Are natural births more risky after a previous caesarean?

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01 October, 2019

Lyndsay Baxter

There has been a number of recent media headlines stating that natural births are more risky if a previous caesarean has already been performed. These headlines have resulted following a research article being published entitled: 'Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland'.

The article, published on 24th September 2019, is in relation to a study carried out by the University of Oxford and the University of Aberdeen looking at the relationship between the risk factors of the method of giving birth and the outcomes for the mother and baby. The study considered over 74,000 births which took place in Scotland between 2002 and 2015. The study looked at the following health outcomes for the mothers:

  • Rupture of the womb, which can cause major blood loss and is dangerous for the mother and the baby;
  • The need for a blood transfusion;
  • Post-birth sepsis infection;
  • Surgical injury to the vagina, bowel or urinary system.

For babies, they looked at:

  • Stillbirth or death during birth;
  • Admission to a neonatal unit;
  • The need for resuscitation;
  • Poor health score 5 minutes after birth.

The study identified the following risks to the mother if they have had a previous caesarean:

Outcome Natural Birth Caesarean
Rupture of womb 0.24% 0.04%
Blood transfusion 1.14% 0.5%
Overall Complications 1.8% 0.8%

It was noted that other complications, such as a sepsis infection were rare.

The following risks in relation to the baby were identified if the mother has had a previous caesarean:

Outcome Natural Birth Caesarean
Still birth or death during birth 0.07% 0.01%
Needed resuscitation at birth 1.63% 0.33%
Poor health score 5 minutes after birth 1.44% 0.42%
Admitted to neonatal ward 5.45% 5.27%
Overall problems 7.99% 6.37%

Other factors that were considered that could affect the outcome included the mother's age, BMI and smoking status, previous births either by caesarean or natural, length of time between pregnancies and labour was induced.

The study found that overall 1.8% of those attempting a natural birth and 0.8% of those having a repeat caesarean experienced serious maternal complications. However, the risk does increase in relation to the baby, with 7.99% of those mothers attempting a natural birth following a previous caesarean and 6.37% of those having a repeat caesarean experienced one or more adverse outcome occurring in relation to the baby, such as needing medicine or equipment to help with breathing. In extreme cases the previous caesarean can rupture during the course of a natural birth which can lead to major complication for both mother and baby.

The study confirms that the absolute risk of adverse outcomes is small for either delivery approach, although the study does advise that more research is needed on long-term outcomes, and so it appears as though the media has overstated the risks.

The study concludes that, among women considered eligible to have a planned natural birth, a planned natural birth compared to caesarean is associated with an increased risk of the mother having serious birth-related and baby complications. On the other hand planned natural births are associated with an increased likelihood of breastfeeding, which has its own health benefits.

The decisions as to whether to proceed with a caesarean or a natural birth is not an easy decision and whilst the mother's preference is a factor, health professionals also need to review other circumstances and the relative risk and benefits of both options and explain these to the mother.

The full article by the University of Oxford and University of Aberdeen is free to read and can be found here.

If you have concerns about your previous care involving a caesarean section or natural birth or if you consider it fell below the proper standard, please contact the Clinical Negligence team on 01254 770501 to discuss the matter further.

Learn more about our Clinical Negligence department here

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