For many years, caesarean section has been a problem for mothers for two reasons: the baby was not born as expected, but was removed (with everything that physically and emotionally can affect a woman and the baby) and because the fact of having a caesarean section meant that all subsequent deliveries would be treated in the same way.
Unfortunately, there are still professionals who continue with this old protocol "if you had a cesarean section, a cesarean section will be done to you" and this has led me to meet a few days ago with what I thought I would not see anymore, a woman explaining that she had been I had a C-section because I already had a previous C-section.
And I say I did not expect it because the most common thing today is that the opposite happens, that there is a vaginal delivery after caesarean section, and to show a button (well, a video), which you will see below in which a woman gives birth at home, in her bathtub, after giving birth to her first child by caesarean section.
The birth of Astrid
I have taken the video of Astrid's birth but I could have taken any other, because there are thousands of experiences like this. I can explain myself that my first child was born by caesarean section and both the second and third were vaginal deliveries. The birth of Astrid happened a little less than 4 months ago and her mother, at the time of holding her baby, between sobs, said "I have done it. I have achieved my vaginal delivery after caesarean section." Perhaps because for her the most important thing was childbirth, and not so much the safety of the baby? Not at all. Perhaps because the safety of the baby is not more compromised than if a new caesarean section was made and, sure, because he did not keep a good memory of his first birth, and this second, in a way, showed him that she is capable of giving to light a baby.
What is the risk of having a previous cesarean in a new birth?
That can complicate the next delivery. Is WHO very heavy when it asks that caesarean sections be done only in case of urgency and that only 10-15% of deliveries should be attempted by caesarean section? Not at all. It is not because the risks of a C-section not only affect the delivery of the moment, the mother and the baby, but also to the next delivery.
The fact that a woman has had a cesarean section means that there is a scar on her uterus. This means that during the next delivery there is a risk of uterine rupture, which is something very dangerous for the life of the woman and the baby. To avoid this risk, the most advisable thing is that in the second birth, the least possible intervention is performed, that is, that there is still more care for the woman to have time, space, freedom and calm to give birth, to force things, to want accelerate them and start intervening, they can be strategies that make everything end badly.
The risk of uterine rupture, if you are wondering, is quite variable. In hospital deliveries it is estimated that round 0.2 to 1% of births. In deliveries at home or in childbirth homes the risk ranges from 0.02% to 0.2% of births, although there are few births analyzed (outside the hospital), by comparison, and more studies are needed to determine what the data are and how reliable they are.
What happens if there is uterine rupture?
Well, you have to run, because there is a risk of hemorrhage in the mother and a risk of hysterectomy (the woman has just had her uterus removed). In the case of the baby, about 5.5% of tears end in death, the risk being greater the longer the time between the break occurs and the baby is detected and removed.
Cesarean vs. vaginal delivery
As explained, it seems that it is safer to have a caesarean section to avoid rupture of the uterus, however, there is a risk of undressing a saint to dress another. Come on you control a risk, but add others. In a C-section there is a greater risk of neonatal morbidity and maternal mortality, so the first option is always vaginal delivery, whose benefits for the mother and the baby compensate for the risk of uterine rupture.
Success is when it comes to trying a birth is relatively high. A hospital in Murcia showed in 2013 that they had achieved 51.3% of deliveries after caesarean section. In this case it is not a great success, but they have a large number of risk births, as they explain, and they can always say that half of the women who had previously had a C-section managed to give birth vaginally when, according to more protocols ancient, they would have given birth by caesarean section yes or yes. Another hospital, this time one from Argentina, estimated that they succeed in 71.8% of the time. There are only two examples, but it is estimated that in hospitals success is between 60 and 80% and that in childbirth homes or at home, 90% of births are achieved.
To find out which is better, if you try to give birth or if you do a cesarean section, it is interesting to show the data of a meta-analysis carried out in 2010 in which all the studies that could give information when comparing a vaginal birth after a C-section, a vaginal delivery after two C-sections and a C-section delivery after a C-section. They saw that when comparing the PVD2C the success rate was 71.1% compared to 76.5% of PVDC. Cases of uterine rupture were 1.59% versus 0.72% and hysterectomy rates of 0.56% vs. 0.19%.
When comparing the PVD2C versus the cesarean section, the cases of hysterectomy were 0.40% versus 0.63%. The need for transfusion was 1.68% versus 1.67% and febrile morbidity 6.03% versus 6.39%. The maternal morbidity was similar in both cases and in the case of the babies, it was considered that there was a lot of limitation in the data to draw conclusions, although it was indicated that in the data they had there were no differences in the admission rates in Neonatal ICU, asphyxiation injuries or neonatal mortality rates when comparing PVCD, PVC2C and cesarean section.
They did not compare the PVDC and the cesarean section, but we can see that the data is better if there is only one previous caesarean section than if there are two, and if we see that PVD2C is similar to a cesarean section, it seems clear that at the risk level it is better to try a vaginal delivery than to directly perform a C-section.
At least this is what scientific societies already recommend, that there are try to achieve a vaginal delivery.
