Childbirth Delivery Options at FAME
Mary, holding her newborn daughter in FAME’s maternity ward.
Mary* is 36 years old and has just given birth to a little girl. This is her fifth child and her fourth pregnancy. Her first child was delivered by an emergency cesarean section (C-section), which was not a very good experience for her. Her last three pregnancies have been vaginal birth after cesarean (VBAC), including a twin pregnancy here at FAME.
“I wanted a vaginal delivery because of the C-section’s downtime. It took half a year for me to recover from the operation completely. I couldn’t work. I stayed home, lying down to rest between simple house chores. My husband does not make much money, so I have to work for our family to live comfortably. That C-section turned our lives upside down and sadly stole our joy as first-time parents.”
Mary’s story is not unique. For a long time, medical professionals have told women that once they’ve had one C-section, they had to have the operation with every other pregnancy.
“My husband and I always wanted to have a big family, and thus I wanted to try a vaginal delivery despite already having had a C-section. I couldn't have had many kids if the operation had been my experience every time. It was just too painful.” - Mary.
At FAME, the purpose of any obstetric intervention is not only to reduce morbidity and mortality of the mother and baby but also to increase maternal satisfaction while ensuring patient safety. When Mary walked through our doors, we were ready to help.
Dr. Anne Ghati
Dr. Anne Ghati, FAME’s Assistant Medical officer, explains the approach that FAME takes towards TOLAC and VBAC.
“At FAME, trial of labor after cesarean (TOLAC) has a 70-75% success rate and reduces maternal morbidity by allowing women to have a vaginal birth after a cesarean (VBAC) which is associated with fewer complications than repeat elective C-sections. When successful, VBAC causes a decrease in maternal morbidity and risk of complications in future pregnancies.”
However, not all pregnant women are eligible for TOLAC. When they get to FAME, they are first screened and their past and present obstetric and reproductive history is recorded.
“The ideal candidates for TOLAC are patients with a high likelihood of VBAC and a very low likelihood of intrapartum uterine rupture. Some risk factors, such as gestational diabetes and estimated fetal weight of more than 8 lbs 13 oz, are just some of the impending factors. A C-section scar less than 18 months after a previous delivery also disqualifies the woman as it presents a higher risk of uterine rupture. Same as having undergone a classical cesarean delivery, which is a midline uterine incision in the contractile portion of the uterus.” - Dr. Anne
“I was appropriately counseled regarding delivery options. The risks and benefits of elective repeat cesarean delivery versus trial of labor were clearly explained. I didn’t know there were benefits to TOLAC, other than less pain and faster recovery until I attended FAME’s antenatal classes.”
FAME can perform TOLAC as it is equipped to handle any emergencies that could arise. Extensive maternal education for its staff, the availability of fetal monitoring tools, and proper monitoring during labor ensure the safety of mothers and newborns. Nurses and doctors are trained to check for the signs of uterine ruptures, such as acute pain and repetitive or prolonged fetal heart rate deceleration, which are both potential risks with TOLAC.
“As a doctor, I recommend TOLAC as it usually presents fewer complications. However, screening of the women is required to rule out possible risk factors. High C-section rates increase maternal and neonatal morbidity, and VBAC has been a good way to counter this.”
For women like Mary, avoiding surgical recovery in the postpartum period is the biggest motivator for TOLAC. FAME continues to invest in these procedures so that we can help other women like Mary deliver vaginally despite a history of C-sections, improving maternal and newborn outcomes and meeting the needs of our patients.
*While the patient’s name has been changed to protect privacy, permission was secured to share her photos and story with FAME supporters and to raise awareness of available medical care at FAME Medical.