When you want to have a VBAC after several c-sections, discuss your individual circumstances with your doctor. It’s also a good idea to look at the hospital notes from your last section. Was your scar healthy or had it started to open? Are there any anticipated problems related to your previous c-sections? Find out as much information as possible to help you make the right decision for you and your baby.

Your risk of uterine rupture increases if you have a vertical scar, but it’s much more usual to have a horizontal scar nowadays. And also if you are given prostaglandin to induce labor.

Your chances of having a successful VBAC are higher if you have delivered at least one baby vaginally in the past and also if your last c-section was for a breech baby

VBAC rates are lower if you previously had a c-section because of a small pelvis, or if you have already had more than one c-section.

However hard it seems, do try to move. About 6 hours after delivery you can attempt to. The earlier you can, the better for your circulation and general recovery. As well as moving around out of bed, you’ll be encouraged to do ankle exercises while you’re in bed, to improve circulation to your legs and help prevent clots.

Physically
Everyone knows a c-section is major surgery, but you may still be surprised by how much it hurts afterwards. You may feel you can’t do anything on your own. Trapped wind is another problem, especially by about day three. Tightening the abdominal muscles on an outward breath helps expel the gas. Peppermint water or tea also helps. It will hurt to cough or laugh, but less if you support your wound (with your hands or by holding a pillow over your stomach) as you do so. Wearing boxershorts that are a size bigger than you really need may make the wound feel more comfortable, and you’ll need to use sanitary pads because the lochia, or bleeding from the uterus, is the same as after a vaginal birth.

Going home
You’ll probably have to stay in hospital for about 3 days. It may take your body up to 6 months to recover fully after a section and many women say they don’t feel completely themselves for up to a year. You’ll probably be warned not to drive for 5 weeks, as turning and twisting may cause pain and having to do an emergency stop would be very painful. You shouldn’t lift anything heavy either. You will be encouraged to start gentle postnatal exercises the day after your operation. This will help speed your physical recovery. You should not start a more strenuous exercise program until 6 to 8 weeks after delivery.

The scar
The majority of c-sections these days are lower segment section, which means your scar runs horizontally along your bikini line. At first it will look very red, but as the weeks and months go by it will gradually fade to pink. By 2 years after your operation the scar will probably have faded to a silvery line, and it may eventually be almost invisible.

• Be in optimal condition when labor starts. Stay healthy during pregnancy; eat well, exercise and get plenty of rest.
• Maintaining an upright position as long as you can during labor. Walking and standing can hasten the process by making contractions stronger, longer, and more effective. Even sitting, rather than lying down, can cut the length of labor.
• Drinking plenty of fluids during labor to prevent dehydration. Some experts also suggest eating little bits but often during labor to keep your energy levels up.

Your husband or partner can be with you during the preparation and for the birth. Only when your c-section is a real emergency, or if you need a general anesthetic, will your partner be asked to leave. This is not often the case.

A c-section is done with an epidural or spinal block so you can be awake and see your baby immediately after the birth. You will have a catheter inserted to drain your bladder, and a drip in your arm or hand to give extra fluids or pain relief if needed. You may also have a heart monitor on.

A screen will be put up while the procedure is taking place. Some partners like to peek over the screen but others prefer not to see what is happening. You may like your doctor to tell you what he is doing, so that you know the minute your baby is born.

When the epidural is doing its work, the doctor makes a small horizontal incision in your skin above your pubic bone, and then makes a cut in the lower section of your uterus. Then your baby is lifted out, this only takes a few minutes. Your baby will be quickly checked and then shown to you.
If your baby is very small or unwell he or she may need to go straight to the special care unit. Otherwise your partner can hold him while the placenta is delivered and you are stitched up. This all can take as little as half an hour.

Some of the conditions that may require a planned c-section are:

• The baby is in a breech (bottom first) or transverse (sideways) position.
• You’re carrying three or more babies.
• The baby has a known fetal illness or abnormality.
• You’re having a genital herpes outbreak, which can be passed along to a baby delivered vaginally.
• You have placenta praevia: when the placenta is blocking the baby’s exit, because it’s very low in the uterus.
• You have abruptio placenta: when the placenta is separated from the uterine wall and the baby is in danger.
• Your pre-eclampsia (swellings due to high blood pressure) is getting worse fast, making it dangerous to delay delivery.
• You have had multiple caesarean sections.

Women have an unplanned surgical delivery for several reasons, including:

• The baby’s heart rate becomes irregular, which means that she may not be strong enough for a vaginal delivery.
• The placenta has abrupted.
• The umbilical cord slips through the cervix, it may get compressed during delivery and cut off the baby’s oxygen supply.
• The baby is not moving down the birth canal, because the cervix has stopped dilating or for a different reason.