Women who give birth through caesarean section can safely plan to use natural birth for future pregnancies, according to guidelines published today.
The guidelines aim to reduce the high rate of caesarean section by reassuring women that natural birth is a "safe choice" for future pregnancies.
The Royal College of Obstetricians and Gynaecologists said that vaginal births in these circumstances have a 75% success rate – with 25% ending up in caesarean operations.
This is about the same rate of caesarean sections as is found in first pregnancies, the college says.
Overall about 15% of births take place through emergency caesareans and 10% through elective caesareans.
The guidelines say that if there are no clinical reasons after 20 weeks of gestation for a vaginal birth not being attempted, doctors and midwives should "begin a conversation" with the mother. A decision should be made by the 36th week.
The college says that overall vaginal births have fewer complications than repeat caesarean. But there are small increased risks of uterine rupture and stillbirth – and there are increased risk of serious complications if the pregnancy ends in an emergency caesarean.
Professor Janesh Gupta, who developed the guidance, said: “Women can be assured that in most cases it is possible and safe to have a vaginal birth after a previous caesarean section.
"This guideline can be used to aid doctors in their assessment of individual women and, unless there are clinical reasons why a vaginal birth should not be attempted, help inform the woman and her partner of her choices and the risks involved with either vaginal birth or a repeat caesarean section.”
The Green-top Guideline Birth after Previous Caesarean Birth [Guideline – pdf]
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