Birth after caesarean section can be successful in more than 90% of cases and therefore may be considered a reasonable option for both mother and child, according to a study published in BMC Pregnancy and Childbirth.

With detailed information about the risks and benefits associated with different birth options, pregnant women were more likely to choose vaginal delivery after a previous caesarean section than a repeat caesarean section.

Dr. Kaname Uno, author of a study conducted at Toyota Memorial Hospital, Japan, said: “Caesarean section rates are increasing worldwide with almost half of the decisions about whether or not to have a caesarean section based on previous caesarean sections.. Trial of birth after caesarean section (TOLAC) is considered a safe option, but most eligible women undergo a second caesarean section instead. This may be due to a lack of sufficient education about the risks and benefits of both types of childbirth.”.

The authors analyzed data from April 2005 to August 2017 on 1086 pregnant women with at least one previous caesarean section.. Of these, 735 expectant mothers were eligible for TOLAC. They were provided with detailed explanations of the risks and benefits of TOLAC and repeat caesarean section.. Each woman was asked to consider both modes of delivery and make an informed decision during 34 weeks of pregnancy..

Dr. Uno said: “A potential risk of vaginal delivery after a previous caesarean section is uterine rupture, which can occur during healing incisions after previous caesarean sections.. However, caesarean births themselves carry the risk of bleeding, infection, and other complications.. The benefits of a successful TOLAC include reduced risk of bleeding, infections, and improved outcomes in future pregnancies."

Of 735 pregnant mothers, 471 (64.1%) opted for TOLAC and 264 (35.9%) opted for repeat cesarean. Among the 471 women who chose TOLAC, 430 (91.3%) women had a successful vaginal delivery, while 41 (8.7%) were classified as “TOLAC failed” and delivered by caesarean section after they failed to. Of this group, three women (0.6%) experienced uterine rupture, but there were no maternal or neonatal deaths..

Premature rupture of membranes before labor onset and gestational age greater than 40 weeks were significant risk factors for failure of TOLAC.. In a study, 96.4% of women with a history of vaginal delivery had a successful TOLAC. The results confirm previous studies indicating that delivery after caesarean section may be a safe alternative to repeat caesarean sections..

Dr. Uno said: “Choosing vaginal delivery after a previous caesarean section can increase the length of pregnancy with a corresponding reduction in the risk of potential health complications for the baby.. The results show that healthcare providers should be encouraged to have ongoing discussions with pregnant women about the risks and benefits associated with each mode of birth, allowing them to make informed choices.”.

The authors caution that because the group sizes assessed in the study were directly dependent on the choice of each mother-to-be, the results may be subject to individual bias, previous experience, and regionality and therefore cannot be generalized broadly.. Because only three women experienced uterine rupture, further research is needed to evaluate this as a potential complication..

medical-heal. en.