Vaginal birth can be OK after multiple C-sections

Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.

At one time, doctors believed that once a woman had a C-section, she would have to have one for all subsequent pregnancies - mainly out of concern that the scar on the uterus could rupture during vaginal childbirth.

That thinking has changed, and vaginal delivery is now considered a safe option for many women who have had a past C-section. Because C-sections also carry risks and downsides - such as blood loss or infection from the procedure, and a longer hospital stay and recovery time - many women may prefer a try at labor.

Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.

In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.

In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.

Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.

These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.

In an interview, she noted that next month, the National Institutes of Health is holding a consensus conference on the overall issue of vaginal birth after cesarean. According to the NIH, the conference will look at the scientific evidence on a number of questions - including the short- and long-term risks and benefits of vaginal delivery versus repeat C-section; an independent panel will then develop a consensus statement on those issues.

For now, Cahill said, it is important for women with a history of three or more C-sections to be aware of the current ACOG recommendation. But, she added, they can also talk with their doctors about the possibility of vaginal birth as an option, as "recommendations can change as new science emerges."

For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.