Pertussis

Signs & Symptoms

Español: Signos y síntomas

Pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks.

In infants, the cough can be minimal or not even there. Infants may have a symptom known as "apnea." Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Learn more about pertussis complications.

Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to throw up and be very tired. The "whoop" is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.

Early symptoms can last for 1 to 2 weeks and usually include:

Runny nose
Low-grade fever (generally minimal throughout the course of the disease)
Mild, occasional cough
Apnea – a pause in breathing (in infants)


Because pertussis in its early stages appears to be nothing more than the common cold, it is often not suspected or diagnosed until the more severe symptoms appear. Infected people are most contagious during this time, up to about 2 weeks after the cough begins. Antibiotics may shorten the amount of time someone is contagious.

As the disease progresses, the traditional symptoms of pertussis appear and include:

Paroxysms (fits) of many, rapid coughs followed by a high-pitched "whoop"
Vomiting (throwing up)
Exhaustion (very tired) after coughing fits
The coughing fits can go on for up to 10 weeks or more. In China, pertussis is known as the "100 day cough."

Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and severe as the illness continues, and can occur more often at night. The illness can be milder (less severe) and the typical "whoop" absent in children, teens, and adults who have been vaccinated.

Recovery from pertussis can happen slowly. The cough becomes less severe and less common. However, coughing fits can return with other respiratory infections for many months after pertussis started.

Prevention

Español: Prevención

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Vaccines

The best way to prevent pertussis (whooping cough) among infants, children, teens, and adults is to get vaccinated. Also, keep infants and other people at high risk for pertussis complications away from infected people.

In the United States, the recommended pertussis vaccine for infants and children is called DTaP. This is a combination vaccine that protects against three diseases: diphtheria, tetanus and pertussis. For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. The fourth shot is given between 15 and 18 months of age, and a fifth shot is given before a child enters school, at 4–6 years of age. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing.

Vaccine protection for pertussis, tetanus and diphtheria fades with time. Before 2005, the only booster available contained protection against tetanus and diphtheria (called Td), and was recommended for teens and adults every 10 years. Today there are boosters for pre-teens, teens and adults that contain protection against tetanus, diphtheria and pertussis (Tdap). Pre-teens going to the doctor for their regular check-up at age 11 or 12 years should get a dose of Tdap. Teens who did not get this vaccine at the 11- or 12-year-old check-up should get vaccinated at their next visit. Adults who did not get Tdap as a pre-teen or teen should get one dose of Tdap. Pregnant women who have not been previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. Adults 65 years and older (grandparents, child care providers, and healthcare providers) who have close contact with infants should get a dose of Tdap, following the newest vaccine recommendations. Getting vaccinated with Tdap is especially important for families with and caregivers of new infants.

The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster—that Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it is a good idea for adults to talk to a healthcare provider about what is best for their specific situation.

Treatment

Pertussis is generally treated with antibiotics and early treatment is very important. Treatment may make your infection less severe if it is started early, before coughing fits begin. Treatment can also help prevent spreading the disease to close contacts (people who have spent a lot of time around the infected person) and is necessary for stopping the spread of pertussis. Treatment after three weeks of illness is unlikely to help because the bacteria are gone from your body, even though you usually will still have symptoms. This is because the bacteria have already done damage to your body.

There are several antibiotics available to treat pertussis. If you or your child is diagnosed with pertussis, your doctor will explain how to treat the infection. Learn more about the antimicrobial treatment recommended by CDC for treatment of pertussis. (208 KB, 20 pages)

Foods to Avoid When You're Pregnant

Pregnant? Think twice about these foods to avoid health risks for you and your baby.

Reviewed by Kathleen M. Zelman, MPH, RD, LD
When you’re expecting, what you eat and drink influences your child’s health, possibly forever. Everyday foods and beverages take on new meaning, as some may present a danger to your developing baby.

Whole and lightly processed foods, such as whole grains, lean meats, fruits and vegetables, legumes, and low-fat dairy should form the basis of your pregnancy diet. Here are items that you may want to avoid while you're pregnant.

