VBAC: Is VBAC Possible After CPD?

My wife is pregnant with our second child. She had a cesarean with our first. Her doctor told that her pelvic structure was too small (CPD) and she would require a repeat cesarean. Is that correct or is there a chance of a VBAC?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

The American College of Obstetricians and Gynecologists states that unless contraindicated, all women should be given the chance to give birth vaginally after a cesarean. Labor is good for the baby and for the mother. It stresses the baby a bit which is good, forcing fluid from the lungs. It minimizes blood loss for the mother if a cesarean must be performed later. Scheduled cesareans may be convenient, but are not necessarily better.

In midwifery education, we learned that progress in labor and eventual successful delivery depends upon the three "P's": The powers (uterine contractions and maternal effort), the passage (the pelvic structure and musculature) and the passenger (the baby's position, presentation, size and health status).

In cases where a mother is unable to deliver vaginally, we really only have a hint about her ability to give birth to subsequent babies. She may have a different size baby, a baby who is in a more favorable position, better, more efficient uterine contractions, a more relaxed vaginal musculature and a more relaxed and knowledgeable mother and father.

Almost all cesareans done today in the U.S. today use a transverse incision into the uterus (across the grain). This makes for a stronger more secure repair. The skin incision may be vertical or horizontal. If for some reason, a longitudinal incision (ask the obstetrician who performed it or read the operative note) was performed, a vaginal birth is often not recommended.

If your provider is still unwilling to discuss a VBAC, I would seek out a second opinion. A nurse-midwife, if there is one in your community, would be able to discuss all the pros and cons and work with you. Best of luck.

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