Repeat C-section often a safer choice
Serious risks low regardless of delivery method
Women who have had a caesarean section can lower the risk of death and serious complications for their next baby and themselves if they deliver the same way again, an international study concludes.
The study compared more than 2,300 women and babies in Australia. About half chose vaginal birth after a C-section to deliver their second child and the rest had another C-section.
The risk of death or serious complication for the baby was low for both ways of giving birth: 2.4 per cent for a planned vaginal birth compared with 0.9 per cent for a planned elective C-section.
Women in the caesarean group also suffered less serious blood loss — nine women, or 0.8 per cent of the group, compared with 29 (2.3 per cent) in the other group.
The researchers estimated that one baby death or near death would be prevented for every 66 planned repeat caesarean sections.
"Among women with one prior caesarean, planned elective repeat caesarean compared with planned vaginal birth after caesarean was associated with a lower risk of fetal and infant death or serious infant outcome," Christine Crowther of the University of Adelaide and her co-authors concluded.
The number of women opting for the operation has increased in recent years worldwide. About one in four children are now born by C-section, the Society of Obstetricians and Gynecologists of Canada said in 2008.
Prevent 1st C-section
A second study appearing in the same issue of the journal PLoS Medicine, a peer-reviewed online publication published by the non-profit Public Library of Science (PLoS), also found a higher risk of a rare complication among British women who went through labour after a previous C-section compared with having a second surgery.
Among women having a planned vaginal birth, the risk of uterine rupture was 21 per 10,000 pregnancies compared with three per 10,000 births in the other group.
What's needed now is a new way to counsel patients, either with new data or by gaining a better sense of their risk, Catherine Spong of the U.S. National Institute of Child Health and Human Development in Bethesda, Md., said in a journal commentary accompanying the research.
"All this discussion would be moot and neither the patient nor the clinician would have to fret about whether to attempt a trial of labour or choose a repeat caesarean if the first caesarean had been prevented," Spong concluded.
Two unexplained stillbirths among those intending to give birth vaginally were more likely a result of the length of gestation than the mode of delivery, Spong noted.