Raw or Undercooked Food of Animal Origin

Undercooked animal foods -- such as rare meat, raw oysters, clams, sushi, unpasteurized eggs, raw cookie or cake dough, and homemade eggnog), may contain an array of bacteria, viruses, and parasites. To reduce your risk of foodborne illness, test the doneness of meat, poultry, and fish with a food thermometer, cook eggs until they are no longer runny, and follow baking instructions -- don't eat raw dough.

Hot Dogs, Luncheon Meats, and Unpasteurized Dairy Foods

These foods are prone to Listeria monocytogenes, a bacteria that causes listeriosis, which may result in miscarriage, stillbirth, or other serious health problems.

Besides hot dogs and luncheon meats --- which include deli ham or turkey, bologna, and salami -- other processed meats and seafood that may contain listeria include refrigerated pates or meat spreads, and refrigerated smoked seafood (such as salmon, trout, whitefish, cod, tuna, or mackerel). These items may be labeled as "nova-style," "lox," "kippered," "smoked," or "jerky."

Refrigerated smoked seafood is safe when it's part of a cooked dish, like casseroles. Luncheon meats and frankfurters are OK to eat if you reheat them until they are steaming hot, says Michael Lu, MD, UCLA professor of obstetrics, gynecology, and public health and author of Get Ready to Get Pregnant: Your Complete Pre-Pregnancy Guide to Making a Smart and Healthy Baby.

"Pregnant women should avoid getting the fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash their hands after handling hot dogs, and deli luncheon meats," to further decrease potential contact with listeria, Lu says.

Unpasteurized dairy foods are also prone to listeria.

Avoid raw milk and dairy products made from unpasteurized milk, such as Brie, feta, Camembert, Roquefort, blue-veined, queso blanco, queso fresco, and queso Panela.

Certain Seafood and Fish

Large fish -- such as swordfish, shark, tilefish, and king mackerel -- harbor higher concentrations of mercury, compared to other fish. Mercury is a byproduct of coal-burning plants that interferes with the normal development of a growing child's brain and nervous system.

According to the FDA, pregnant and nursing women may eat up to 12 ounces weekly of seafood low in mercury, including salmon (farmed and wild), shrimp, canned light tuna, pollock, sardines, tilapia, and catfish. Because albacore (white) tuna has more mercury than canned light tuna, the FDA recommends that pregnant women limit albacore tuna to no more than 6 ounces a week, and include it in the 12-ounce limit.

Fish caught for sport in rivers, lakes, ponds, and streams may also contain industrial pollutants that play havoc with a developing nervous system. Recreational anglers should check the safety of waterways with their local health departments.

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Raw Vegetable Sprouts

The FDA advises everyone, regardless of pregnancy, not to eat raw sprouts -- including alfalfa, clover, radish, and mung bean sprouts.

The reason: Bacteria can get into sprout seeds and are "nearly impossible" to wash out, states the FDA's web site. The FDA recommends that pregnant women request that raw sprouts not be added to your food.

It's OK to eat thoroughly cooked sprouts, according to the FDA.



Drinks to Limit or Avoid

Alcohol (beer, wine, or spirits) robs developing cells of oxygen and nutrients, preventing normal fetal development. The effects of alcohol exposure in the womb on intellectual abilities and physical growth are permanent.

According to the CDC and the March of Dimes, there is no level of alcohol consumption that's known to be safe at any time during pregnancy.

Unpasteurized juices, such as cider purchased from roadside stands, at farms, or in stores. These products are prone to germs, including E. coli. Check the label to be sure juice is pasteurized.

Lead is linked to low birth weight, preterm delivery, and developmental delays in children. If you have an older home with pipes made of lead, it can leach into your tap water, and home filtration systems may not prevent it from reaching you.

If you’re in doubt about your tap water, have it tested.

Bottled water isn't necessarily purer; it's often repurposed municipal water.

