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Op no bar to normal birth

Wednesday February 3rd, 2010

Women can safely attempt normal birth even after having several babies through a caesarean operation, researchers reported today.

The findings challenge the convention that after three caesarean births a woman should not attempt normal birth.

Currently, both the American College of Obstetricians and Gynaecologists and the UK's Royal College of Obstetricians and Gynaecologists recommend an elective repeat caesarean attempt for women with three or more prior caesareans.

But the figures available on normal birth after caesarean (VBAC) among women with more than two prior caesareans are limited. Complications such as uterine rupture have been reported but rates appear to be low.

Dr Alison Cahill of Washington University in St Louis, Missouri, USA, and her team looked at figures from 25,005 women who had a least one prior caesarean delivery and gave birth between 1996 and 2000.

Those with three or more prior caesarean deliveries (89 women) experienced equal rates of adverse outcomes whether they attempted a VBAC or had an elective repeat caesarean. They were almost as likely to be successful with a VBAC as those with one or two prior caesareans: 80 per cent compared to 76 per cent and 75 per cent respectively.

Details are published in BJOG: An International Journal of Obstetrics and Gynaecology.

Dr Cahill said: "These data suggest that perhaps it is time to revisit the current recommendations for VBAC attempts for women with more than one prior caesarean. Given appropriate patient selection, VBAC following two or even three previous caesareans in certain cases may be reasonably safe."

Cathy Warwick of the Royal College of Midwives commented: "This is a welcome study challenging the status quo in childbirth practice, providing significant new information for women choosing a VBAC."

Cahill, A. et al. Vaginal birth after caesarean for women with three or more prior caesareans: assessing safety and success. British Journal of Obstetrics and Gynaecology, published online February 3, 2010.

Tags: Childbirth and Pregnancy | North America | Nursing & Midwifery | Women’s Health & Gynaecology

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