A study by a group of Australian researchers—the Birth After Caesarean Study Group— published in this week's PLoS Medicine, suggests that in women who had a previous caesarean section, delivering their next baby by a planned repeat caesarean section was linked to better health outcomes for the mother during her stay in hospital and also better outcomes for her baby compared to having a vaginal birth.
The researchers, led by Caroline Crowther from the Australian Research Centre for Health of Women and Babies based at the University of Adelaide, recruited 2345 suitable women—women who had one previous caesarean section, were currently 37 weeks pregnant with a single baby and who were clinically able to have a vaginal birth— from 14 maternity hospitals throughout Australia. Depending on the woman's preferences for mode of birth, or willingness to be randomized, participating obstetricians either scheduled a date for an elective caesarean section (1108 women) or assessed on-going suitability for the woman to have a planned vaginal birth (1237 women).
The researchers found that women who had a planned caesarean section experienced less severe bleeding than women who gave birth vaginally. Furthermore, there was also a reduced risk of non-fatal serious outcome before discharge from hospital for infants born by planned repeat caesarean section. The researchers calculated that one infant death or near death would be prevented for every 66 planned elective repeat caesarean sections performed in women who had a previous caesarean section.
The researchers say: "Our results, whilst not generalisable for other populations, indicate that for women who have had one previous caesarean birth and are considered eligible at term to attempt a planned [vaginal birth] in their next pregnancy, an [elective repeat caesarean section] as planned mode of birth is significantly associated with a lower risk of both fetal death or liveborn infant death prior to discharge or serious infant morbidity and major maternal haemorrhage without increasing other maternal and perinatal complications.
The authors conclude: "Women, clinicians, and policy makers can use this information to develop health advice to assist in making evidence-based decisions about care for women who have had a previous caesarean and their infants."
In an accompanying Perspective, Catherine Spong from the National Institute of Child Health and Human Development in the USA (uninvolved in the research study) says:
"What is needed is a new way to counsel patients, be it new data or better categorization of patients' risk."
Article by Crowther and colleagues
Funding: This project was funded by a three-year project grant from the National Health and Medical Research Council, Australia; and a grant from the Women's and Children's Hospital Foundation, South Australia. JD was supported through a National Health and Medical Research Council Neil Hamilton Fairley Clinical Fellowship (ID 399244) and an NHMRC Practitioner Fellowship (ID 627005). Infrastructure support was provided by the Australian Research Centre for Health of Women and Babies (ARCH), The University of Adelaide. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Crowther CA, Dodd JM, Hiller JE, Haslam RR, Robinson JS, et al. (2012) Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial. PLoS Med 9(3): e1001192. doi:10.1371/journal.pmed.1001192
CONTACT:
Caroline Crowther
Australian Research Centre for Health of Women and Babies (ARCH)
The Discipline of Obstetrics and Gynaecology
University of Adelaide
Adelaide
Australia
caroline.crowther@adelaide.edu.au
Perspective by Catherine Spong
Funding: No specific funding was received to write this article.
Competing Interests: The author has declared that no competing interests exist.
Citation: Spong CY (2012) To VBAC or Not to VBAC. PLoS Med 9(3): e1001191. doi:10.1371/ journal.pmed.1001191
CONTACT:
Catherine Spong
National Institute of Child Health and Human Development
Bethesda
Maryland
United States of America
spongc@mail.nih.gov
Journal
PLoS Medicine