Caffeine from coffee, tea, soft drinks, energy beverages, and other sources may increase the risk of miscarriage, reduced birth weight, and stillbirth, but the research is conflicting. The March of Dimes recommends limiting caffeine consumption to 200 milligrams a day. That's about the amount found in 12 ounces of coffee.

Bisphenol A (BPA)

BPA is an industrial chemical used to make many hard plastics and the liners of many canned foods. It's an endocrine disruptor that could disturb normal fetal development, Lu says.

The FDA is studying BPA and has not recommended that pregnant women avoid BPA. But in January 2010, the FDA stated that "recent studies provide reason for some concern about the potential effects of BPA on the brain, behavior, and prostate gland of fetuses, infants, and children." Most of those tests have been done on animals, and the FDA says there are "substantial uncertainties" about BPA's effects on human health. The plastics industry has maintained that low levels of BPA exposure are safe.

If you choose to avoid BPA while pregnant, a wide range of BPA-free plastics and glass containers are available.

Herbal Teas and Supplements

Herbal teas are caffeine-free, but their safety is unclear when you’re expecting. There are no reliable human studies on the safety of herbal preparations, including supplements such as Echinacea and St. John’s wort, during pregnancy.The FDA does not routinely monitor the quality of dietary supplements.

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Herbal Teas and Supplements continued...

"While it’s probably safe to drink the herbal teas found on supermarket shelves, pregnant women should avoid large quantities of herbal tea, and completely avoid herbal supplements," Lu says.

Duffy MacKay, ND, is the vice president of the Council for Responsible Nutrition, a trade group for the supplements industry. In an email to WebMD, MacKay states that "there are herbs and other supplements that can be used safely to support a healthy pregnancy” but tell your doctor or midwife about any supplement use during pregnancy.

MacKay says there is "scientific consensus" that these common herbs and supplements should be avoided during pregnancy:

Herbs that contain stimulants or caffeine-containing supplements, especially those that are intended to promote weight loss, guarana, kola nut, betel (Piper betle), Citrum aurantium, yohimbe, theobromine (cocoa extract), Garcinai cambogia.
Other botanicals to avoid while pregnant include golden seal, Cascara sagrada, black walnut, wormwood, tansy, pennyroyal, senna, saw palmetto, pao d'arco, MacKay says.
MacKay also advises women who are pregnant, or who could become pregnant, not to take 10,000 or more IU per day of vitamin A because of the risk of birth defects. And MacKay says that "many newer and specialty nutrients have not been proven safe for use during pregnancy and should be avoided."

The bottom line: Talk to your obstetrician about any herbal supplements or vitamins before taking them during pregnancy.

Foods That May Cause Food Allergy

If you, your child’s father, or one of your other children has allergies, your baby is more likely to have food allergies.

The American Academy of Pediatrics says that avoiding certain food allergens, such as peanuts and peanut products, during pregnancy and when nursing a child may reduce allergy in susceptible children.

But there’s little, if any, benefit to avoiding allergens during pregnancy and breastfeeding for everyone else.

Before changing your diet, talk to your doctor about your family history of allergies and asthma, and speak with a registered dietitian who is knowledgeable about food allergies.

Excess Calories

You’re eating for two now, but you don’t need twice the calories. Gaining too much weight threatens your health, and may increase the risk of childhood overweight in your future child.

In the second trimester, add 340 calories a day to your pre-pregnancy calorie needs, and 450 a day more in the third trimester. But if you’re very overweight at conception, or if your physical activity level drops, you may need fewer calories during pregnancy. Still, pregnancy is not a time to try to lose weight. Ask your doctor or dietitian what calorie level is right for you.

There is room for treats like ice cream, chips, and cookies during pregnancy, but it’s important to choose foods that do double duty by providing the additional calories you need, as well as the extra nutrients that maximize your baby’s development.

Stretch Marks from WebMD

Stretch Marks Getting Under Your Skin?

