The reasons why a Caesarean section may be performed as a matter of emergency include:

  • insufficient progress in labour (e.g. your contractions have slowed down/become weaker, your cervix is not dilating, you are getting too tired to push)
  • fetal distress during labour
  • the placenta starts to separate from the uterus
  • the presentation of one/both babies changes during labour
  • labour has begun prematurely and the babies’ health means that this could put them at risk
  • a prolapsed cord of one of the babies during delivery (usually because of breech presentation), which could cut off oxygen supply to the descending baby.

Vaginal birth after a Caesarean section

In the past, if you had previously given birth by Caesarean section, all subsequent deliveries would be by this method. This was largely because the incision made in your abdomen was vertical, which meant that there was a significant risk of uterine rupture caused by contractions in a subsequent labour. Now that a horizontal incision in the lower part of the abdomen is used, that risk is very much reduced.

A subsequent vaginal birth after a Caesarean section (VBAC) is therefore considered possible in certain circumstances (eg if both twins are cephalic), as long as there are no contraindications either for the woman or for her baby/babies.

The risks and benefits of a VBAC will therefore be discussed by you and your doctors in relation to your own situation and will affect the decision you eventually take.

This is an edited extract from One Born Every Minute: Expecting a Twins? by Professor Mark Kilby and Jane Denton (Quadrille, £25).

Text © 2013 Mark Kilby and Jane Denton

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