it's good to go with that plan because over all the benefits of a successful V back are tremendous. But, um, if you're at your doctor's office and they're talking to you about the fact that you are a poor candidate for Avi back, have that discussion with them, you know, go back and forth questions and things like that. So you can fully understand why that may be and also understand that, you know, it's not that we're dooming you to a C section or trying to do me to a C section. We're just trying to make sure that you don't end up in that category of patients that have that repeat C section anyway, after going through a trial of tryingto labor because of that increased risk to you and your baby. Okay, so very important to have that in depth discussion with your doctors. But the one thing about V back that you know would be wrong of me to not say in this podcast episode is that it is not without risk. So if you have had a C section incision to the abdomen and removal of a baby were also in sizing your uterus, the uterus is basically like a big ball of muscle, right, and we're cutting it and suit during it or sewing it back together. Now that area of muscle will never be the same. It's never gonna be as strong as before we cut into it. It's always gonna have that weakened area that was opened up in order to deliver your baby when you had the C section. So there is a small risk of that same area opening back up or what we call a uterus rupture when you're trying to have a vaginal delivery and going through the labor process and have also had a prior C section cried. Does that make sense? That risk of uterine rupture is low. I mean, it can be very, very dangerous if it happens for you and your baby. But it is low. It's less than 1% of chance of it happening, So that's a pretty low number. And it's also important to keep in mind that the uterine rupture risk, even though it can be a catastrophic situation If it happens. It's still so low that it holds true that a successful vaginal delivery after C section still has an overall lower rate of complications than a scheduled C section. So if you had just went ahead with the C section without trying labor, that C section still has a higher risk than trying to have a vaginal delivery. Even with that uterine rupture risk. Okay, Sometimes I feel like I explain it, and it doesn't really, you know, crossover that well. But I'm holding that. I'm explaining it well enough in this instance that you guys kind of catch my drift and understand. But if not, make sure that you clarify it with your own physician and talk about if a scheduled repeat C section or a trial of labor to lead to a vaginal delivery after C section is right for you because you know, as always, like I say here, not all women are candidates for any of the things that I've talked about. And even though some of the things might seem pretty clear cut like I mentioned earlier, nothing is ever as clear cut as it seems. I just try to explain it in the best way possible for you guys so that you can talk about it with your doctor and see how it relates to your own personal situation. And that's the best that I can do. And I'm hoping that with a little bit of knowledge under your belt, that conversation goes really well. And you feel like you understand more about why certain things are happening to you and your body, and in this case, your pregnancy and your child as well. All right, so that's it. That's C sections why they occur, the possibility of having a vaginal delivery after a C section, and that's everything. So thank you guys were listening to a another episode of four vaginas only as always. Please do not forget to follow for at four vaginas only on Instagram and also on Facebook. If you want to send me any messages, you could always d m e on instagram. That's probably the social media outlet I checked the most, and you can email me at Dr C at f ve only dot com to get in touch with me. All right, guys, I hope you have a great day. And I hope you learned a little bit. And, um, we'll see you in episode 17 by