Q. ive previously had a c section a year ago,im 25 weeks pregnant now can i have a repeat section?first one was brech

A. For a lot of women having their first baby, one of the main reasons for having a caesarean is when their baby is found to be in the breech position (‘bottom down'). While in the past, once a caesarean section had been performed it was often automatic that any future births would also be by caesarean, this is now no longer the case. The placement of the incision (cut) favoured in the past meant that there was a risk of the uterus (womb) tearing during labour. However, a change in the location of this incision (called a lower segment caesarean section (LSCS) /'bikini line' incision), has meant that this risk has been greatly reduced. Alongside serious concerns and publicity about the high rate of caesarean section births, the UK maternity services and health professionals are trying to ensure that caesareans are only performed when absolutely necessary.

While it is recognised that having your baby by caesarean section is much safer now than it was sixty years ago, a vaginal birth has always been safer than a caesarean and this is still the case. Despite improved techniques, maternal deaths from caesarean section are still five times higher than from vaginal birth. For emergency (‘unplanned') caesareans, this figure increases to twelve times higher, and even for planned (‘elective') caesareans the mortality rate is twice that for vaginal birth. You may also recall that recovering from a caesarean birth is likely to take longer than from a vaginal birth, because you are recovering from a major operation and have an abdominal wound. This often means it is more painful to move about, to get comfortable, to look after your baby, and get started with breastfeeding. Having a caesarean birth also increases your risk of developing postnatal complications, such as infection, and needing to be re-admitted to hospital in the postnatal period. The risks associated with having a caesarean also increase with the number of caesareans a woman undergoes. This is why, where there are no medical or obstetric indications for delivering a subsequent baby by caesarean section, your doctor is likely to suggest that you consider a vaginal birth - this is termed vaginal birth after caesarean (VBAC).

Research shows that VBAC is safe for the majority of women who have had an LSCS, and that undertaking repeat caesareans where there is no obvious medical reason may not offer any advantages to you or your baby. Research also shows that when you have had a previous caesarean for breech, you are more likely to achieve a successful VBAC. How your previous caesarean wound healed, and whether there were any complications during the operation, might be of significance when it is relatively recently that you had your last caesarean. For these reasons, your doctor will carefully balance the advantages and disadvantages associated with each method of delivery to ensure the health and safety of you and your baby, and to safeguard you both against unnecessary risk, while also taking on board your feelings and preferences.

Your midwife and doctor will talk through these with you and listen to any concerns or worries that you might have about the method of birth you would prefer. They will be sensitive to your concerns and wishes, and will support you in making an informed decision that is right for you and your baby. It is therefore important that you receive adequate information with which to make an informed choice. For more detailed information on this subject see Informed Choice leaflet ‘Caesarean section and subsequent births' at: www.choicesforbirth.org

Best regards
Vicky