Vaginal Birth After Cesarean: The Facts

What are the potential risks of a cesarean?
The risks of planned repeat cesarean fall into three categories:

1. Risks of cesarean, compared with vaginal birth (14):
Cesarean section results in more pain, debility, and a longer recovery period. It substantially increases the risk of infection, injury to other organs, hemorrhage, and blood clots. These complications, in turn, increase the likelihood of prolonged hospitalization, hysterectomy, readmission to the hospital, and maternal death. Babies who were healthy before delivery are more likely to be born in poor condition or have breathing difficulties. In the long term, cesareans can lead to chronic pain or bowel problems, and they increase the risk of infertility, miscarriage, placental abruption (placenta detaching before the birth), and placenta previa (placenta overlaying the cervix).

2. Excess risks of planned cesarean versus labor:
Hysterectomy: In the Swiss study, three times as many women having planned cesareans required hysterectomies as women who labored (45 per 10,000 versus 16 per 10,000) (15,30). Among 29 other studies, comprising 18,500 planned cesareans and 38,700 labors after cesarean, hysterectomy rates were also tripled in the planned cesarean group (21 per 10,000 versus 7 per 10,000) (15).

Blood clot complications: In the Swiss study, planned cesarean doubled the risk of blood clot complications (43 per 10,000 versus 22 per 10,000) (30).

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