Vaginal birth after caesareans more dangerous to mother and baby, study suggests

Attempting vaginal birth after one or more caesarean deliveries is more dangerous to mother and baby than sticking to the surgical procedure, a new study suggests.

Caesareans are one of the most common procedures and on the rise globally.

Currently, nearly 30% of births in the UK are via caesarean delivery.

While most mothers are given a choice as to which they would prefer, there is a lack of robust information on the benefits and harms of the delivery methods of subsequent births.

Researchers from the University of Oxford looked at the records of 74,043 single babies born in Scotland between 2002 and 2015 to mothers who had already undergone at least one caesarean.

Those who attempted a vaginal birth rather than opting for a further C-section were seven times more likely to experience uterine rupture, twice as likely to require a blood transfusion and three times as likely to suffer a surgical injury.

And they were more likely to develop sepsis, a potentially fatal infection.

Serious infant outcomes, such as stillbirth, admission to a neonatal unit, resuscitation requiring drugs or intubation, were more common in the babies delivered by caesarean.

The authors of the study said women should be reassured that the risk of complication with either type of delivery remains small.

Overall, 1.8% of those attempting a vaginal birth and 0.8% of those having a planned caesarean experienced serious maternal complications.

And 8% of those attempting a vaginal birth and 6.4% of those having a planned caesarean had one or more of the adverse infant outcomes.

Kathryn Fitzpatrick of the University of Oxford’s Nuffield Department of Population Health, who led the study, said: “Our findings can be used to counsel and manage women with previous caesarean section and should be considered alongside existing evidence on the increased risk of serious maternal morbidity in subsequent pregnancies associated with elective repeat caesarean section.”

The authors also found that the mothers who gave birth vaginally were more likely to breastfeed their newborn, both in the immediate days and six to eight weeks after birth.

The women who opted for vaginal births were more likely to be younger, poorer, single mothers and born outside of the UK.

They were also significantly less likely to have a hospital stay exceeding five days after the birth, or to be readmitted overnight within 42 days, if they had given birth vaginally before.

This could be due to the “protective effect” of previous vaginal delivery which can lead to less complicated, quicker future labours, the study says.

If the women attempting vaginal delivery had experienced two or more previous caesareans, they were significantly more likely to have a hospital stay of more than five days after the birth.

Women who were induced when they gave birth vaginally were more likely to be readmitted than those who had caesareans.

The authors say further studies are needed to investigate the longer-term outcomes of multiple caesareans and attempted vaginal deliveries after at least one previous caesarean.

They say their findings should be considered alongside guidelines from the Royal College of Obstetricians and Gynaecologists, which note there is much evidence that caesarean is linked to an increased risk of serious maternal morbidity in subsequent pregnancies.

The research is published in the journal PLOS Medicine.

Dr Pat O’Brien, consultant obstetrician and spokesman for the Royal College of Obstetricians and Gynaecologists, said: “Women can be assured that in most cases it is possible and safe to have a vaginal birth, or a planned repeat caesarean birth, after a previous caesarean birth.

“The results provide additional useful data to inform women and clinicians when discussing and making decisions around birthing plans, following a previous caesarean birth, for which the risks and benefits will also differ based on the woman’s individual circumstance and wishes.

“A detailed conversation with a woman and her senior obstetrician should take place so she can make an informed choice about the safest way she can plan to give birth and be supported by a team of specialists.”