Once a Caesarean Always a Caesarean?

A generation ago, a woman who had a Caesarean birth was restricted to that procedure for any future children. Anything else was generally deemed much too risky.

Caesarean deliveries are often performed for the convenience of the mother or the obstetrician. A recent study found that first-time Caesareans in American women who had no apparent medical need a so-called elective Caesarean lave lisen by 67% since 1991.

Worth A Try?

One explanation as to why there are so few vaginal births after Caesarean (VBACs) is that many doctors stopped doing VBACs because of liability fears. In fact, in 2002, a survey by the American College of Obstetricians and Gynecologists (ACOG) revealed that nearly 15% of its members no longer offered VBAC.

But a new study found that 587 of 588 women did just fine by having a vaginal birth following a previous Caesarean. But in the real world, that 1-in-588th delivery could have serious problems for the mother or child, mostly uterine ruptures, despite special precautions that are taken for a VBAC delivery.

of the women who underwent a trial of labor, fewer than 1% experienced uterine rupture.

"The overall risk of serious adverse outcomes at term is one in 2,000 trials of labor," says study chairman Dr. Mark B. Landon, of Ohio State University.

"For many women, that level of risk is clearly acceptable, with the benefit being a potential vaginal birth with shorter recovery, less hospitalization and the satisfaction that goes with vaginal delivery itself. For other women, any level of potentially preventable fetal risk is unacceptable."

His study did not assess the potential risks of repeat C-sections.

Risks From Elective C-Section

Women who have an elective C-section are at a significantly higher risk of pain after surgery, infection, re-hospitalization and problems with subsequent pregnancies. In short, an elective Caesarean is not necessarily innocuous, equal to a first-time vaginal birth.

Babies delivered by C-section are less likely to be breast-fed, seem to have a higher risk for asthma, and, if born before the 39th week of pregnancy, are more likely to have respiratory problems than babies delivered vaginally.

"Choosing whether to have a vaginal delivery or an elective Caesarean section is based on the premise that these two choices are essentially equivalent, but this is simply not true," says Eugene Declercq, professor of maternal and child health at Boston University School of Public Health.

As to VBAC, a government study notes that "patients, clinicians, insurers and policymakers do not have the data they need to make truly informed decisions about appropriate delivery choices following one of the most common surgical procedures performed on women."