Posted by Jyoti Pal on July 22, 2010

The rule "once a Caesarean, always a Caesarean" was largely based on the fact that the scar left in the womb from a previous c-section might tear open during labor, causing excessive bleeding, putting both mother’s and baby’s life at risk.

As a result, nearly 90 percent American women who’ve already had a first c-section opt for a repeat caesarean.

However, results of recent studies show that the risk of uterine rupture or tear is quite low, only 0.7 percent to 0.9 percent. Furthermore, nearly 60 to 80 percent who opt for vaginal birth after Caesarean (VBAC) can successfully do so, experts highlight.

Latest guidelines of the American College of Obstetricians and Gynecologists
According to the latest guidelines issued by the American College of Obstetricians and Gynecologists (ACOG), an expecting woman who has had a prior C-section should be given an informed option to go in for a VBAC.

"Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives," they say.

Referring to a planned VBAC attempt, Dr. Jeffrey L. Ecker, co-writer of the new guidelines, said, "For most women with a previous cesarean delivery, a trial of labor is a safe and appropriate option."

VCAB is reasonably safe for women carrying twins and those who have had two prior Caesareans, provided the cut in the uterus is low and horizontal.

While a spontaneous, as opposed to induced, labor increases the likelihood of a successful VBAC, older maternal age, obesity, and short time between pregnancies decreases its success rate, Ecker highlighted.

Risk of repeat Caesareans
Caesarean delivery heightens the risk of placental problems in later pregnancies. Placental problems are linked to hemorrhage and hysterectomy, surgical removal of a woman’s uterus.

Babies who are born VBAC, as against those born with a repeat Caesarean, run an increased risks of stillbirth. However, they stand a reduced risk of breathing problems and jaundice, experts say.

The latest guidelines feature in the online issue of the journal Obstetrics & Gynecology.




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