Women warned of risks when deciding how to give birth

ATTEMPTS at a natural birth after a woman has had a Caesarean section are more dangerous for the baby than another surgical delivery, researchers said yesterday.

Serious complications including a ruptured womb and a lack of oxygen leading to brain damage in the newborn child were found among women who tried to have a vaginal delivery after a previous Caesarean.

Researchers, writing in the New England Journal of Medicine, said women should be aware of the risks when deciding how to give birth. In recent years there has been growing concern that women are opting to have their baby by Caesarean even when there is no medical reason behind it - sometimes dubbed “too posh to push.” In other cases, cautious doctors can choose to perform Caesareans when there are the first signs of difficulty in labour.

The latest US study focussed on 46,000 women with a prior history of Caesarean. Of these, some 16,000 had an elective repeat Caesarean, 18,000 attempted a vaginal birth after Caesarean, and 12,000 had other circumstances and needed a repeat Caesarean.

The researchers said that, when compared to elective repeat Caesareans, women attempting a vaginal birth faced increased risks to their own health and complications with the birth.

Around 39% of women chose to attempt a vaginal delivery despite a previous Caesarean. Of these, 73% succeeded in this “trial of labour” and managed to deliver naturally.

Uterine rupture occurred in 124 women - less than 1% of cases.

The researchers also found that in these women there was an increased risk of hypoxic ischemic encephalopathy (HIE) - damage to the baby’s brain caused by lack of oxygen. While there were only 12 cases of this complication in the “trial by labour” deliveries, there were no cases in those women who elected to have a repeat Caesarean section. Seven of the 12 cases of HIE, including two infant deaths, followed rupture of the womb.

The researchers also found that maternal morbidity, endometritis - infection of the uterus - and blood transfusion were all more likely in women who chose a vaginal birth after a Caesarean than among those who elected for a repeat Caesarean.

Mark Landon, of the Ohio State University Medical Centre, said: “While the magnitude of these risks for serious complications is small, women who have had a previous Caesarean section and who are considering choices for childbirth should be aware of the level of risk involved.”