Planned repeat cesarean birth lowers risk of complications and infant death

Washington - Women who have had one prior cesarean can lower the risk of death and serious complications for their next baby - and themselves - by electing to have another  cesarean.

This is the finding of a major study led by the University of Adelaide and it involves more than 2300 women and their babies and 14 Australian maternity hospitals.

The study, known as the Birth After Caesarean (BAC) study, is the first of its kind in the world.

The study found that infants born to women who had a planned elective repeat cesarean had a significantly lower risk of serious complications compared with infants born to mothers who  had a vaginal birth following a prior cesarean - the risk of death or serious complication for the baby is 2.4 percent for a planned vaginal birth, compared with 0.9 percent for a planned  elective repeat cesarean.

The mothers of these babies were also themselves less likely to experience serious complications related to birth. For example, the risk of a major hemorrhage in the mother is 2.3 percent  for a planned vaginal birth, compared with 0.8 percent for a planned elective repeat cesarean.

“Until now there has been a lack of high-quality evidence comparing the benefits and harms of the two planned modes of birth after previous cesarean,” said the study’s leader, Professor

Caroline Crowther from the Australian Research Centre for the Health of Women and Babies (ARCH), part of the University of Adelaide’s Robinson Institute.

“The information from this study will help women, clinicians and policy makers to develop health advice and make decisions about care for women who have had a previous cesarean.

“Both modes of birth have benefits and harms. However, it must be remembered that in Australia the risks for both mother and infant are very small for either mode of birth,” Professor  Crowther noted.

Cesarean section is one of the most common operations performed on childbearing women, with rates continuing to rise worldwide. Repeat cesarean births are now common in many  developed nations.

“We hope that future research will follow up mothers and children involved in this study, so that we can assess any longer term effects of planned mode of birth after cesarean on later  maternal health, and the children's growth and development,” Professor Crowther added.

The results are published this week in the international journal, PLoS Medicine.