Q:
I have a 3-year-old son who was born by c-section because he was breech. Since his birth, I have had three miscarriages and been diagnosed with an incompetent cervix. I am now 35 weeks pregnant and had a cerclage put in at 12 weeks. My husband and I are trying to decide whether or not to try VBAC (vaginal birth after cesarean). Will a vaginal delivery make it more difficult for me to carry future pregnancies to the 12-week mark when I would have a cerclage put in? Will a cesarean increase my chances of carrying another child to that 12-week mark?
A:
Dear Bonnie,
You are asking very interesting questions. In order to answer them so others will benefit as well, I'd like to digress for a moment. Some women develop a weakness in their cervix. It cannot stay closed long throughout a pregnancy. In these situations, the pregnancy doesn't last long enough to have a healthy child. Most times, the incompetent cervix was triggered by surgery on the cervix (cone biopsy, LEEP (loop electrosurgical excision procedure), or many dilations of the cervix with miscarriages). Cerclage—placing a stitch around the cervix to tighten it—has proven to be a very successful treatment. Obviously, it is working well for you.
You should be able to have a vaginal delivery. I have delivered numerous women vaginally after removing their cerclage who have gone on to have other healthy pregnancies. Speak with your doctor about having a vaginal delivery. It sounds like he or she has done a great job to get you this far—as have you! Congratulations and good luck.
Craig L. Bissinger M.D.
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