Mothers should not force a child to go out naturally after cesarean section due to complications

Scientists have warned that mothers who try to give birth naturally after having a cesarean section run a greater risk of serious complications.

Researchers say mothers choose another caesarean section to avoid injury and harm to the baby.

University of Oxford scholars followed more than 74,000 births of mothers who had previously had a cesarean section.

The results showed that people who planned a vaginal birth for their next child were more likely to need a blood transfusion or to be stricken with sepsis.

They were seven times more likely to have uterine rupture, which could lead to stillbirth or the need to resuscitate the baby.

Gynecologists have now reassured mothers who delivered with cesarean section that it is safe for pregnant women.

British clinical guidelines indicate that women who have a caesarean should be informed of the advantages and disadvantages of their next birth choice.

But they do not have a lot of evidence, which has prompted researchers to explore the risk of complications.

Experts examined more than 74,000 births in Scotland between 2002 and 2015 of mothers who had had at least one caesarean section.

A total of 45,579 babies were born by planned caesarean section and 28,464 by vaginal birth attempt.

According to the findings published in the journal PLOS Medicine, about 1.8% of women who attempted to give birth normally had serious complications.

The rate was more than double the 0.8% recorded by those who opted for a caesarean section.

The probabilities of uterine rupture were seven times higher at 0.24% versus 0.04%.

The tear of the uterus can cause serious bleeding to the mother and possibly even push the baby into a slit of the abdomen where it might suffocate.

The chances of women needing a blood transfusion or sepsis were twice as high in the group having attempted a vaginal birth.

Although the possibility of suffering an injury requiring surgery, such as damage to the bladder, bowels or ureter, was three times higher in the group of vaginal births.

Eight percent of women who attempted a normal birth and 6.4 percent who had a cesarean section had complications with their newborns.

These complications, grouped together, included stillbirth, the baby's admission to the neonatal unit or their resuscitation.

Of the women who had a planned vaginal delivery, 71.6% were successful. The rest needed an emergency cesarean section.

They were significantly more likely than those delivering by planned cesarean section to experience all serious complications.

The experts, led by Kathryn Fitzpatrick, PhD student, said the overall risk of complications was low, regardless of the type of delivery.

The team said that mothers should not be afraid to choose a vaginal delivery if they wish and are able to accept the risks.

Andrew Shennan, professor of obstetrics at Kings College London, said: "We know that, overall, vaginal births are by and large the safest, if you can achieve it.

"If an attempt to vaginal delivery is attempted after a previous cesarean section, the risk of uterine rupture and bleeding is very low, which can be safely managed at the hospital."

The increased risk of uterine rupture in women who attempt a vaginal birth may be caused by the scar of a previous caesarean section torn under the pressure of labor contractions. This can lead physicians to decide to perform an emergency cesarean section.

An earlier profession of cesarean section has always been recognized by the medical profession as one of the potential risk factors for uterine rupture, says the NHS.

The Royal College of Obstetricians and Gynecologists has stated that uterine rupture affects every woman in 200 who are planning vaginal deliveries after a cesarean section.

Dr. Pat O'Brien, an obstetric consultant and spokesperson for RCOG, said the research provided more useful data to help guide women's choices.

He said: "A detailed conversation with a woman and her experienced obstetrician should take place so that she can make an informed choice about the safest way to plan her delivery and be assisted by a team of specialists.

"Women can be assured that, in most cases, it is possible and safe to have a vaginal delivery or planned new caesarean section after a previous cesarean birth.

Elizabeth Duff, Senior Advisor at the National Childbirth Trust, said, "This latest study confirmed that the risks associated with vaginal birth after a cesarean section and a scheduled repeat caesarean section are low.

"Most women can have a safe vaginal delivery after a previous, uncomplicated caesarean section.

"But the results will vary and will depend on their obstetrical history, including why they had a caesarean section initially."

Figures show that about one in four pregnant women in the UK now deliver by cesarean section.

In Great Britain, only 19.7% of babies were born by caesarean section in 2000. On the other hand, this figure was 26.2% in 2015.

Experts speculate that women opt for cesarean section even if they have no medical reasons, fear of labor pains and believe that a caesarean section is safer.

Caesareans can be life-saving interventions for the mother and her child in case of complications, such as bleeding.

Ms. Fitzpatrick said, "Our findings can be used to counsel and care for women who have had previous Caesarean sections and should be considered in conjunction with existing evidence."