If previous c-section is not considered a high risk pregnancy, why are many midwives now not allowed to care for a woman who has had a previous c-section? If women who have had a previous c-section aren't considered high risk, why do many areas of the country (including the one that I live in) not allow them to give birth vaginally anymore? Whether women who have had previous c-sections *should* be considered "high risk" I think is definately debatible; I personally think they aren't, in most circumstances. But ACOG isn't calling me on a regular basis to ask my opinion!!
C-section comes with many risks. Of course everyone knows that. There is much higher morbidity and mortality with c-section vs. vaginal birth; yet, for many instances, the risk of infection, hemorrhage, surgical complications, uterine rupture and adhesions do not outweigh the risk to mother and baby if a vaginal birth were to continue. A c-section is a wonderful means of saving the life of a mother and child, and of preventing long-term health complications in both mother and child. C-section rates of 25-30% or more is horrible, though, and it is completely unnecessary and is putting moms and their future babies at risk. This study shows one of those risks.
You can go to www.thelancet.com
to read the abstract of the study. You have to register, but registration is free, and of course, you can be like me and register some completely bogus name and address, if you don't want to give your own.
Then you can judge the validity of the study and its methods for yourself, and come to your own conclusions.
My reading of the article doesn't lead me to believe that this risk is such that, if there is a present risk to a mom or baby, it should be a determining factor in deciding for a c-section or not. BUT, in elective c-sections, this is a risk that should be considered, and that the mom who is thinking about an elective c-section should be aware of this risk.
Because the fact of the matter is, women with a previous c-section experienced unexplained stillbirth at twice the rate of women who had no history of c-section (This from the abstract on the Lancet website):
" The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not."
While the numbers are still small, that is a statistically significant (very significant) difference! And the numbers studied were not small (again, from the Lancet abstract):
" For 120 633 singleton second births, there were 68 antepartum stillbirths in 17754 women previously delivered by caesarean section (2·39 per 10 000 women per week) and 244 in 102879 women previously delivered vaginally (1·44; p<0·001). "
This isn't the study that definitively tells all....but I think that it points to yet another risk of c-section that needs to be weighed when a c-section is being considered.
Anyhow, go to thelancet.com and read the abstract and judge for yourself!!
edited for clarity, though I don't know if it helped much!!!