Smoother Skin Doesn't Have to Be a Stretch, Doctors Say, Because Treatment Options Abound

By Annabelle Robertson
WebMD Feature
Reviewed by Louise Chang, MD
When Adrienne Nugent of San Antonio gave birth to her third child, she was dismayed to see that the stretch marks from her earlier pregnancies -- which she had diligently tried to minimize with topical creams and ointments -- had multiplied.

She'd heard that stretch marks were hard to avoid, but Nugent wasn't particularly concerned. She was looking forward to abdominoplasty surgery.

"I still have some stretch marks, but they're very, very low on my belly," says the 38-year-old. "Most got cut out with my tummy tuck."

Not everyone is willing to go to such lengths to get rid of stretch marks, however. So it's important to understand first what causes stretch marks, and what steps, if any, you can take to prevent them.

What Causes Stretch Marks?

Known by doctors as "striae" (usually "striae distensae" or, in the case of pregnancy, "striae gravidarum") stretch marks typically appear after rapid weight gain or loss. They are most common during pregnancy and the teen years, when growth spurts and increased levels of steroid hormones cause significant changes throughout the body. Stretch marks can also be brought on by obesity and weight lifting.

Genetic factors -- including inherited defects of connective tissues -- also play a role, Mohamed L. Elsaie, MD, MBA, says in the August 2008 issue of Esthetic Dermatology News. But the basic cause of stretch marks is unknown.

"Basically, if your mother had them, you're probably going to have them," says Leslie Baumann, MD, director of the University of Miami Cosmetic Group and author of The Skin Type Solution.

Stretch marks affect as many as 90% of all women, she says, and they are not easy to get rid of. Once they have passed the initial stage, when they are red or purple, to the later stages, where they become white or silver -- often with deep indentations -- they are much more challenging to treat.

Prevention, therefore, is key.

"Avoiding rapid weight gain or loss is a good start. For those who are pregnant or experiencing the hormone changes of the teen years, it is crucial to moisturize," Baumann says. "Skin becomes more pliant, more plasticized and better able to stretch when it's well hydrated."

She recommends moisturizing three or four times a day with products that contain cocoa butter or shea butter as a prime ingredient. Massage the moisturizer deep into breasts, belly, hips, and buttocks.

How to Get Rid of Stretch Marks

The appearance of stretch marks depends on the color of your skin; they can start out pink, reddish brown, brown, or dark brown, and fade over time to a more silvery color. Once stretch marks have appeared, it's essential to treat them as early as possible. Research has focused exclusively on the early stages of stretch marks, when they are still red or purple and most readily respond to treatment, Baumann explains.

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How to Get Rid of Stretch Marks continued...

Grocery stores, pharmacies, and web sites boast a multitude of products and cosmetics that claim to "repair" striae. However, only a few work, she says.

Here's a rundown of the products available for stretch mark removal and what they can -- and cannot -- do:

Wheat germ oil: There is not much scientific data on whether home remedies for stretch marks, such as wheat germ oil, can help. One recent study did find it helped improve stretch marks in their early phase.

Glycolic acid: Widely touted for its rejuvenation powers, glycolic acid is a sugar cane derivative and a member of the alpha hydroxy acid (AHA) family. It most likely works on stretch marks by increasing collagen production, says Baumann. Glycolic acid can also be administered in higher doses by a dermatologist. Treatment typically costs around $100 and requires three or four office visits before results will appear.

Vitamin C: Certain formulations of vitamin C, which have become increasingly popular as over-the-counter brands, may also increase collagen production and help early-stage stretch marks, says Baumann. For maximum effect, combine with glycolic acid. Vitamin C supplements may also be effective. She suggests 500 milligrams three times a day.

Peptide-containing products: Peptide-containing products, which are widely marketed as effective "repair" creams, are a waste of time and money, Baumann says. Despite commercial claims, there is no convincing data that these work.

Retinoids: A family of products that includes vitamin A, retinoids have been shown to be fairly effective in increasing collagen and elastic production during the early stages. Retinoids should be avoided entirely if pregnant or nursing. Retinol, tretinoin, and the prescription medications Retin-A, Renova, Tazorac, and Differin are examples of retinoids.

