Two papers published in PLoS Medicine look at mode of delivery after a previous caesarean section. One paper looks at womb rupture and the second looks at planned repeat caesarean section.
The first paper from Oxford University found that the risk of womb rupture in pregnancy and labour is very small and lower than previously thought. The researchers found that womb rupture occurs in just 2 in 10,000 pregnancies in the UK.
The study found that most cases of womb rupture happen in women who have already had a caesarean section. The risk remains small in women planning a vaginal birth after a previous caesarean section although this group of women is at a slightly higher risk that those who opt for a another caesarean.
The second Australian paper examines planned vaginal birth versus elective repeat caesarean. It suggests that women who had a previous caesarean section, delivering their next baby by a planned caesarean section have better health outcomes and also better outcomes for her baby compared to a vaginal birth.
The researchers found that women who had a planned caesarean section experienced less severe bleeding than women who gave birth vaginally. In addition, there was a reduced risk of non-fatal serious outcomes before discharge from hospital for infants born by planned repeat caesarean section.
Dr Virginia Beckett, RCOG spokesperson, said:
“Women who have already had a caesarean section need to consider how they would like to deliver in their subsequent pregnancy. Choosing a vaginal birth or a caesarean section carries different risks and benefits but overall either choice is safe with only very small risks.
“It is important that women discuss all the options for their individual case with their midwife or obstetrician. Despite there being a slightly higher risk of rupture following a previous caesarean, the procedure itself carries risks such as risk of blood clots, longer recovery period and the potential need for elective caesareans in future pregnancies.”
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The two papers are published in PLoS Medicine. The full papers can be found here:
Oxford paper (Fitzpatrick/Knight): http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001184
Adelaide paper (Crowther): http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001192
RCOG Green-top Guidelines on Birth after previous Caesarean Birth can be found here: http://www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45