Repeat C-section may be safer option for moms, babies

By Cari Nierenberg
MyHealthNewsDaily

For women who delivered their first baby by cesarean section, delivering a second baby also by C-section may be somewhat safer for both mother and baby than a vaginal birth, a new study reveals.

Australian researchers found that, among babies born by a planned repeat C-section, 0.9 percent died or had serious complications, compared with 2.4 percent of babies born by a planned vaginal birth after a previous C-section.

And 0.8 percent of mothers who had a repeat C-section experienced severe bleeding, while 2.3 percent of those who gave birth vaginally after a previous C-section did.

"The risks for women and their babies are small," but there were significant differences between the groups, said study author Dr. Caroline Crowther, a professor of obstetrics and gynecology at the Australian Research Centre for Health of Women and Babies in Adelaide.

The study is published today (March 13) in the journal PLoS Medicine.

For a long time, it was believed that women who had a cesarean delivery would need C-sections for all future pregnancies. The most feared complication of delivering vaginally after a C-section is a rupture of the uterus during labor, which can result in a hysterectomy for a mother or neurological complications for a baby. But uterine ruptures are uncommon.

In 2010, the National Institutes of Health (NIH) asked a panel of experts to review the scientific evidence on the matter, because some U.S. hospitals had banned vaginal births after the mother had a cesarean, and many doctors were advising against them.

The NIH panel recommended that a "trial of labor," meaning a planned attempt to give birth vaginally, was a "reasonable option" for many pregnant women who had one prior cesarean.

Months later, the American College of Obstetrics and Gynecology updated its guidelines, expanding the NIH recommendations and suggesting vaginal delivery after Cesarean was "a safe and appropriate option for most women" — including women who have had two C-sections and those carrying twins. 

In the new study, scientists followed 2,323 pregnant women in Australia who gave birth at 14 hospitals over a five-year period. All had given birth once before via C-section, and were at least 37 weeks along in their pregnancies. None were having twins or other multiples.

About 1,225 women planned to have a vaginal delivery, while nearly 1,100 women elected to have a repeat cesarean. When the time came to give birth, 98 percent of the mothers who planned to have a C-section succeeded at delivering that way, while only 43 percent of women hoping for a vaginal delivery after a first cesarean did.

There were no infant deaths among the babies born by a planned C-section; two babies were stillborn among the planned vaginal deliveries.

According to the National Center for Health Statistics, the rate of cesarean deliveries reached an all-time high in 2009, at roughly one in three U.S. births.

Dr. C. Edward Wells, a clinical professor of obstetrics at University of Texas Southwestern Medical Center in Dallas, was part of the NIH panel. He said the new study was "fascinating" because it was one of the first to consider women's planned preferences for birth.

Wells said he was surprised to see a higher risk of infant death and serious complications in the vaginal delivery group. However, he said, it was reassuring that the mothers had a low risk of uterine rupture.

The researchers also conducted, within their study, a small randomized trial, the gold standard in medical research.

The trial had only 22 patients — most women did not want to participate because it meant giving up their choice of delivery method, and being assigned to a group by the scientists. None of the mothers or babies in the trial developed any complications.

Wells noted the trial looked at the very best candidates for vaginal births after having a cesarean.

"I think this study will become an important reference for many of us," Wells said.

Dr. Jeffrey Ecker, a high-risk obstetrician at Massachusetts General Hospital in Boston, agreed this was a large, well-done study.

"The most important message for many women with a single prior C-section is that a trial of labor is a safe and appropriate alternative to a planned repeat C-section delivery in a second pregnancy," Ecker said.

For some women, there may be a small benefit to having a planned repeat C-section, but couples need to view their decisions in terms of their individual circumstances, he said.

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Fact. My sister and many other military wives gave birth to their first child through C section because of complications. Many were convinced to have their second child vaginally. Low and behold the military has a large number of these women who did this and their children came out with brain damage because of complications during the delivery. Once they are in the birth canal it is too late to do a C section. Now who do you think is paying for a lifetime of therapy, education, and support for these kids. Big savings there. And it is not just government who tries to save a buck on birth. A few years ago they tried a mandatory 24 hours and out for normal deliveries until babies and moms started ending up in the hospital or dying. This is why our infant death rate is pretty high compared to other industrialized countries. Its insurance companies and many of those people have their asses where their heads should be.

