The Times Australia
The Times World News

.

Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows

  • Written by Anthea Lindquist, Obstetrician and Perinatal Epidemiologist, The University of Melbourne
Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows

Pregnant women who previously birthed by caesarean section are presented with a choice: whether to try for a vaginal birth, or book in for a repeat caesar.

Those mulling over a vaginal birth are counselled at length about the risk of a rare but nasty outcome – the uterus rupturing while labour is in full flight.

But new research looking at 130,000 births over five years has uncovered an increased risk of another outcome women deserve information about: extensive tearing around the vaginal region during birth.

Our new study, published[1] in the British Journal of Obstetrics and Gynaecology, hones in on the risk of vaginal trauma for those who birth vaginally after a prior caesarean. This kind of birth trauma relates to significant injury to a woman’s perineum, the important region between the vagina and anus. The perineum anchors many pelvic floor muscles that help control the bladder and bowels.

We defined serious birth injury as a tear in the perineum that extends[2] into the anal sphincter – the delicate ring of muscle that helps us control our bowels. Damage to this muscle is called a third-degree perineal tear.

Read more: Explainer: vaginal birth after caesarean[3]

What we studied

The study looked at 130,000 births in Victoria and compared the risk of a third-degree perinatal tear among first-time mums with those who birth vaginally after a prior caesarean (sometimes referred to as a VBAC[4]). In our study, vaginal birth included women birthed without any medical assistance, and births by forceps or the ventouse (vacuum birth). Anything but birth by caesarean.

The results were clear: a vaginal birth after a previous caesarean increases the chance of significant vaginal trauma (third-degree tear) by 21% (albeit from a low baseline rate).

A potential reason for this increased risk might include a mismatch between a uterus that has birthed before and a perineum that has not. If this is the case, the labour progresses quickly, which does not allow enough time for the perineum to stretch naturally. However, the real reason for this risk is unknown and further research is needed.

Lifelong impacts

Once a vaginal birth injury occurs, the tears are immediately repaired by obstetricians. Many women heal fully – but some who sustain a third-degree tear during birth develop distressing issues that never disappear, despite expert care, including from specialist physiotherapists.

Symptoms can include an ongoing dragging sensation in the pelvic floor, or true prolapse of the vaginal walls. Sometimes, coughing or sneezing can cause urine leakage. And for some, jogging becomes too hard due to leaking of urine and pelvic discomfort. Others might suffer from reduced faecal control and even the odd episode of faecal soiling. Sex can be painful.

woman with caesar scar holds baby
Women who had a caesarean birth the first time around are at greater risk of serious birth injury from a subsequent vaginal birth. Shutterstock[5]

This doesn’t mean women shouldn’t consider VBAC

This increased risk of injury does not make it unsafe for women who have had a caesarean before to try for a vaginal birth. But our results should be incorporated into counselling of these women about their choices.

Since the risk of vaginal birth injury including the anal sphincter sits at around 5-7%[6] in Victoria for first-time mothers, the increase of 21% raises the overall likelihood to around 6–8.5%. It’s a modest rise that will bother some, but not others.

Still, women deserve to be given this information so they can judge for themselves whether it worries them enough to ask for a repeat caesarean, or try for a vaginal birth.

pregnant woman in waiting room Birth counselling should fully explain the risks. Shutterstock[7]

Read more: Mothers need better care to reduce post-traumatic stress after childbirth[8]

Counselling is not just about cautioning women of the risks. As midwives and obstetricians, we talk with these women about what will happen when they go into labour, when to come into hospital, and what their chance (and definition) of “successful” vaginal birth might be.

We also mention the most enticing advantage for those whose destiny is an uncomplicated vaginal birth – they sidestep another caesar. Often, this means a shorter recovery time[9] and improved likelihood of breastfeeding[10].

After these discussions, some women will feel the very small risk of serious vaginal trauma (or uterine rupture[11]) is one well worth taking and opt to try for a vaginal birth. Others will opt for the certainty of a repeat caesarean.

