Women who have been through pregnancy already (known as multigravida in clinical lingo) have some definite physical benefits when it comes to carrying and delivering their baby. On average labor is typically shorter, and such women are statistically less likely to have vaginal tearing and need an episiotomy.

In addition, you'll probably feel your little one stirring earlier than your first, primarily because you can identify the sensation this time. Depending on the tone of your abdominal muscles, which may be laxer after your first pregnancy, you might also start to show earlier.

Every Pregnancy Is Different…Or the Same

In pregnancy, practice doesn't always make perfect. Just when you think you have it down, Mother Nature can throw you a curve ball. You might have been horribly nauseous throughout your first pregnancy but not even have a gas bubble this time around. Or your second pregnancy could be filled with all sorts of strange new symptoms. Each baby has her own genetic blueprint, her own site of implantation, and her own unique placenta. The environment and life circumstances each child is born into can be vastly different as well. It's also possible that your second pregnancy is a carbon copy of your first. For all of your pregnancies share the same maternal infrastructure, which can account for similarities in labor, delivery, and pregnancy complications. So is this pregnancy the same or different? You just have to wait and see.

VBAC or Another C-section?

“Once cesarean, always cesarean” is an out-of-date obstetrical concept. Although many factors are involved in the decision to repeat a C-section (for example, a high-risk pregnancy, the fetal position, type of incision made in the first C-section, scarring of the uterus, number of previous C-sections), many women can and do try vaginal birth after cesarean (commonly known as VBAC). According to the ACOG, the success rate of attempted VBAC is between 60 and 80 percent.

In the days when a classical (or vertical) incision of the uterine wall was the obstetrical norm, VBACs were often discouraged because of the risk of uterine rupture. Rupture might occur when a weakened scar from a first C-section burst open under the pressure of strong contractions of the muscles of the uterus. Today the standard of care for a cesarean is a low, horizontal midline incision across the part of the uterus where the uterine wall is thinnest.

According to the National Center for Health Statistics, in 2004 the rate of vaginal birth after a previous cesarean was at an all-time low of 9.2 percent of total births. The VBAC rate has dropped 67 percent between 1996 and 2004. Part of this is attributable to the overall rise in cesarean births in general — some 1.2 million in 2004.

Clinical studies have shown that labor inducting agents like prostaglandins can increase the chance of uterine rupture in VBAC. For this reason, the ACOG recommends avoiding their routine use in labor induction of VBAC, especially when followed by oxytocin. Misoprostol, another prostaglandin induction agent, should not be used at all in VBAC. (For more on labor induction, see Chapter 18.)

In women who are considered appropriate candidates for VBAC, vaginal delivery is often encouraged over C-section because of the potential complications involved with abdominal surgery (for example, infection, hemorrhage). And if you are a third-, fourth-, or more-time mom who has had a previous vaginal delivery in addition to a previous C-section, your risk of complications can actually be lower if you opt for a trial of labor rather than a repeat cesarean. A large-scale study published in 2006 found that among women who have had both a previous vaginal delivery and a previous cesarean, those who chose VBAC rather than repeat cesarean delivery had fewer complications.

The picture changes if you've undergone two previous C-sections, however. An analysis of over 25,000 women who had undergone a prior cesarean delivery found that the likelihood of major complications is higher with a VBAC attempt in women with two prior cesarean deliveries compared with those who have had only a single previous cesarean delivery.

Do keep in mind that another C-section also requires a longer recovery period than in vaginal birth, something to consider when you already have children who must be cared for postpartum in addition to your new baby duties. However, recovery might seem a bit faster than after your first C-section just because you know what to expect.

If you are having a VBAC, your provider may prefer that you deliver in a hospital equipped to handle a C-section if one becomes necessary. And in fact, the ACOG recommends this type of setting. On the other hand, for an uncomplicated pregnancy scheduled to deliver by VBAC, many midwives don't believe such a setting is necessary. Such a decision is highly dependant on your medical history and also on the laws and facility regulations in your area. If you are considered at low-risk, a birthing center or even a home birth may be a reasonable choice for you. Consult your provider for her take on the situation.

VBAC isn't for everyone. At the same time, if you had a difficult labor and delivery that ended in a C-section with your first child and you really want an elective (or planned) C-section this time, discuss this option with your provider. It will benefit you to explore all the pros and cons of either choice so your decision is a fully informed one.