Glycolic acid and retinoids: Using these together may provide better results. According to Elsaie, while glycolic acid alone for stretch mark treatment has not been fully studied, a trial comparing glycolic acid plus tretinoin with glycolic acid plus vitamin C both showed equal improvement and increased elastic in stretch marks after 12 weeks of daily application. Various prescription-strength retinoids are often applied as a preparation to "rev up" the skin before a glycolic acid peel is applied.

Laser treatment: This popular treatment option is used by many dermatologists, and they are also being tried on white stretch marks, as well.

Linda K. Franks, MD, a clinical assistant professor at New York University School of Medicine and director of Gramercy Park Dermatology Associates, is a big fan of laser procedures, which she frequently uses in her New York City practice to treat both red/purple and white stretch marks.

"Lasers promote synthesis of healthy, new collagen, which has been damaged when stretch marks appear," she explains.

For red and purple marks, Franks uses a vascular laser which targets swollen and inflamed blood vessels and helps with skin cell production and increased collagen production. Treatments usually require three to six sessions at an average rate of $450 per session.

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How to Get Rid of Stretch Marks continued...

"Vascular lasers won't take away the superficial skin but will take away the redness," she says. "The redness is caused by blood flow. V-Beam treats those blood vessels.

One laser that may help minimize older, more entrenched stretch marks is the fractionated laser, which hits tiny "fractions" of the skin, often in a grid-like pattern. Franks describes the process as "smudging" the lines of stretch marks, which makes them less distinct.

Like most Floridians, Franshely Calero, 25, loves to go to the beach near her home in Miami. But after giving birth to her son one year ago, she was plagued with stretch marks and became too embarrassed to take off her shirt.

Pink at first, the stretch marks turned white after three or four months and deepened significantly. So Calero decided to try a fractionated laser that has been approved by the FDA for use with age spots, acne scars, and "mask of pregnancy" also known as melasma. She received three laser treatments.

"They're still there but they're a lot less noticeable. I mean, a lot," she says. "I had big, deep wide ones on my stomach. You could run your finger over them and it was like falling into a pit. They were super wrinkly and saggy. Now, the skin is more even and smooth. It doesn't look like my body has been taken over by stretch marks."

Expect to pay up to $1,000 per session for these treatments, and be prepared to pay for at least three sessions.

Even in the best cases, however, Franks warns not to expect perfection. She estimates that patients will see about 30% improvement but is quick to add that almost everyone who does the treatments is usually quite pleased.

"People are resigned to the fact that stretch marks are permanent and can't be fixed, but there are ways to treat them," Franks says. "There will always be some left, though, whether you're treating the red ones or the white ones."

Preterm Labor

Preterm labor

Preterm birth is any birth that occurs before the 37th week of pregnancy. It is the cause of many infant deaths and lingering infant illnesses in the United States. Every pregnant woman needs to know about preterm labor and birth—why it happens and what she can do to help prevent it.

Preterm birth occurs in about 12 percent of all pregnancies in the United States, often for reasons we just don't understand. A normal pregnancy should last about 40 weeks. That amount of time gives the baby the best chance to be healthy. A pregnancy that ends between 20 weeks and 37 weeks is considered preterm, and all preterm babies are at significant risk for health problems. The earlier the birth, the greater the risk.

You might have read in the newspapers about babies who are born really early and do very well. But it's important for you to know that those babies are the exceptions. Babies who are born very preterm are at a very high risk for brain problems, breathing problems, digestive problems, and death in the first few days of life. Unfortunately, they also are at risk for problems later in their lives in the form of delayed development and learning problems in school. The effects of premature birth can be devastating throughout the child's life. The earlier in pregnancy a baby is born, the more health problems it is likely to have.

Why Does preterm labor occur?
There are no easy answers. Stress might play a part for some women, personal health history or infection for others, or smoking or drug use for others. With funding from the March of Dimes and others, researchers are studying how various factors contribute to the complex problem of premature labor and birth.

