Study: Vaginal Delivery Safe After Multiple Cesareans

[BellyBelly]

Vaginal Delivery Can Be Safe After Multiple Cesareans

By David Douglas

NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after multiple previous cesarean deliveries, the risk of uterine rupture is no greater than in women who have had only one previous cesarean delivery, researchers report in the July issue of Obstetrics and Gynecology.

The author of an accompanying editorial, Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters Health that this "is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean. Each woman's situation is specific and advice should be individualized for those specifics."

In the study, Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, and colleagues prospectively examined data for women attempting vaginal birth after a single or multiple cesareans.

Uterine rupture occurred in 9 of 975 women who had had multiple prior cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean (0.7%), a nonsignificant difference.

However, the rates of hysterectomy were significantly increased in the multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2% versus 1.6%).

Similarly, a composite of maternal morbidity, including endometritis and operative injury, was significantly increased in women who had had multiple cesareans.

Despite this increased risk of complications, the absolute risk is small, the researchers conclude, and "vaginal birth after multiple cesarean deliveries should remain an option."

Dr. Katz added that there is a "shifting paradigm of cesarean, not as an adverse outcome -- a complication -- but as one tool towards achieving the goal of a healthy mother and baby."

"Thus," he concluded, "the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool."

Obstet Gynecol 2006;108:2-3,12-20.

[Katstribe]

Awesome information. Thanks heaps. I was wondering what the chances of having a VBAC considering I have now had two. My first born was c-sec and now my 6th born was also a c-sec. Great to know that if i ever end up pregnant again hopefully i would be able to try another vbac.
Thanks for this insight

[Berry]

That's good to know the option is there after two caesarians....

[BellyBelly]

The problem is we don't know the full story around this birth. It is not recommended, and I have never heard of an Ob before who will induce for a VBAC. It increases the risk of rupture. You can rupture with an induction - no matter if you have had a c/s or not before. So adding that rupture risk on top of the VBAC risk of 0.7%.

We all hear bad or scary stories but we never know the full story to be able to understand properly...

[Katstribe]

Originally Posted by Katstribe

Awesome information. Thanks heaps. I was wondering what the chances of having a VBAC considering I have now had two. My first born was c-sec and now my 6th born was also a c-sec. Great to know that if i ever end up pregnant again hopefully i would be able to try another vbac.
Thanks for this insight

How funny that i looked this up now and to read my own words!!!! As fate would have it I fell PG just after i was in here! Mind you i didn't realise for just over 5 weeks,i had symptoms galore but just thought my body was still out of whack after my c-sec!!!!!! A gf told me i was PG which i laughed at, then later did a test and got a BFP!!! So now i am on this roller coaster ride of wantinga VBA2C and definately didn't get the support from the doc who did my last c-sec!!!! At first this upset me greatly, but now i have had time to cry and get my head clear, i will be fighting him on this! As he said if I choose to not come in until i am in labour they have no choice but to help me birth my baby!!!!!
I have had one health nurse tell me not to let them bully me into a repeat c-sec so that was wonderful. I have my next appointment with MW on the 7th Nov so will be talking to her and finding out how she feels about it all and if need be i will be showing her that i have done my research and know the facts and figures!!!!!!

Anyway just thought i would pop in and put my thoughts out there! If this is not the pace for it then please feel free to move it. Thanks

Cheers
Kat

[littlescottishboy]

Wow... it helps to be informed... i am due with no.2 at Christmas, and after a c-section with no.1, i am a little unsure about the best option for me. Thanks for the interesting comments though, everyone!

[onlyone]

easier to find a supporting midwife rather than force one into changing their believes?

I meet my ob today and he seems to be very supportive if I wanted to go down that path, but I am going with an elective c-section far less risk and problems for me with time

[*MRS M*]

if i fall preggers after ivf next year i'm going to see if i can have VB after having 3 cerareans hopefully i can

sarah

[gardeningkate]

At my first hospital appt I stated my position, that statistics back me up that VBAC need be treated no differently to VBAC 1, and was told firstly that statistics are not everything, (he asked me if I would cross a road knowing that I had a 9/1000 chance of being hit - I wish I had thought quick enough to say all the things that I thought of later) but he continually came back to the notes in my vbac saying I had a bilateral extension down inferiorly on both angles, and this put my risk much higher anyway, that in his opinion I would rupture and did I understand the consequences of that, what does this mean, I tore during my last birth, could I get some reassurance or unbiased advice on what potential impact could have on my vbac2!!
Thank you
Kate
Kate