After One C Section, Another May be Best

C section delivery appears to be the safer choice for women with a prior C section

(RxWiki News) Women who have already had one cesarean section may be better off planning to have another for their next child instead of attempting a vaginal birth.

So says a new study that looked at the health outcomes for both mothers and their newborns for women who had already had a previous C section.

"Speak with your OB/GYN about C sections."

Lead author Caroline Crowther, of the Australian Research Centre for Health of Women and Babies at the University of Adelaide in Australia, and her colleagues studied 2,345 pregnant volunteers from 14 maternity hospitals in Australia.

All the women were 37 weeks pregnant with a single baby, had previously had a C section delivery and were medically able to attempt to deliver their next baby vaginally.

The women were split into two groups, based on their own birthing preference or their willingness to be assigned randomly to one of the groups: 1,108 would have an elective C section, and 1,237 would plan to give birth vaginally as long as no medical reason not to occurred.

The researchers found the women who had another C section had less severe bleeding than those who had a vaginal birth. Vaginally birthing moms had a 2.3 percent likelihood of severe bleeding, compared to 0.8 percent for the moms who had a C section.

The newborns of moms who had C sections also had a lower risk of serious complications or death before they left the hospital. The babies born vaginally had a 2.4 percent risk of death or serious problems, but the risk was only 0.9 percent for babies born via C section in the study.

According to the calculations of Crowther and her colleagues, one newborn death or near-death could be prevented for every 66 women who elected to have a C section after having previously had one.

"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," Crowther said. The study is the first to measure outcomes in women assigned to give birth vaginally or by C section.

"Both modes of birth have benefits and harms," Crowther said. "However, it must be remembered that in Australia the risks for both mother and infant are very small for either mode of birth." The risk rates for Australian women are approximately comparable to the risks for American women.

The research was published in this week's PLoS Medicine. It was funded internally and by grants from the National Health and Medical Research Council of Australia and the Women's and Children's Hospital Foundation of South Australia. The authors declared no conflicts of interest.

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Review Date: 
March 15, 2012