Many countries have seen a rise in their cesarean section rate, leading to an increasing proportion of women having a subsequent pregnancy with a history of previous cesarean section.
Pregnant women who have had previous cesarean section may be offered a choice between planning an elective repeat cesarean section or attempting a vaginal birth, providing they do not have medical reasons why a planned cesarean is considered the safer or more advisable option.
Clinical guidelines recommend that women should be counseled about the benefits and harms of planning to have another cesarean section compared to attempting a vaginal delivery to help with this decision. However, there is a lack of robust comprehensive information on the associated outcomes to counsel eligible women about this choice.
What did the researchers do and find?
We undertook a cohort study of 74,043 term singleton births in Scotland to women with one or more previous cesarean sections to determine the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section.
We found that attempting a vaginal birth compared to having an elective repeat cesarean section is associated with an increased risk of the mother having serious birth-related complications such as uterine rupture and blood transfusion, as well as an increased risk of adverse perinatal outcomes.
Conversely, we found that attempting a vaginal birth is associated with an increased likelihood of breastfeeding, whereas the association with other maternal outcomes appears to differ according to whether a woman has any prior vaginal deliveries and the number of previous cesarean sections she has had.
However, the absolute risk of adverse maternal and perinatal outcomes was found to be small for either delivery approach: overall, just 1.8% of those attempting a vaginal birth and 0.8% of those having an elective repeat cesarean section experienced serious maternal complications, and 8.0% of those attempting a vaginal birth and 6.4% of those having an elective repeat cesarean section experienced one or more of the adverse perinatal outcomes considered.