more-in Doctors at a city government hospital have suggested, in a new study, the high chances of having a natural birth for women immediately after C-section. The study flies in the face of a popular belief that C-section the first time necessarily warrants surgery the next time. The C-section birth rate in Telangana stands at 74% with births in the private health sector taking the bigger share. Doctors in both the private and government health sector, say the rise can be at least partly attributed to optional C-section surgeries, besides the non-risk-taking attitudes of many obstetricians to wheel the second-time pregnant women into the operation theatre if they had given C-section birth the first time. The study was conducted at the Government Maternal Hospital at Petlaburj by doctors Ananthalakshmi Paga and Amitha Kumari from January to August 2016. It was published in the International Journal of Contemporary Medical Research. Patients were included in the study based on inclusion criteria that favoured vaginal birth after C-section. In all, 194 pregnant women who had a first child through C-section were selected for the study. One thirty two women were able to give birth naturally while trial of labour failed for 62 women who had to later undergo C-section. The success rate was calculated at 68%. Though the study pointed out higher morbidity risk for women who are wheeled in for emergency C-section, it concluded that the C-section rate can be reduced significantly by carefully selecting cases for trial of labour. “It is very common for doctors to wheel in pregnant women for a C-section after a first C-section without an assessment, mainly in private hospitals. Though in government hospitals the scope for trial of labour is more, often the assessment for trial of labour is not thorough,” said a senior government doctor. The doctor also said that most experts perform surgery after a previous C-section given that it requires intense monitoring. “Deciding for a vaginal or a C-section is not a straightforward matter. But in cases it is opted for, it is essential to have the right support system, including highly skilled obstetricians on hand at all time when such patients are around.” Pointing out the circumstantial differences between the government and private hospitals, Meena Ugale, doctor at Kirloskar Hospital, explained that a C-section should be opted for only after the assessment made for natural birth is not favourable or a labour trial is not proceeding as expected. “We assess a woman’s pelvis, the size and weight of the baby, the mother’s health and the indications for previous C-section as part of the assessment for vaginal birth after C-section. Every woman should be given the option of vaginal birth as the recovery is much faster,” Dr. Ugale said. She added that in case women opt for vaginal birth and if the labour presents with complications, a C-section has to be resorted to in order to avoid the risk of fatal complications like uterine rupture.

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