VBAC Singapore: Your Options After a Previous C-Section 剖宫产后再次分娩（新加坡）：顺产还是再剖腹？

If you are considering VBAC in Singapore, you may be wondering about your options after a previous caesarean section. Both vaginal birth after caesarean (VBAC) and a planned repeat caesarean section are reasonable choices.

Birth after a previous caesarean section

A patient leaflet on VBAC and planned repeat caesarean section

If you have had one previous caesarean section, both a vaginal birth after caesarean (VBAC) and a planned repeat caesarean section can be reasonable options. The right choice depends on your previous birth, your current pregnancy, and what matters most to you.

At a glance• Around 3 in 4 women with one previous caesarean and a straightforward pregnancy who go into labour naturally will have a successful VBAC.• A previous vaginal birth makes VBAC more likely to succeed.• A successful VBAC usually means quicker recovery and fewer complications than another operation.• A planned repeat caesarean avoids labour, but recovery is longer and future pregnancies can become more complex.

Comparing your two main options

VBAC (vaginal birth after caesarean)	Planned repeat caesarean section
Quicker recovery, shorter hospital stay, earlier return to daily activity.	Planned date of birth and avoids labour.
Avoids another abdominal operation and may make future births easier.	Lower risk of uterine scar rupture than labour.
Small chance labour may end in an emergency caesarean.	Longer recovery, more post-operative pain, driving restriction after surgery.
Small risk of scar rupture; risk increases if labour is induced.	Each further caesarean may increase scar tissue and placenta-related risks in future pregnancies.
Continuous fetal monitoring in labour is usually recommended.	Babies born by caesarean can have more short-term breathing problems, especially if done before 39 weeks.

When VBAC may be a good option

·       Your previous caesarean was a lower-segment scar and your current pregnancy is otherwise straightforward.

·       You have had a previous vaginal birth, especially a previous successful VBAC.

·       You prefer a shorter recovery and want to reduce the number of caesarean sections in future pregnancies.

When VBAC may not be advisable

·       Three or more previous caesarean deliveries.

·       Previous uterine rupture.

·       A classical / upper uterine incision in a prior caesarean.

·       Another pregnancy complication that already requires a planned caesarean section.

Important points to discuss with your obstetrician• Why your previous caesarean was done.• Whether you have had a previous vaginal birth.• Any complications during your last caesarean or recovery.• Your plans for future pregnancies.• Whether labour induction may be needed in this pregnancy.

Every pregnancy is different. A personalised discussion is important before deciding on your birth plan.

Educational leaflet prepared for www.drtanengkien.com and adapted into original patient-friendly wording from evidence-based guidance on birth after previous caesarean birth.

VBAC 与计划性再次剖宫产患者指南

如果您曾经做过一次剖宫产，再次怀孕时通常有两个主要分娩选择：剖宫产后阴道分娩（VBAC）或计划性再次剖宫产。哪一种更适合，要结合您上一次分娩原因、这次怀孕情况，以及您个人最重视的因素来决定。

重点摘要• 曾有一次剖宫产、这次怀孕情况稳定，而且自然发动产程的孕妇，大约四分之三有机会成功 VBAC。• 如果您曾经阴道分娩过，VBAC 成功率会更高。• 成功 VBAC 一般恢复较快、住院时间较短，也能避免再次腹部手术。• 计划性再次剖宫产可避开产程，但术后恢复较慢，未来怀孕的复杂度也可能增加。

两种主要选择的比较

VBAC（剖宫产后阴道分娩）	计划性再次剖宫产
恢复通常较快，住院时间较短，较早恢复日常活动。	可预先安排日期，不必经历自然产程。
避免再次腹部手术，也可能让未来分娩更容易。	子宫疤痕破裂风险比产程中更低。
仍有小机会最后需要紧急剖宫产。	术后疼痛及恢复时间通常较长，术后数周内不宜驾车。
有小概率出现子宫疤痕裂开；若需要催生，风险会增加。	随着剖宫产次数增加，未来可能出现更多粘连及胎盘植入相关风险。
分娩时一般建议持续监测胎心。	宝宝在出生初期出现呼吸适应问题的机会略高，尤其在 39 周前手术时。

哪些情况较适合考虑 VBAC

·       上一次剖宫产属于常见的子宫下段切口，而这次怀孕整体情况平稳。

·       您曾经有阴道分娩经历，尤其曾成功 VBAC。

·       您希望恢复较快，并尽量减少未来再次剖宫产的次数。

哪些情况通常不建议 VBAC

·       曾做过三次或以上剖宫产。

·       曾发生过子宫破裂。

·       之前剖宫产属于古典式 / 子宫上段切口。

·       这次怀孕本身已有其他原因需要计划性剖宫产。

和产科医生讨论时可重点了解• 上一次剖宫产的原因。• 是否曾经阴道分娩。• 上次手术或术后恢复有没有并发症。• 您是否计划将来再怀孕。• 这次怀孕是否可能需要催生。

每一次怀孕都不一样，最终分娩方式应结合您的个人情况，与产科医生详细讨论后决定。