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Vaginal Birth After C-Section: Risk Low

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WebMD Health News

May 21, 2002 -- You've had a C-section. Now you're pregnant again and want to try normal delivery. What should you do?

For most women, the surprising answer is this: decide for yourself. There are many things to consider. One of them is the latest report in the Journal of the American Medical Association by Gordon C.S. Smith, MD, PhD, of England's Cambridge University.

Smith and colleagues find that the risk of a baby dying during labor is very low: a little more than 1 in 800. But that same study shows that the risk is 11 times lower if the mother plans -- and has -- a second C-section. The risk that the mother will die during labor is also very low (less than 1 in 2,000), but it's eight times higher than if she had a planned C-section.

What does all this mean to a pregnant woman?

"The absolute risk [of vaginal birth after C-section] is low," Smith tells WebMD. "I don't want this to worry women. It is a very small risk of death. However, there is no way of getting around the fact that a planned C-section is a very safe way to have a baby. If the prime intent is to avoid risk to the baby -- and further pregnancies are not being considered -- then a second C-section may be the best way to go."

Even this cautious opinion is not held by all experts. Lisa Paine, DrPH, is a certified midwife and past chairwoman of the department of maternal and child health at Boston University.

"For a woman coming in the office, [the Smith study] is one piece of information. But the woman's decision will not rest on these findings," Paine tells WebMD. "The woman's own situation and family and feelings about things has to be taken into consideration. Other issues are the consequences of a planned cesarean."

Paine maintains that natural childbirth and a C-section are not two different ways of doing the same thing.

"We are comparing apples and oranges, vaginal birth vs. C-section," Paine says. "For the woman, it is the difference between the experience of serious abdominal surgery and the experience of normal vaginal birth. So what people should ask is, 'What are the expected outcomes of these two events for the mother, for the child, and for the family? What are the benefits, the risks, and the personal preferences?'"

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