The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Vaginal Cesarean

Are you referring to "Laparoelytrotomy" which is an abdominal wall incision followed by mobilisation of the bladder and then an incision into the vagina ???

If so this is seldom extraperitoneal and can only be done if the cervix is completely dilated. When done it is usually by accident and many times never even recognized by the surgeon. This is usually a patient who gets to complete dilatation and then pushes for 3-4 hours without descent. In this situation the cervix retracts upwards and the vagina is where the lower uterine cervix "ought to be". The main thing about recognizing it is that it is not a contraindication to trial of labor the next time since no uterine incision was made.

There was just an article in the Clinical Opinion section of Obstetrics and Gynecology by Dr. Robert Goodlin describing this procedure and suggesting it as a possible answer to preventing the occurrence of a uterine scar so that subsequent VBAC will be safer. I think it was within the past 3 months. I must say I was rather flabbergasted at the idea. I'd be interested in hearing other comments.

I was amazed it got past the editors/referees !

It was a small series, some cases entered ( on intention to treat basis ) didn't get the procedure. His conclusion was no-one should be doing this except in a prospective study - yet he admits doing it with no such basis over several years.

We discussed it in our journal club - couldn't understand why all/most of the eligible women didn't have vaginal births - using forceps or Ventouse !!!