Is natural birth too risky after you have had a C-section?

The history of caesarean births is cloaked in myth and mystery. According to one account, the first successful caesarean may have been performed in the 1500s when a sow-gelder in Switzerland delivered his first baby. According to the story, both the mother and child survived. The mother went on to have five more babies - all natural births. And the caesarean baby lived to 77.

Historians have raised questions about the accuracy of this story. But it does tell us one thing for sure: for as long as there have been caesarean operations (C-sections), there have been questions about whether women can safely deliver their next baby naturally.

Representational image. Image source: Getty Images.

Rise of Caesareans

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Year-on-year, more women are giving birth through C-sections. The reasons can vary from doctor’s recommendation to the fear of pain during natural birth. Globally, around 18.6% of babies are born through caesarean operation - India has a slightly lower incidence, at 17.2%.

“There are some reasons why doctors recommend a caesarean. For example, if it’s your first pregnancy and you have a breech baby (the baby is upside down in the womb), then we mandatorily do a C-section,” said Dr Archana Nirula, a senior gynaecologist associated with myUpchar.

Women who become pregnant again after undergoing a C-section the first time, often have elective repeat caesarean section (ERCS), partly because of the risks involved in vaginal birth after caesarean (VBAC).

“The mother-to-be's gynaecologist may give her a green light to try for a spontaneous birth the second time if the mom and baby meet a few conditions. One, the reason why they had a caesarean the first time should not occur again - say, the mom had a breech baby the first time, but the second baby is in a cephalic position (head first). Two, the scar from the first C-section should have thinned (healed) appropriately and the doctor should feel it may be able to take the pressure of normal delivery,” she added. “Even then, the mother-to-be should only try for a natural delivery in a hospital that can do an emergency C-section - if the need arises.”

Risks of Vaginal Delivery

Parents-to-be often have misgivings about the safety of VBAC. Seeing this, a new study has compared the risk of VBAC birth and ERCS.

Researchers from the University of Oxford studied the health of 74,043 women in Scotland who had previously had a C-section. Of these, 45,579 women opted for ERCS birth whereas 28,464 chose VBAC; 28% had non-elective repeat caesarean delivery.

The researchers found that the women who had planned a VBAC suffered more health complications than those who went for ERCS:

• 1.8% of women who had planned VBAC and 0.8% of women who had planned ERCS birth had complications like uterine rupture or sepsis
• 0.24% of women who chose VBAC births had a uterine rupture while 0.04% of those who delivered by ERCS experienced the same
• About 1.14% of women who opted for VBAC birth needed a blood transfusion during delivery while only 0.5% of women who delivered by ERCS needed blood
• Adverse infant health outcomes like stillbirth or admission to the neonatal unit were 8% for VBAC births and 6.4% for ERCS births

VBAC birth has only marginally higher risk than ERCS birth. But the risks are very real. Mothers-to-be should arrive at an informed decision in consultation with their doctor.

“Nearly half the women who have a C-section can deliver spontaneously the next time. But they should talk to their doctor. It is important for them to understand their choices and weigh the options,” said Dr Nirula.

Clear for VBAC?

Your health, your baby’s health and the type of scar you have from the previous C-section are all deciding factors for whether you can have a VBAC.

You can go for a VBAC even if you are pregnant with twins, but only if you and your babies are in good health. However, your doctors will not allow it if:

• You are obese, with a body mass index higher than 30
• You have high blood pressure during pregnancy
• The foetus is too large
• You are over 35 years old
• You had your previous Caesarean in the last 19 months

Previous C-section scar: In a C-section, the incision can be done vertically or from side to side (transverse). If your previous C-section was vertical, your doctor will likely advise against a VBAC because there is a high risk that the scar will rupture during VBAC - which could be harmful to you and your baby.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please read our article on Caesarean Birth.