Why might my maternity care provider recommend a repeat C-section?

There are a number of special situations where your care provider might recommend a C-section. It's important to note that in the situations listed below, research does not support a specific need for C-section based on risk of the previous C-section scar rupturing. If you're facing any of these situations, you may have to push your doctor a bit to consider the VBAC option.

• Your care provider doesn't know what type of uterine scar you have. Many years ago, studies showed that a side-to-side cut on the lower part of the uterus (low transverse incision) produced a much stronger scar than the previously used up-and-down (classical) incision. As a result, nearly all women who had a C-section before and are pregnant again have a side-to-side scar. To be sure what kind of scar you have, your care provider will need your medical record from your earlier C-section (the direction of the scar on your skin may not be the same as the scar on your uterus). Ultimately, research suggests that there is no increased risk for scar rupture in women when the direction of the scar is unknown, compared with women with a known low transverse scar.
• Your previous C-section was because you had a premature (preterm) birth. In this case, the lower part of your uterus may not have developed enough when you had the C-section to allow the doctor to do a side-to-side cut, so she or he might have done an up-and-down incision at the bottom of the uterus. The limited research available shows this type of scar should be just as strong as the more common side-to-side scar.
• Your doctor expects your baby to be larger than average. Some people believe babies that are expected to weigh more than 8 pounds, 13 ounces (4,000 grams) put extra pressure on the C-section scar, increasing risk of rupture. Research does not support this concern.
• Your pregnancy goes beyond your due date. Studies do not show an increase in problems with the scar in pregnancies going beyond 40 weeks, although some studies show an increase if labor is induced after this point.
• You're expecting twins. Studies have not shown an increase in problems with the scar during labor with twins, compared with one baby.
• Your baby is in a buttocks- or feet-first (breech) position. Few providers are comfortable with vaginal birth for breech babies, even if you haven't had a C-section before. That being said, if you're interested in attempting VBAC and your baby is breech, your provider can use hand maneuvers on the belly to try to turn the baby into a head-first position (external cephalic version). There is little research on whether turning the baby could increase risk of scar rupture, but the existing research does not indicate increased risk.