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Repeat Caesarean Section, do you need one?



If you're pregnant following a previous caesarean section, you may be feeling slightly frustrated and anxious about the birth of your baby. You will need to decide if you will have a repeat elective cesarean or try for a vaginal birth also known as a VBAC.


Your care providers, midwife and OBGYN, may have a plan to guide you down the route of elective repeat caesarean and may suggest it's the safest option for you because you have a scar from your previous caesarean on your uterus.

But is this correct information?

Is it safer to have another major surgery on your uterus?

Do women have a high risk of having a uterine rupture after a previous caesarean?

What effects does having another cesarean have on my baby and me?

Am I a candidate for VBAC?


It's important to ask as many questions as possible and find the answers. Not just answers on parenting websites, but the facts so you are well-informed and know how to handle any situations that may occur. You cannot rely on your care providers to provide you with the facts as it's your duty to search and find the truth.

Many organisations and studies state the caesarean section rates are ridiculously out of control, yet, women are still having unjustified caesareans which can increase the medical risk for both mother and baby when done excessively. Tadevosyan et al

We are not telling you not to have a caesarean because it's imperative to remember when a caesarean section happens for a genuine medical emergency; it can save the mother and babies life. But we do want to raise awareness on the risks associated with caesarean sections being it is significant and has massive long term effects on the mother and baby.


It has been advised by the WHO, that we need to reduce and maintain a caesarean rate of between 10%-15% to ensure we preserve the safety and the best outcome for mum and baby.


Unfortunately, the caesarean section rates are still climbing out of control and women are experiencing more difficulties due to the caesarean sections.


What is a Caesarean section?

A caesarean section is an operation performed by a qualified obstetrician and surgeons to deliver your baby through an incision made into your stomach, the abdominal wall and into your uterus. You will be given a strong pain medication called anaesthetic so you wont feel the procedure. Depending on the medical emergency you can be awake for the procedure or you may need to be asleep.


What are the risks of a caesarean?

Please remember a caesarean is major surgery and can pose some risks to you and your baby. If you have a caesarean you have an increased risk of


  • Blood Clots - you may receive blood clot in one of your deep veins which may travel to your lungs and become life threatening also known as Deep vein thrombosis

  • Infection to your womb or the lining of your womb -

  • Problems in future pregnancies - Stillbirth, miscarriage, placenta accreta, placenta previa and low lying placenta

  • Postpartum Haemorrhage - Excessive bleeding may occur

  • Death (Rare)

  • Injury to the baby - Sometimes babies can get cut during the caesarean delivery

  • Injury to your bowel

  • Allergic reaction to the medication used during a c-section

  • Injury to your bladder

  • Infection in your scar wound

  • Your baby may experience breathing problems


Do I have to have a repeat caesarean if I've previously had a caesarean birth?

The answer is NO; you do not. The guidelines state the majority of women who choose a VBAC are successful Keedle et al. But we must understand there are a few reasons why selecting a VBAC would be unsafe and may put your life or your babies life at risk.


  • If you've had a classical caesarean scar

  • You have a pregnancy complication that may cause great danger to yourself or your baby during birth

  • You've had a previous uterine rupture

  • You have a health complication

  • Placenta Previa

Remember VBAC is safe for the majority of women


When is the best time to have a caesarean?

I interviewed the world-renowned Michel Odent, a French Obstetrician who is the author of many of the pregnancy, labor and professional birth books we see today. He is also a public speaker and spends a considerable amount of time going through research and compiling data, and in 2020 I interviewed him as I do every year for our VBAC Summit 2020, and he told me something very profound. He said if the fetus could talk the baby would say to you to allow him to go into labor and not do the caesarean before labor had started, but he also said caesarean should take place before an emergency has arisen.


Is it safe to have a caesarean before 40 weeks gestation?

When babies are born before the body is ready to go into labor, this can affect the baby instantly after birth and can pose long term health conditions for the child later on in life.


  • A cohort study of 2086 women who had a caesarean by Pirjani et al. shows us

1002 ( 48%) women had a caesarean section between 38 and 39 weeks gestation, and the babies showed a higher rate of having TTN Respiratory distress and NICU admissions following the birth compared to elective caesarean deliveries after 39 weeks gestation.

  • Matsuo et al. Reported babies born by pre-labor caesarean between 38 - 39 weeks gestation these babies had severe neonatal respiratory complications (RDS and TTN) which mirrored a study in Japan with 415 pregnant women who underwent scheduled cesarean delivery at 38 and 39 gestational weeks.

  • Balchin et al. found In a study of 442,596 South Asian and Black women the respiratory dysfunction rate was lower in white infants who mothers went for a section after 39 gestational weeks and in south Asian babies whose mothers had a scheduled C-section at 38 weeks gestation.


The studies above prove it is safer to have a caesarean after 39 weeks gestation. If you end up having a caesarean between 38-39 weeks gestation your baby may experience respiratory problems and will have an increased risk of needing NICU care post the birth.


How many women have caesareans?

In the United Kingdom, 1 in 4 babies are born via caesarean section, and the caesarean rate is currently 26.2

In the United States of America 1 in 3 babies are born via caesarean, and the caesarean rate is 32.2%

In Australia 1 in 3 babies are born via caesarean, and the current c-section rate is 33%

In Saudi Arabia,


Can I still be in control of my caesarean?

Most certainly. In many countries you can only have one person with you during a caesarean birth bring your own pillows, you can have your birthing partner with you and your VBAC practitioner or doula with you so you can still have the support you need.


Conclusion

If you decide to have a repeat caesarean section make sure you know the facts and do as much research as you can to stay informed and keep in the loop. It's ok to choose a repeat c-section as long as it's your decision and you haven't been forced into thinking having a VBAC is dangerous. I had a successful VBAC 3x and many women have VBACs.


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