| Three prior caesareans no barrier to VBAC |
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| Friday, 05 February 2010 10:25 | |||
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Women who have three or more prior caesarean sections (CS) are just as successful at attempting a vaginal birth as those that have had one previous CS. This is the finding from a study that reviewed data from 25,005 women who had at least one previous caesarean delivery in the US. The study not only looked at success rates for vaginal birth after caesarean section (VBAC) but the risk of maternal morbidity. In total, 860 had three or more previous caesarean deliveries and, of these, 89 attempted VBAC. The study found they were as likely to have a successful VBAC as women with one or two prior CS – 79.8% compared to 75.5% for one CS and 74.6% for two previous CSs. Furthermore, none of them experienced significant maternal morbidity, such as uterine rupture, uterine artery laceration and bladder or bowel injury. The authors note that neither the RCOG nor the American College of Obstetricians and Gynecologists recommend planned VBAC attempts in women with three or more previous CS. BJOG editor-in-chief Professor Philip Steer said: ‘Although confidence in the findings of the study is limited by the relatively small sample size of women who have had three previous caesareans, these findings provide additional information for women, and contribute to the available evidence on VBAC success and safety in women with more than one prior CS.’ The RCM’s general secretary Cathy Warwick said: ‘This is a welcome study challenging the status quo in childbirth practice, providing significant new information for women choosing VBAC.’ She added that VBAC is an individual’s choice when exploring options for labour, and is sometimes a difficult choice for women to make, but it should always be discussed and supported by midwives and other health professionals providing care to the pregnant woman.
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