Normal delivery can be OK after multiple cesareans

For women who have had several previous cesarean deliveries, attempting a vaginal birth is not much riskier than for women who have had only one previous c-section, researchers report in the journal Obstetrics and Gynecology.

This "is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean," the author of an accompanying editorial told Reuters Health.

"Each woman's situation is specific and advice should be individualized for those specifics," said Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon.

The findings come from a study by Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, examining data on women attempting vaginal birth after a single or multiple cesareans.

Uterine rupture, a serious complication of labor, occurred in 9 of 975 women who had had multiple prior cesareans (0.9 percent) and in 115 of 16,915 women with a single previous cesarean (0.7 percent) - a difference that wasn't significant from a statistical standpoint.

A composite score of injuries and complication affecting the mother was significantly increased in women who had had multiple cesareans. However, the absolute risk is small, the researchers conclude, and "vaginal birth after multiple cesarean deliveries should remain an option."

Dr. Katz added that there has been a shift in the view of cesarean delivery, with obstetricians seeing it not as a complication "but as one tool towards achieving the goal of a healthy mother and baby."

"Thus," he concluded, "the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool."

SOURCE: Obstetrics and Gynecology, July 2006.