Roger Harms, M.D., Mayo Clinic specialist in obstetrics-gynecology

Well first of all one of the best segments of advice to be given to a patient approaching labor and delivery is to be flexible. You never know quite what cards are going to be dealt to you until labor begins. In approaching the VBAC question (vaginal birth after C-section), if you have an elective Caesarean section, you never see what cards were in the deck. You've pre-empted the decision about whether you're going to have a successful vaginal delivery and that might be just fine. But if you're electing a VBAC, always remember that the circumstances that we're discussing today prospectively looking toward your labor could be very different on the day you go into labor and you see what cards are in your hand. And they may not look so good, and we might decide against a vaginal birth after Caesarean section very shortly into the next labor. So, being flexible is really something that is thrust upon you when you're having babies. It isn't really elective. It's going to happen, you've got to be flexible. If not prior to birth, then after the birth there's no question that you're going to have to be flexible. So in approaching the question of vaginal birth:

No. 1 — I think the variables include what is the value of vaginal delivery to you personally? That needs to be weighed in.

No. 2 — How many children do you plan to have? If you would really like to have a family of six or seven children, you have great measures of advantage to be gained by a successful vaginal delivery and this is your second pregnancy. If, however, this would be the last delivery under any circumstance, you want only two children or only two pregnancies and you're certain of that, then the advantages of seeking a vaginal delivery is dramatically diminished because the difference in morbidity, the difference in risk, between a second C-section and a first vaginal delivery is not that great.

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