Do you see many cases of women with a previous caesarean section?
The rate of caesarean section around the world is approximately 30% and increasing. This means that 1 in every 3 babies is born by caesarean section. Therefore, women returning in a 2nd pregnancy who had a previous caesarean section is a very common occurrence.
What additional treatment do you recommend in this pregnancy?
In general, the antenatal care in this pregnancy is relatively straightforward. Iron supplements may be advisable if the woman is found to be anaemic. The main risk applies to women with multiple previous caesarean sections. There is a very small risk that the placenta in this pregnancy can attach itself close to where the previous caesarean scar is located. Although this is rare, this can lead heavy bleeding after delivery.
What advice can you offer regarding mode of delivery in this pregnancy?
The most important aspect of caring for women with a previous caesarean section is a detailed discussion regarding the mode of delivery for this baby. The choice is between an elective repeat caesarean and attempting a vaginal birth after caesarean (VBAC). VBAC is not generally considered safe after 2 or more caesareans but can be a very good option for women with 1 caesarean only, particularly for couples who want more children in the future.
It is important that the woman and her partner are aware of the issues regarding VBAC versus elective repeat caesarean section. The overall rate of successful VBAC is approximately 70% for women who labour spontaneously. There is a small (1-in-200) risk of scar rupture during labour. Every couple will have their own ideas regarding the best mode of delivery for their baby. Once these issues have been discussed in detail, we are happy to support whatever is the right decision for you.