Women considering a vaginal birth after a previous caesarean section can be assured that it is a clinically safe choice for the majority of women, according to revised guidelines published today by the Royal College of Obstetricians and Gynaecologists (RCOG).
Around a quarter of births in the UK are delivered by caesarean section, the majority – 15 per cent – due to emergency intervention, and around 10 per cent are elective.
This research confirms that vaginal birth after caesarean section has a success rate of around 75 per cent, which is the same as for first time mothers. The success rate rises to 85 to 90 per cent if the woman has had a previous successful vaginal birth. After two or more caesarean sections the rate of success remains high at 71 per cent.
This guideline provides evidence based information to help doctors advise women of the choices available to them, and manage their care through subsequent pregnancies and births. It includes details of how to assess a women’s suitability for vaginal birth or repeat caesarean, highlighting the need for a personalised approach. Factors such as presentation of the baby, previous uterine rupture, type of previous incision, previous surgery and position of the placenta, may mean a vaginal birth after caesarean is not recommended.
The guideline also emphasises the need for a checklist, or clinical care pathway, to ensure best practice in antenatal counselling, shared decision making and documentation. Following a woman’s 20 week scan, if there are no clinical reasons why a vaginal birth should not be attempted the guideline suggests that the maternity team begin a conversation with the women and her partner, and that a preferred option should be reached by week 36.
Janesh Gupta, a professor of Obstetrics and Gynaecology and lead author of the guideline, said:
“Women can be assured that in most cases it is possible and safe to have a vaginal birth after a previous caesarean section. This guideline can be used to aid doctors in their assessment of individual women and, unless there are clinical reasons why a vaginal birth should not be attempted, help inform the woman and her partner of her choices and the risks involved with either vaginal birth or a repeat caesarean section.”
Compared to a repeat caesarean section, vaginal birth has fewer complications and the extremely rare risk of a mother dying during childbirth is the same as for first time mothers. However there is a small (1 in 200) risk of uterine rupture, an additional risk of stillbirth after 39 weeks (1 in 1,000), and mothers who attempt a vaginal birth but have to have an emergency caesarean have a higher risk of complications such as haemorrhage or infections (14.1 per cent compared to 2.4 per cent for a successful vaginal birth after caesarean and 3.6 per cent for repeat caesarean section).
Professor Alan Cameron, Vice President of Clinical Quality at the Royal College of Obstetricians & Gynaecologists said:
“It is important for women to know that both caesarean section and vaginal birth after a previous caesarean section are safe and that when reaching a decision their individual circumstances, and preferences, should be taken into account. This updated guideline includes a new recommendation on the use of a checklist or clinical care pathway to make sure best practice is maintained, that women are counselled regarding their options and the risks with either a repeat caesarean or vaginal birth are fully explained to them.”
For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email firstname.lastname@example.org.
The Green-top Guideline Birth after Previous Caesarean Birth (Green-top Guideline No. 45) can be found here.
This is the second edition of this guidelines, first published in 2007 and updated in 2014.
The RCOG Green-top Guidelines provide systematically developed recommendations to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The recommendations are not intended to dictate an exclusive course of management or treatment. They must be evaluated with reference to individual patient needs, resources and limitations unique to the institution and variations in local populations. It is hoped that this process of local ownership will help to incorporate these guidelines into routine practice.
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.