A while ago, when a woman gave birth by caesarean section, the next birth had to be, yes or yes, caesarean section. The scientific evidence said, however, that a vaginal birth was possible and that, since the risks derived from a vaginal delivery are lower than those of a C-section, it was indicated to try a vaginal delivery after caesarean section, which are called PVDC.
Over time the protocols have been changing forced by the practice of midwives, gynecologists and mothers who have shown that it is possible to give birth after a C-section. In fact, they have even seen vaginal births after two caesarean sections (PVD2C) and even vaginal births after three caesarean sections (PVD3C) that, although they show that it is possible, there are few cases, basically because there are few women who have 4 or more children and few meet the criteria of "three consecutive C-sections".
After all this road traveled, Two new studies conclude that after a C-section it is less risky for both the baby and the mother to practice a new C-section.
The first of the two studies says ...
The first of the two studies was conducted in Australia and they concluded that women who gave birth by caesarean section, after a previous caesarean section, had less risk of giving birth to a lifeless baby (0.9% of the mothers were at that risk) than those who opted for a vaginal delivery (2.4% of the mothers). To understand it better, they explained that for every 66 deliveries per caesarean section after caesarean section one baby could be saved for every 66 children who die from being born in a PVDC, one would not have done so if they had all been treated by caesarean section.
To carry out this study, 2,345 women had a previous cesarean section and also observed that women who had given birth by caesarean section were at less risk of severe bleeding. A blood loss of 1,500 ml or more and / or the need for a blood transfusion was considered as a complication and observed that it happened in 0.8% of women who had a C-section (9 of 1,108 women) and 2.3% of women who gave birth through a vaginal delivery (29 of 1,237 women).
The second of the studies says ...
The second of the studies, carried out in the United Kingdom, was done with the objective of quantifying and knowing the risks of uterine rupture.
During 2009 and 2010, 159 cases of uterine rupture were identified. The majority, no less than 139, occurred in women who had had a previous caesarean section (This is one of the reasons why a caesarean section should be done only when strictly necessary).
When it came to having a second baby, it was observed that the risk of uterine rupture in a second birth was higher in women trying a vaginal delivery (2.1 cases per thousand PVDC) than in those who had their baby by caesarean section (0.3 cases per thousand births by caesarean section).
However, as we say, they observed that the more caesarean sections a woman had, the greater the risk of rupture in the following delivery: those who had had two or more children by caesarean section had up to three times the risk of uterine rupture in the next pregnancy.
What the experts say about it
The doctor Virginia Beckett, spokesman of the Royal College of Obstetricians and Gynecologists of the United Kingdom wanted to comment on the conclusions of these studies and said the following:
Choosing a vaginal birth or a C-section carries different risks and benefits, but in general any choice can be safe with very small risks. Although vaginal delivery presents a slightly higher risk of rupture after a previous C-section, this operation also carries risks, such as clots, longer recovery periods, etc. It is important that women discuss their individual case options with their midwife or obstetrician.
In the UK study, where they talk about uterine rupture, they claim that it is a very rare complication. It can happen, because it happens, but it is dangerous to decide to do a subsequent C-section based on the risk of rupture, due to the low incidence. If in addition to this we add that the more caesarean sections, the greater the risk later, the decision becomes even more problematic.
On the other hand, it would be necessary to assess all the risks that a C-section entails: it affects the success of breastfeeding, it can affect the mother psychologically, there is an increased risk of maternal death during childbirth, the baby is not contaminated with microorganisms of the mother, greater risk of type 1 diabetes in the baby, celiac disease, and more that I leave, and it is that a C-section is still an important surgical intervention with a recovery worse than that of a vaginal delivery.
In other words, as Dr. Beckett says, it is best to talk with the medical team to get all the information and make an individual decision about it. Meanwhile, we must continue to emphasize the importance of avoiding cesarean deliveries because, as we see, once you have had one, the risks in the following deliveries are greater.
