A new study raises concern about childbirth options for women who have had a C-section and are planning another pregnancy.
The research finds a higher risk of death among newborns whose mothers have vaginal deliveries after a previous caesarean, compared with those who have a planned repeat C-section.
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- JAMA
Journal of the American Medical Assoc.
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The perinatal death rate, babies who died during birth or shortly after, was eleven times higher among the c-section women who delivered vaginally compared to those who had a repeat c-section.
The study was conducted at Cambridge University.
From The Associated Press
Another Caesarean section is the safest childbirth method for women who have already had a surgical delivery, although the risks from a vaginal delivery after Caesarean are lower than previously thought, British researchers say.
A study of 313,238 births in Scotland found that for women with previous Caesareans, the delivery-related death rate for subsequent babies was about 11 times higher in vaginal births than in planned repeat Caesareans.
Still, the overall infant death rate for vaginal-after-Caesarean births was about equal to the death rate in first-time vaginal births _ about 1.2 per 1,000 babies, the study found. That compared with 0.1 per 1,000 for planned repeat Caesareans.
Often-cited previous research suggested a death rate of 5.8 per 1,000 births for vaginal-after-Caesarean deliveries.
Unlike the current study, those figures included many premature babies, who are born before 37 weeks' gestation and facing slimmer survival chances than full-term infants, said Dr. Gordon C.S. Smith of Cambridge University in Cambridge, England.
Smith helped conduct the study, which involved babies born between 37 weeks and 43 weeks gestation. It appears in Wednesday's Journal of the American Medical Association.
Smith said his study should reassure women "that the absolute risk to the baby from vaginal birth after Caesarean is very low."
Smith said the results are generally applicable to the United States and other Western nations.
In Caesarean sections, babies are delivered surgically through incisions in the uterus and lower abdomen.
Before the 1980s, doctors recommended repeat Caesareans for all women who'd already had one because of the possibility that labor and a vaginal birth could rupture the scars and uterus. That can deprive the baby of oxygen and cause severe blood loss in the mother.
As thinking shifted, the U.S. rate of vaginal-after-Caesarean births climbed 27.4 percent in 1997, Dr. W. Benson Harer Jr. said in another JAMA report.
Current guidelines recommend limiting vaginal-after-Caesarean births to full-term babies in the headfirst position, born to women with only one previous Caesarean that was done with a low horizontal incision. Vertical uterine scars are considered higher-risk than horizontal ones.
While many insurers have advocated vaginal-after-Caesarean births to cut costs and reduce hospital stays, some doctors remain wary.
Dr. Christian Chisholm, assistant professor of obstetrics and gynecology at Johns Hopkins University School of Medicine, said calling the results reassuring "is definitely a different way of looking at the data."
The risks are real, and because the complications can be devastating, Chisholm said the trend is toward more repeat Caesareans.
(Copyright 2002 by The Associated Press. All Rights Reserved.)
May 21, 2002
