This article appeared on page 3 of the Weekend Australian (29-30 Nov 03) - Food for thought in the VBAC/csec decision as this is potentially applicable to any woman who has a csec (1st or not) and then a subsequent pregnancy.
Caesareans Put Next Child At Risk
by Helen Tobler Medical Reporter
by Helen Tobler Medical Reporter
Women who give birth to their first baby by caesarean section could have double the risk of an unexplained stillbirth in their next pregnancy.
new research to be published today prompted experts to warm women to reconsider having a caesarean section if the procedure was not necessary.
One in four Australian women give birth by caesarean - one of the highest rates in the developed world and higher than the World Health Organisation's recommendation of 15 per cent.
A study of more than 120 600 second births in Scotland between 1992 and 1998 found the proportion of stillbirths in second pregnancies was almost double amont the women who had had caesareans.
The risk of stillbirth was 2.4 per 10 000 per week among those who had had caesareans compared with 1.4 per 10 000 per week for those who had vaginal births.
The researchers, whose study appears in The Lancet, said the link could be explained by damage to blood vessels in the uterus or placental abnormaliti! es caused by surgery.
Head researcher Gordon Smith, from the University of Cambridge, said the results were unlikely to change the decision to have a caesarean for a breech baby.
"However if women are being counselled about caesarean birth with no clear obstetric advantage, such as caearean section for maternal request, the possible effect on the risk of unexplained stillbirth in future pregnancies should be discussed", he said.
Michael Bennett, professor of obstetrics and gynaecology at the University of NSW and Sydney's Royal Hospital for Women, said most caesarean were done for health reasons.
Professor Bennett said only 3 per cent to 5 per cent of women who have caesareans do so by choice.
"The majority don't actually have a choice," he said.
The added risk of stillbirth that the study showed was "an extra tiny fraction" of the overall risks.
Judith Lumley, director of the centre for study of mothers' and children's health at La Trobe Universi! ty worte a commentary for The Lancet.
"The finding ....that caesare an increases the risk of unexplained stillbirth before labour in the next pregnancy has the potential to redefine the nature of the debate about the place of caesarean delivery in maternity care."
new research to be published today prompted experts to warm women to reconsider having a caesarean section if the procedure was not necessary.
One in four Australian women give birth by caesarean - one of the highest rates in the developed world and higher than the World Health Organisation's recommendation of 15 per cent.
A study of more than 120 600 second births in Scotland between 1992 and 1998 found the proportion of stillbirths in second pregnancies was almost double amont the women who had had caesareans.
The risk of stillbirth was 2.4 per 10 000 per week among those who had had caesareans compared with 1.4 per 10 000 per week for those who had vaginal births.
The researchers, whose study appears in The Lancet, said the link could be explained by damage to blood vessels in the uterus or placental abnormaliti! es caused by surgery.
Head researcher Gordon Smith, from the University of Cambridge, said the results were unlikely to change the decision to have a caesarean for a breech baby.
"However if women are being counselled about caesarean birth with no clear obstetric advantage, such as caearean section for maternal request, the possible effect on the risk of unexplained stillbirth in future pregnancies should be discussed", he said.
Michael Bennett, professor of obstetrics and gynaecology at the University of NSW and Sydney's Royal Hospital for Women, said most caesarean were done for health reasons.
Professor Bennett said only 3 per cent to 5 per cent of women who have caesareans do so by choice.
"The majority don't actually have a choice," he said.
The added risk of stillbirth that the study showed was "an extra tiny fraction" of the overall risks.
Judith Lumley, director of the centre for study of mothers' and children's health at La Trobe Universi! ty worte a commentary for The Lancet.
"The finding ....that caesare an increases the risk of unexplained stillbirth before labour in the next pregnancy has the potential to redefine the nature of the debate about the place of caesarean delivery in maternity care."
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