Who is at risk for preterm labor?
Preterm labor and delivery can happen to any pregnant woman. But they happen more often to some women than to others. Researchers continue to study preterm labor and birth. They have identified some risk factors, but still cannot generally predict which women will give birth too early. Having a risk factor does not mean a woman will have preterm labor or preterm birth. It just means that she is at greater risk than other women.

Three groups of women are at greatest risk of preterm labor and birth:

Women who have had a previous preterm birth
Women who are pregnant with twins, triplets or more
Women with certain uterine or cervical abnormalities
If you have any of these three risk factors, it's especially important for you to know the signs and symptoms of preterm labor and what to do if they occur.

Lifestyle and environmental risks
Some studies have found that certain lifestyle and environmental factors may put a woman at greater risk of preterm labor. These factors include:

Late or no prenatal care
Smoking
Drinking alcohol
Using illegal drugs
Exposure to the medication DES
Domestic violence, including physical, sexual or emotional abuse
Lack of social support
Stress
Long working hours with long periods of standing
Exposure to certain environmental pollutants
Medical risks
Certain medical conditions during pregnancy may increase the likelihood that a woman will have preterm labor. These conditions include:

Urinary tract infections, vaginal infections, sexually transmitted infections and possibly other infections
Diabetes
High blood pressure and preeclampsia
Clotting disorders (thrombophilia)
Bleeding from the vagina
Certain birth defects in the baby
Being pregnant with a single fetus that is the result of in vitro fertilization (IVF)
Being underweight before pregnancy
Obesity
Short time period between pregnancies (less than 6-9 months between birth and the beginning of the next pregnancy)
Groups at increased risk
Researchers have also identified certain groups that are at increased risk of having a premature baby. These groups include:

African-American women
Women younger than 17 and older than 35
Women who have a low income
Preventing preterm labor and birth
You can help prevent preterm birth by learning the symptoms of preterm labor and following some simple instructions. The first thing to do is to get medical care both before and during pregnancy. If you do have preterm labor, get medical help quickly. This will improve the chances that you and your baby will do well.

Medications sometimes slow or stop labor if they are given early enough. Drugs called corticosteroids, if given 24 hours before birth, can help the baby's lungs and brain mature. This can prevent some of the worst health problems a preterm baby has. Only if a woman receives medical care quickly can drugs be helpful. Knowing what to look for is essential.

Treatment with a form of the hormone progesterone may help prevent premature birth in some women who have already had a premature baby.

Symptoms of preterm labor
Remember, preterm labor is any labor that occurs between 20 weeks and 37 weeks of pregnancy. Here are the symptoms:

Contractions (your abdomen tightens like a fist) every 10 minutes or more often
Change in vaginal discharge (leaking fluid or bleeding from your vagina)
Pelvic pressure—the feeling that your baby is pushing down
Low, dull backache
Cramps that feel like your period
Abdominal cramps with or without diarrhea
If you start to have any of these symptoms between 20 weeks and 37 weeks of pregnancy, follow the instructions in the section below "What to do if you have symptoms of preterm labor."

Don't let anyone tell you that these symptoms are "normal discomforts of pregnancy"! If any of them (you don't need to have all of them) happen before your 37th week of pregnancy, you need to do something about it.

What to do if you have symptoms of preterm labor?
Call your health care provider or go to the hospital right away if you think you are having preterm labor. Your provider may tell you to:

Come to the office or go to the hospital for evaluation.
Stop what you are doing and rest on your left side for one hour.
Drink 2–3 glasses of water or juice (not coffee or soda).
If the symptoms get worse, or don't go away after one hour, call your health care provider again or go to the hospital. If the symptoms go away, take it easy for the rest of the day. If the symptoms stop but come back, call your health care provider again or go to the hospital.

When you call your provider, be sure to tell the person on the phone that you are concerned about the possibility of preterm labor. The only way your provider can know if preterm labor is starting is by doing an internal examination of your cervix (the bottom of your uterus). If your cervix is opening up (dilating), preterm labor could be beginning.

