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A scheduled caesarean section may be the safest option for women who have had a previous cesarean in the past, according to a new PLoS Medicine study.
Attempted vaginal delivery was associated with a low but increased risk of complications for the mother and baby compared to repeat caesarean section.
The results come from more than 74,000 births in Scotland.
Experts say that expectant mothers should have the choice between delivery – natural or caesarean – as far as possible.
A recent survey by the BBC's Victoria Derbyshire program suggests that this does not always happen, with many women requesting a caesarean section being refused a caesarean section.
What is a birth by caesarean section?
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Caesareans occur during the delivery of a baby by performing a surgical incision in the abdomen and uterus.
They can be:
- elective or planned – at the request of the mother or for medical reasons, for example if the baby is in a bad position or is very fat
- urgency – usually because of complications during labor
In the UK, more than one in four births had a cesarean section. Half of them are planned or optional and the other half in an emergency situation.
Which is the safest – natural or cesarean?
Birth carries risks, no matter how it is done.
Research in Scotland compared the risks of scheduled or voluntary cesarean delivery with vaginal delivery (in women who had previous Caesarean section) and revealed:
- 45,579 women delivered by planned caesarean section and 28,464 vaginal delivery attempts
- 28.4% of those who attempted to give birth vaginally then had an emergency caesarean section
- attempts at vaginal delivery were associated with an increased risk of severe birth and postpartum maternal problems compared to choosing another caesarean section
- 1.8% of those who attempted a vaginal birth and 0.8% of those who had a planned cesarean section had serious maternal complications, such as uterine rupture, bleeding, or infection.
- Complications in the baby occurred in 8% of pregnancies with attempted vaginal birth and in 6.4% of planned cesarean sections.
According to the Royal College of Obstetricians and Gynecologists, in most cases the choice of one or the other solution is safe for women because the risks associated with it will be low.
Generally, after a caesarean section, about three in four women who give birth give birth naturally vaginally, while one in four women eventually need an emergency cesarean section.
An emergency caesarean section carries more risk than a planned cesarean section, and women should be informed.
Advantages and disadvantages
Recovering from a caesarean section may take longer and there is a risk of infection and bleeding as a result of the operation. Each caesarean section causes more scar tissue, which increases the chances of the placenta developing in the scar in future pregnancies and causes complications.
There are also small risks to the baby born by caesarean section, including temporary breathing difficulties and accidental cutting (about 2 out of 100 babies, but usually recovering without further injury).
A vaginal birth can mean shorter hospitalization, faster recovery and return to everyday activities such as driving, and avoid the risks of an operation.
But this can sometimes lead to a tear in the perineum – the skin between the vagina and anus.
In addition, for women who have had a cesarean:
- a vaginal birth can put a strain on the scar, which can separate or break. This happens to about one in 200 women
- Serious risks to the baby, such as brain damage or stillbirth, are higher during vaginal delivery than at a planned cesarean section
A vaginal birth is not recommended if a woman has had at least three caesareans, for example.
Dr. Pat O. Brien, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynecologists, said the new research provided useful data for informing women and clinicians in discussions and decisions about the plans. # 39; s birth.
He said: "Women can be assured that, in most cases, it is possible and safe to have a vaginal delivery or cesarean section scheduled to repeat after a previous cesarean birth.
"A detailed conversation with a woman and her experienced obstetrician should take place so that she can make an informed choice as to the safest way to deliver and accompany a team of specialists."
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