Women deserve full support in their birth choices. And they deserve to be fully informed about possible risks. It’s time we broaden our discussions with women planning a vaginal birth after caesarean section to include the increased risk of vaginal birth trauma.

References

  1. ^ published (pubmed.ncbi.nlm.nih.gov)
  2. ^ extends (www.thewomens.org.au)
  3. ^ Explainer: vaginal birth after caesarean (theconversation.com)
  4. ^ VBAC (www.acog.org)
  5. ^ Shutterstock (image.shutterstock.com)
  6. ^ around 5-7% (www.safetyandquality.gov.au)
  7. ^ Shutterstock (www.shutterstock.com)
  8. ^ Mothers need better care to reduce post-traumatic stress after childbirth (theconversation.com)
  9. ^ shorter recovery time (pubmed.ncbi.nlm.nih.gov)
  10. ^ improved likelihood of breastfeeding (pubmed.ncbi.nlm.nih.gov)
  11. ^ uterine rupture (doi.org)

Read more https://theconversation.com/vaginal-birth-after-caesarean-increases-the-risk-of-serious-perineal-tear-by-20-our-large-scale-review-shows-173249

Times Magazine

Choosing the Right Legal Aid Lawyer in Sutherland Shire: Key Considerations

Legal aid services play an essential role in ensuring access to justice for all. For people in the Sutherland Shire who may not have the financial means to pay for private legal assistance, legal aid ensures that everyone has access to representa...

Watercolor vs. Oil vs. Digital: Which Medium Fits Your Pet's Personality?

When it comes to immortalizing your pet’s unique personality in art, choosing the right medium is essential. Each artistic medium, whether watercolor, oil, or digital, has distinct qualities that can bring out the spirit of your furry friend in dif...

DIY Is In: How Aussie Parents Are Redefining Birthday Parties

When planning his daughter’s birthday, Rich opted for a DIY approach, inspired by her love for drawing maps and giving clues. Their weekend tradition of hiding treats at home sparked the idea, and with a pirate ship playground already chosen as t...

When Touchscreens Turn Temperamental: What to Do Before You Panic

When your touchscreen starts acting up, ignoring taps, registering phantom touches, or freezing entirely, it can feel like your entire setup is falling apart. Before you rush to replace the device, it’s worth taking a deep breath and exploring what c...

Why Social Media Marketing Matters for Businesses in Australia

Today social media is a big part of daily life. All over Australia people use Facebook, Instagram, TikTok , LinkedIn and Twitter to stay connected, share updates and find new ideas. For businesses this means a great chance to reach new customers and...

Building an AI-First Culture in Your Company

AI isn't just something to think about anymore - it's becoming part of how we live and work, whether we like it or not. At the office, it definitely helps us move faster. But here's the thing: just using tools like ChatGPT or plugging AI into your wo...

The Times Features

From Farms to Festivals: How Regional NSW Is Repurposing Shipping Containers

Regional NSW communities are repurposing containers for farms, tourism, and events Farmers and small businesses use them as cost-effective, flexible infrastructure Festivals ...

What a Mobile Speech Pathologist Really Does for Late Talkers

As a parent, it’s natural to keep a close eye on your child’s development. When your toddler isn’t using as many words as their peers, the internet can feel like a rabbit hole ...

Benefits of Tree Pruning for a Thriving Australian Garden

Tree pruning is an essential aspect of garden maintenance that often doesn't get the attention it deserves. It's a practice that involves the selective removal of certain parts...

What is psychosocial therapy? And why is the government thinking about adding it to Medicare for kids?

The government is considering new, bulk-billed health checks for three-year-olds, to pick up developmental concerns and refer kids that might need additional support. The de...

Detect Hidden Water Leaks Fast: Don’t Ignore Hot Water System Leaks

Detecting water leaks early is crucial for preventing extensive damage to your home. Among the various parts of a home’s plumbing system, hot water systems are particularly suscept...

Why do hamstring injuries happen so often and how can they be prevented?

In a recent clash against the Melbourne Storm, the Brisbane Broncos endured a nightmare rarely seen in professional sport — three players tore their hamstrings[1] in a single g...