‘This is a fresh look at the evidence supporting vaginal birth after  caesarean section. A new guideline by the world body of obstetricians and gynaecologist supporting birth after caesarean has refuted the old saying of “Once a caesarean, always a caesarean,” reports Sade Oguntola.

Mrs. Tola Tamuno, a 30-year old mother of two, concern had been the fear that she would again need to have caesarian section rather than the option of trying vaginal birth.

With her husband retrenched and several bills to be met, a repeat of another caesarean section would be an additional drain on the lean pocket of the family.

Each time the prayer rendered in songs that God should make every pregnant woman deliver her baby without having a caesarian section is sang when she goes for antenatal care, Mrs. Tamuno renders it with all her heart.

For years, the medical profession has seen caesarian section as a life-saving option to adopt. It is the most acceptable option to prevent women dying from prolonged or stalled labours, where babies were stuck in positions and couldn’t navigate a birth canal or developed other complications in labour.

But in Africa communities, many women see it as abnormal to deliver their babies through a caesarian section. In fact, so much fear is attached to caesarian section that sometimes some women told they may require having their babies through caesarian section run to prayer homes to deliver their babies. Some were lucky to deliver their babies safely, while some died as a result of complications of labour.

In recent years, doctors have been refusing to let some women have natural birth, insisting on repeat caesarean section instead because of the fear of the womb rupturing. A ruptured womb can be life threatening for both the mother and the baby.

The rule and the myth attached to caesarian section infuriated many women, thus their turning to other places outside of the hospital such as religious homes and traditional birth attendants.

It’s important that mothers know all of their options of given birth and ultimately make their choice. Doctors say natural births after caesarean sections are safe for most women under some conditions.

While still a concern that repeat caesareans can cause the womb to rupture, a new guideline released by the American College of Obstetricians and Gynecologists indicated that women with two previous caesarean birth and no previous vaginal delivery women expecting twins and women with an unknown type of scar from the previous C-sections could be considered candidates for vaginal delivery.

However, Professor Ladapo Ladipo, President, Association for Reproductive and Family Health (AFH), Ikolaba, Ibadan, explained that whether a woman would require a repeated caesarian section is dependent on what was the initial reason for this option of birth.

According to him, “if the reason for the C-section was an obstructed labour due to her pelvic girdle  being small, the chances of her requiring another C-section is very high because the baby would be bigger than the birth canal.”

“This situation is different from when the baby was distressed and the only way to ensure the baby does not die was to quickly carry out a C-section. Of course, this type of woman would have no reason to have another C-section next time she is pregnant,” he declared.

But, Professor Ladipo stated that any pregnant woman who has had a C-section would be better  going to a hospital that can provide immediate emergency care.” With an obstetrician and the required facilities on ground any problem would be quickly attended to if a woman opts for vaginal birth after Cesarean, “he said.

Professor Adewale Sule-Odu, a consultant obstetrician and gynaecologist, Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, explained that having a normal delivery after a previous C-section is only safe under some circumstances.

He explained that carrying a very large baby can drastically reduces a woman’s chances of being able to deliver vaginally, serious pregnancy complications such as a wrong positioning of the placenta, a wrong lie of the baby and the woman having other medical conditions that may affect her ability to withstand labour.

According to him, “usually a baby presenting with the head is far better and in some situations when we recognise the fact that we may have problems with the baby’s positioning, we measure the diameter of the pelvic girdle that the baby would pass through and compare it with the diameter of the baby. This to be sure that the woman will be able to deliver the baby naturally or asked her to have a C-section.”

“Some of the women may be hypertensive or have a heart problem. Medical conditions as these may not allow them to pull through the stress of labour and as such asking that they have C-section.”

For some women, a vaginal birth after a caesarean remains an inappropriate choice. But for many, if not most women, choosing a trial of labour when they have had a C-section could be a choice since a caesarean delivery in the past doesn’t mean a woman must automatically have one in subsequent pregnancies.

Fortunately, there are certain factors that can make a difference in determining a woman’s chances of having a C-section. Women who begin their pregnancies overweight or obese have less success when attempting vaginal birth after caesarean.

Age is also a factor. For instance, chances of having vaginal birth after caesarean also decline gradually with age. Mothers who have given birth to big babies once are likely to do so again and should probably opt for a repeat cesarean.

Also, women that had a previous C-section because the labour failing to progress or their baby was in distress stand a higher chance of needing a repeat caesarean. The same goes for women who have had a rupture womb or a length-wise incision, often done in emergency C-sections.

Meanwhile women and their health care providers will feel a sense of shared decision-making. Rather than provide a directive of ‘you can’ or ‘you can’t’ do this, women need to have more information about the potential risks and successes on repeated C-section or a trial of labour after C-section.

Neither an elective repeat C-section nor a trial of labour after C-section is without risk to mother and baby. Both are associated with risks of bleeding, infection, operative injury and other problems.