| |
BOSTON (Reuters), Tue Dec 14, 2004
The
finding, based on the cases of more than 33,000 women and
scheduled to be published in
New England Journal
of Medicine, may help settle a decades-old debate.
Doctors
used to think a woman who had delivered one baby via a Caesarean
section should have all subsequent deliveries the same way.
That belief was one reason surgical deliveries eventually represented
more than a quarter of all births. In 1981, only 3 percent
of such women tried conventional labor if they became pregnant
again.
Because any surgery, including Caesarean, poses risks,
doctors tried to bring that rate down by giving women a chance
to deliver vaginally before resorting to a C-section. By 1996,
28 percent of those women were having conventional deliveries.
But that, in turn, seemed to produce more cases where the scar
tissue of the uterus tore during labor -- a serious complication.
That helped the pendulum swing back. By 2002, fewer than 13
percent of such women were having their babies vaginally.
The
new study, led by Mark Landon of Ohio State University and
based on data from 19 U.S. medical centers, was designed to
better assess the risks.
The Landon team found that 0.7 percent
of women who had previously delivered by Caesarean section
had their uterus rupture when they tried to deliver naturally.
And while no babies delivered surgically suffered from lack
of oxygen, there were 12 such cases among mothers who attempted
a vaginal delivery. Two of the 12 babies died.
The risk of
death for the mother was the same for the two groups of women.
The risks may be higher for women who attempt a vaginal delivery "although
the absolute risks are low," the researchers concluded.
Landon
and his colleagues also discovered that the risk of uterine
rupture increased to 1.1 percent from 0.7 percent when the
drug oxytocin was used to induce labor.
The study found that
588 Caesarean deliveries would need to be done to prevent one
serious problem among women who first tried to deliver vaginally.
In an editorial in the Journal, Michael Green of Massachusetts
General Hospital said some women and their doctors might perceive
the danger of trying a vaginal delivery to be small, while
others may disagree.
"Ultimately," he said, "risk, like beauty,
is in the eye of the beholder."
© Copyright Reuters
2004.
|