    Reply#1 - Wed Mar 14, 2012 8:50 PM EDT

    My story: My first PSA blood test was at age 55 and came back at 5.1. I was referred to a urologest who repeated the test with the same results. I agreed to a biopsy and the results were negative. He monitored me every year with a PSA test and the level stayed constant at about 5 to 6 for about 5 years. At age 60, my PSA was measured at 7.5 and I had another biopsy which again was negative. My Uro told me at that time that he was fairly sure that I had prostate Ca but could not treat me until it has been confirmed by biopsy. At age 70 my PSA jumped to 8.5 and after a third biopsy, prostate Ca was detected and staged at T1c. After taking a few deep breaths and studying my options for a few months, I decided not to have the gland removed and opted for radiation. That was two years ago and my PSA has steadly gone down and is now .1. The Uro feels that it will eventually become un-detectasble. Side effects to date have been very minor and everything (yes, everything) is in good working order at age 72. As a retired firefighter, I have tried to keep myself in good physical shape. I go to the gym 3 days a week and can still bench press 200 lbs.

    My Uro feels that every man will develope prostate Ca. Most will be of the slow growing type and that most men will die WITH, but not OF the desease.

    My advise: Dont ignore the fact that you may have "the beast" especially if you have or had, a close relative with it. If you are diagnosed with it, DONT PANIC. Take the time to study your treatment options. Investigate the pros & cons of each. There are numerous very fine sites here on the web that you can gain much valuable info from. Dont be afraid to seek a second opinion from other doctors. Keep in mind that if the Uro is a surgeon, he will most likley recommend surgery. If he is a radiology specialist, he will most likley, recommend radiation treatments. INVESTIGATE all your treatment options and learn the various side effects to each.

    One of my options is called "watchfull waiting". I decided against that even though my Pca was deemed to be low grade. I figured that if I had it, I had it and I wanted to fight "the beast" ASAP. I felt that by starting treatment, I was giving myself an important gift. TIME. Medical science is descovering new treratments and cures for all types of cancer. Who knows what will be discovered next year, next month, next week or tomorrow?

    Prostate Ca used to be considered an "old man's" desease but with the advent of PSA blood testing, they are finding it in younger men. If you have or had a close blood relative with prostate Ca, please consider beginning screening at a younger age. My son (age 42) is being screened...

    Just my 2 cents worth.....................................................................................................................................

      Reply#2 - Wed Mar 14, 2012 11:21 PM EDT

      You stuck your two cents in the wrong slot Jimmy. This is an article about repeat Caesarean sections.

      • 3 votes
      #2.1 - Wed Mar 14, 2012 11:39 PM EDT
      Reply

      Many Obstetricians do not like performing a vaginal birth after a C-section or (VBAC) because of serious risks to the mother and baby. My two oldest children are a set of twins. One of them was breech so I didn't have a choice but to get a C-section. My other two children were natural deliveries. With my younger children, I had to sign a waiver stating that I could not sue the doctor if something went wrong with the deliveries. I was warned that once a woman has a C-section, the uterus has the potential of ripping open during labor with VBACs (due to that muscle being previously cut which weakens it). This could mean potential death to the mother and baby because the mother could bleed to death and the baby could suffocate. I had a good doctor that had performed many deliveries and assured me that the chances of complications with VBACs are low. I am also in good health and was a good candidate for each procedure. As the article stated above, every woman's circumstance is different.

      • 1 vote
      Reply#3 - Sun Mar 18, 2012 5:41 AM EDT

      Bruce Flamm, MD. "Birth After Cesarean." It is absolutely an option!! I did it, and any woman who wants to do it should make that choice for herself instead of being bullied, guilted, etc. by other women and the ACOG.

        Reply#4 - Mon Apr 29, 2013 10:03 AM EDT

        How interesting that they don't mention the mother's four times higher chance of dying from a RCS than a VBAC. Or the increases risk to future pregnancies such as ectopic pregnancy, miscarriage, placenta accretia, placenta previa. Or the risks to her health in having to have corrective surgery, issues with her bladder from a weakened abdominal muscles or increased risk of hystercotomy. This is the most absurd article I have ever read!

          Reply#5 - Mon Apr 29, 2013 11:39 AM EDT

          22 "patients" is not a trial. This is ridiculous.

            #5.1 - Mon Apr 29, 2013 12:17 PM EDT
            Reply
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