Childbirth And Labor

Contraindications for Normal Vaginal Delivery



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In modern obstetric practice many experts are of the opinion that the numbers of caesarian sections performed are excessive and do not align with guidelines issues by professional bodies. It is understood that, many caesarian sections are done for maternal requests and inevitably the incidence of c-section related complications have also risen. This has made health authorities to take measures in alleviating the fears of normal vaginal delivery and assure the superiority of normal vaginal delivery against caesarian sections in many aspects related to health.

What is normal vaginal delivery?

This is the delivery of the baby through the vaginal route without the need of any assisted techniques such as forceps, vacuum or other delivery modes. With modern day obstetric practices, it is apparent that certain medical interventions will be performed during the labor process and such interventions are done to augment the safety and comfort of the baby as well as the mother and therefore is considered as part of normal vaginal delivery in the present context.

What are the contraindications for such delivery?

In obstetric practice, there are only few indications which are considered to be absolute contraindications for spontaneous normal vaginal delivery and the following is a brief description of the same as illustrated in the article ‘Spontaneous vaginal delivery’ published on journal of American Family Physician.

-Complete placenta previa

Placenta previa is the condition in which the placenta lies at a lower plane than it should be inside the uterus and it becomes dangerous when it overlies the outlet or the cervical opening of the uterus. In such instances, if normal vaginal delivery is attempted, the descending fetus may cause placental detachment and severe hemorrhage which can be detrimental to both the fetus as well as to the mother.

-Herpes simplex infection with active genital lesions or prodromal symptoms.

Due to the possibility of developing neonatal herpes simplex virus infection, delivering the baby through the vaginal mode is not recommended in instances where active genital lesions are present and when the prodromal symptoms are in existence.

-Previous classic uterine incision or extensive transfundal uterine surgery

In classic uterine incision, which is a vertical incision as against the usual transverse incision, the strength of the uterine musculature will greatly be depleted and the risk of rupture if normal uterine contractions take place would be relatively high. Thus, such a uterus is a contraindication for normal vaginal delivery.

-Untreated immune deficiency virus infection

When the mother poses HIV and is untreated, there is a high risk of acquiring the same by the baby if delivered through the normal vaginal mode and therefore in such instances vaginal delivery is not indicated.

Apart from these, there are several relative contraindications for delivering normally and such conditions should be determined by the clinicians based on the risk benefit assessment of available options.

Reference:

Spontaneous Vaginal Delivery, Am Fam Physician. 2008 Aug 1;78(3):336-341 <http://www.aafp.org/afp/2008/0801/p336.html>

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