A new study, published in the British obstetrics journal BJOG, suggests that there may not be any additional risk to women who attempt a vaginal delivery after three or more births by C-section.
In the past, a woman who had delivered by caesarean once would be delivered by caesarean section for all subsequent pregnancies. The primary concern had been the potential of the scar, from the previous C-section, to rupture during vaginal delivery. That thinking has gradually changed, in consideration of the potential complications of the caesarean procedure, and data which shows the risk of uterine rupture to be less than 1%. Vaginal delivery is now considered a viable option for women who have previously delivered by caesarean.
The risk of uterine rupture, however, is thought to be higher in women who have had three or more C-section deliveries. The American College of Obstetrics and Gynecology currently recommends against vaginal delivery, for women in this category.
However, the findings of the new study indicate differently. The study looked at the cases of 25,000 women in 17 American hospitals, all of whom gave birth after at least one C-section. Of this group, 860 women had undergone a minimum of three previous caesareans and of those, 89 opted for a vaginal delivery.
Apart from the possibility of uterine rupture, other potential complications include bladder or bowel injury and lacerations of the uterine artery. None of the 89 vaginal deliveries studied presented any of these complications.
The study’s lead researcher, Dr. Alison G. Cahill of the Washington University School of Medicine, points out that all of the 89 women, who opted to deliver vaginally, had previous C-sections involving low transverse incisions. This type of incision has a lower risk of rupture than the ‘classical’ high vertical incision. Cahill also noted that women who had previous vaginal deliveries were more likely to succeed with a vaginal delivery after caesarean.
The National Institutes of Health will be holding a consensus conference, next month, to discuss the issue of vaginal birth after caesarean. Recommendations may be changed at that time but until then, women should be advised of the current recommendation which discourages vaginal birth after three or more caesarean sections. – Jen R, Staff Writer
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