Oct. 23, 2019&mdash;Pregnant women who've had a cesarean have an important decision to make about how to deliver another baby. They can choose a second C-section. Or they can attempt a vaginal birth. But which is safer?
A new, large study published in <a href="https://journals.plos.org/plosmedicine/">PLOS Medicine</a> may offer some guidance. It found that a vaginal birth was riskier for mothers and babies alike. But overall, the risk of serious complications from either type of delivery was small. 
The study looked at data on more than 74,000 births in Scotland between 2002 and 2015. Of the women who attempted a vaginal birth after a cesarean (VBAC), 28% needed an emergency cesarean. 
Women who opted for a VBAC had a higher risk of a ruptured womb, surgical injury and sepsis, a life-threatening reaction to an infection that can cause organ failure and death. They also were more likely to need a blood transfusion. 
Their babies faced an added risk of stillbirth, admission to a neonatal unit, resuscitation requiring drugs or intubation, and lower-than-average Apgar scores. (The Apgar test measures things like a baby's heart rate, breathing, muscle tone and reflexes.) 
Still, overall only 1.8% of the mothers attempting a VBAC had any serious complications. That compared to 0.8% of those who had a planned cesarean.
As for the babies, 8% of those whose mothers attempted a VBAC had one or more complications reviewed in the study. That compared to 6.4% of those who arrived by a planned cesarean. 
Questions for your doctor
This study revealed a low, but real, added risk for attempting a VBAC. That means it's crucial to carefully discuss this type of delivery with your doctor if you're considering one. Here are some questions you might ask: 
<ul>
 <li>What are the benefits and risks of a VBAC?</li>
 <li>Am I a good candidate for a VBAC? </li>
 <li>Could the type of incision used for my past cesarean raise my risk of a ruptured womb? Certain incisions can. </li>
 <li>Is emergency care available if I were to have a problem during a VBAC? </li>
 <li>If I opt for a VBAC, what conditions may increase my chances of needing an emergency cesarean? </li>
</ul>
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