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Reduced Baby Risk from Another Cesarean

Gynecology newsMar 14, 12

A major study led by the University of Adelaide has found that women who have had one prior cesarean can lower the risk of death and serious complications for their next baby - and themselves - by electing to have another cesarean.

The study, known as the Birth After Caesarean (BAC) study, is the first of its kind in the world. It involves more than 2300 women and their babies and 14 Australian maternity hospitals. The results are published this week in the international journal, PLoS Medicine.

The study shows that infants born to women who had a planned elective repeat cesarean had a significantly lower risk of serious complications compared with infants born to mothers who had a vaginal birth following a prior cesarean - the risk of death or serious complication for the baby is 2.4% for a planned vaginal birth, compared with 0.9% for a planned elective repeat cesarean.

The mothers of these babies were also themselves less likely to experience serious complications related to birth. For example, the risk of a major hemorrhage in the mother is 2.3% for a planned vaginal birth, compared with 0.8% for a planned elective repeat cesarean.

"Until now there has been a lack of high-quality evidence comparing the benefits and harms of the two planned modes of birth after previous cesarean,” says the study’s leader, Professor Caroline Crowther from the Australian Research Centre for the Health of Women and Babies (ARCH), part of the University of Adelaide’s Robinson Institute.

“The information from this study will help women, clinicians and policy makers to develop health advice and make decisions about care for women who have had a previous cesarean.

Why would I want a vaginal birth?
There are many reasons that you may want a vaginal birth after a cesarean. Some may be medical and some may be emotional. Others may be financial or in terms of recovery. Here are some brief lists of the benefits to the mother and baby of a vaginal birth.
Mother:

Prevention of Death from surgery
Prevention of lesser complications from surgery
Prevention of blood loss
Prevention of infection
Prevention of injury (bowel, urinary tract, etc.)
Prevention of blood clots in the legs
Prevention of feelings of guilt or inadequacy that surgery sometimes causes
Breastfeeding is generally easier after a vaginal birth
The cost of a vaginal birth is about $3,000 less

Baby:

Prevention of Iatrogenic Prematurity (meaning surgery was done, because of an error in guessing a due date)
Reduction in the cases of Persistent Pulmonary Hypertension
Labor prepares the baby for extrauterine life
Prevention of surgery related fetal injuries (lacerations, broken bones)
VBAC results in fewer fetal deaths than elective repeat cesareans

“Both modes of birth have benefits and harms. However, it must be remembered that in Australia the risks for both mother and infant are very small for either mode of birth,” Professor Crowther says.

Cesarean section is one of the most common operations performed on childbearing women, with rates continuing to rise worldwide. Repeat cesarean births are now common in many developed nations.

What is the criterion I must meet to be considered for VBAC?
No more than 2 low transverse cesarean deliveries.
No additional uterine scars, anomalies or previous ruptures.
Your health care provider should be prepared to monitor labor and perform or refer for a cesarean if necessary .
Your birth location should have personnel available on weekends and evenings in case a cesarean is necessary.

In Australia in 2008, more than 90,700 women gave birth by cesarean, accounting for more than 31% of all births. Of Australian women who had a previous cesarean section, 83.2% had a further cesarean for the birth of their next child. In South Australia alone, repeat cesarean births amount to 28% of the overall cesarean section rate.

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