Second caesarians may be safer suggests research in Australia

Pregnant women who opt for second caesarean deliveries have babies who are less likely to suffer serious health problems, research suggests.

In women who have had the operation once before, mothers and babies suffered fewer complications if further caesarian deliveries were planned rather than natural births.

Experts have now calculated that one baby death – or near death – would be prevented for every 66 planned repeat caesarean sections.

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Published in the journal Public Library of Science (PLoS) Medicine, the research involved 2,345 women recruited from 14 Australian hospitals who had had one previous caesarean but were each then eligible for a subsequent normal vaginal birth.

They were split into two equal groups, mostly depending on whether the women wanted normal or caesarean births, and the risks of both types of birth were analysed.

The results showed that the risk of each baby being stillborn or dying in the first few days of life, and the risk of each baby suffering a serious outcome, was lower in the caesarean group than in the vaginal birth group.

Overall, 10 babies (0.9 per cent) in the caesarean group suffered these problems, compared with 30 (2.4 per cent) in the vaginal birth group.

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Women in the caesarean group also suffered less serious blood loss – nine women, or 0.8 per cent of the group, compared with 29 (2.3 per cent) in the other group.

Caesareans also led to no increased risk of other complications for mother or baby.

The researchers, from universities and departments including the Australian Research Centre for Health of Women and Babies, concluded: “Among women with one prior caesarean, planned elective repeat caesarean compared with planned vaginal birth after caesarean was associated with a lower risk of foetal and infant death or serious infant outcome.”

The research comes as another study found an increased risk of women suffering womb ruptures if they have planned vaginal births following a previous caesarean rather than another caesarean.

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Womb rupture is a rare complication where the womb wall tears open, and can be severe and life-threatening for mother and child.

The research, by experts at Oxford University and also published in PLoS Medicine, found womb rupture is rarer than previously thought.

However, among women having planned vaginal births, the risk of womb rupture was 21 per 10,000 pregnancies, seven times higher than in those who chose further caesarean sections, where the incidence was three per 10,000 births.

Professor Marian Knight, of the National Perinatal Epidemiology Unit at Oxford University, who led the study, said: “Womb rupture is a severe but thankfully very rare complication.

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“We found that many of the hospital maternity units across the country don’t even see one case a year.

“Among women who’ve had a previous caesarean, there is a higher risk for those planning a normal birth rather than another caesarean.

“But the risk remains very small, occurring in just 0.2 per cent of such pregnancies. Given that this figure is lower than many previous estimates, there should be no extra reason to worry.

“We see no reason to change current advice that women can choose how they would like to have their baby after a previous caesarean, and that in general a vaginal birth should be possible.”

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Mary Newburn, head of research and information at the National Childbirth Trust (NCT), said of the Australian study: “This research was carried out in Australia and does not apply directly to maternity care in the UK.”

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