You and your health care provider are a team, working together to have a healthy pregnancy and healthy baby. Your team works best when both of you participate fully, so your knowledge about preterm labor can be essential in helping to prevent a preterm birth. Talk to your health care provider about all of this, and be sure to keep all of your prenatal care appointments. Preterm birth is one of the complications of pregnancy that health care providers are working hard to eliminate. Your participation in this effort is just as important as theirs!

April 2008/April 2010

VBAC: Vaginal Birth after Cesarean

If you have undergone a cesarean delivery, you are not alone. In November 2005, the Centers for Disease Control and Prevention reported the national cesarean birth rate was the highest ever at 29.1%, which is over a quarter of all deliveries.

If you desire to try a vaginal delivery this time around, you’ll be happy to know that 90% of women who have undergone cesarean deliveries are candidates for VBAC. Quite interestingly, the highest rate of VBAC is in women who have experienced both vaginal and cesarean births and given the choice, decide to deliver vaginally.

In most published studies, 60-80% or 3 to 4 out of 5 women who have previously undergone cesarean birth can successfully give birth vaginally. After reading the information below and discussing it with your health care provider, you will be able to make an informed decision on whether VBAC may be an option for you this time around.

The greatest concern for women who have had a previous cesarean is the risk of a uterine rupture during a vaginal birth. According to the American College of Obstetricians and Gynecologists (ACOG), if you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5%, which is approximately 1 in 5001.

Some studies have documented increased rates of uterine rupture in women who undergo labor induction or augmentation. You will want to discuss the possible complications of induction with your health care provider. Recently, ACOG stated that VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk.2

If you were given the following reasons for a previous cesarean and are considering a repeat cesarean, you may wish to discuss the following with your health care provider:

Dystocia: Dystocia refers to a long and difficult labor due to slow cervical dilation, a small pelvis, or a big baby. Many women who are given this reason for previous cesareans, deliver vaginally the next time, and give birth to a bigger baby than the first! ACOG states that the effects [or difficulties] of labor with a baby more than 8 ¾ lbs have not been substantiated.

There is not evidence that a big baby necessitates a cesarean. The pelvis and the baby's head are not rigid structures and both mold and change shape to allow for birth. During labor there are certain positions that a woman can use to help open up the pelvis, allowing a larger baby to move through. For example, squatting opens the outlet of the pelvis by 10%.

Genital Herpes: For many years, women with a history of herpes almost always delivered by cesarean, due to the risk of passing herpes to the baby during delivery. Physicians would do cultures in the last weeks of pregnancy and if the virus were active, a cesarean would be scheduled. Now ACOG has determined and recommended that unless there is a visible lesion at the time of birth, a vaginal birth is acceptable.

Fetal Distress: When it comes to the life of the baby, there is no question in a mother’s mind of what to do. If the baby is in distress, cesarean deliveries can be life saving. According to the Centers for Disease Control and Prevention, 9% of cesarean deliveries in 1991 were due to fetal distress. Fetal heart rate monitoring can be a routine part of the VBAC procedure, which helps detect fetal distress.

Your purchase supports the APA

What is the criterion I must meet to be considered for VBAC?

No more than 2 low transverse cesarean deliveries.
No additional uterine scars, anomalies or previous ruptures.
Your health care provider should be prepared to monitor labor and perform or refer for a cesarean if necessary .
Your birth location should have personnel available on weekends and evenings in case a cesarean is necessary.
What other criteria would make me a good candidate for a VBAC?

If the original reason for a cesarean delivery is not repeated with this pregnancy
You have no major medical problems
The baby is a normal size
The baby is head-down

In what situations would VBAC not be recommended?

If you are pregnant with twins
If you have diabetes
If you have high-blood pressure
Comparing a Repeat Cesarean to a VBAC:



1. ACOG Practice Bulletin, No. 5, July 1999

2. ACOG, Midwifery Today, Winter No 36, page 47.

3. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.

International Cesarean Awareness Network, http://www.ican-online.org/

Last Updated:12/2006