Normal Delivery Riskier After C-Section

By Gene Emery

Wednesday July 4 5:38 PM ET

BOSTON (Reuters) - Women who attempt to give birth the natural way face a greater risk of complications if they previously had a caesarean section, according to a study in Thursday's New England Journal of Medicine.

The findings, based on a Washington state database of all deliveries from 1987 through 1996, run counter to other surveys suggesting that women can safely attempt a vaginal delivery after an earlier child has been removed surgically.

Although women who have had a caesarean section may subsequently want to try a vaginal delivery because the recovery is faster, a Journal editorial recommends that the safest route for the baby is to schedule another c-section.

Led by Mona Lydon-Rochelle of the University of Washington at Seattle, researchers studied 20,095 women who had previously given birth by caesarean. They found an increased risk of uterine rupture associated with spontaneous or induced labor, particularly with labor induced by a class of chemicals known as prostaglandin.

The likelihood that the baby would die was 10 times higher among the women who had a uterine rupture, compared to mothers who did not.

Dr. Michael F. Greene of the Massachusetts General Hospital, in the editorial, said previous studies suggesting that vaginal delivery was safe after a caesarean section were not as thorough and authoritative as the latest research.

He said initial reports proclaiming that vaginal delivery was just as safe as a scheduled c-section ``propelled the juggernaut'' toward encouraging women to try a vaginal delivery with a subsequent child.

``Individual physicians, and to some extent their professional organizations, were cajoled or coerced into supporting'' insurance programs that promoted vaginal delivery, and doctors went along because they didn't want to be portrayed as uncooperative and nonprogressive, Greene said.

``As experience again accumulated, however, so too did reports of maternal and perinatal morbidity associated with vaginal delivery after caesarean section,'' he said.

If a patient asks ``what is the safest thing for my baby,'' according to Greene, ``my unequivocal answer is: elective repeated caesarean section.''

 
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