After the two-child policy was implemented, many mothers, looking at their first child's face, started thinking about having a second child. My first reaction upon hearing this was: It seems most people in our country are still quite wealthy?
Then, for expectant mothers, in addition to preparing for pregnancy, what they need to think about even more is: for a second child, cesarean section or vaginal delivery?
If your first child was delivered via cesarean section, the most common answer you'll hear is "you must have a cesarean section for your second child as well." However, I've also heard of some cases where the first child was delivered via cesarean section and the second child was delivered vaginally.
So, how should we choose?
Data shows that more and more people are choosing cesarean sections.
In fact, the cesarean section rate is rising all over the world, and as a result, more and more mothers are carrying the painful memories of cesarean sections.
More than 50% choose cesarean section
In 2018, The Lancet conducted another survey on global cesarean sections: from 2000 to 2015, the global cesarean section rate almost doubled—from 12% to 21%.
Among them, the rate was 32.8% in the United States, 32.4% in Australia, and 36.2% in China. Egypt and Brazil even reached an astonishing 51.8% and 55.6% respectively—half of pregnant women chose cesarean section!
Therefore, the choice of having a second child has become a hot topic of discussion.
A recent study published in the journal PLOS Medicine suggests that the risks to both mother and baby are higher for women who have undergone one or more cesarean sections and then attempt vaginal delivery than for those who choose to have another cesarean section.
This study, led by Kathryn Fitzpatrick of Oxford University, and her colleagues examined data from 74,043 full-term only babies born in Scotland between 2002 and 2015.
For women who have had a cesarean section, researchers conducted short-term assessments of the perinatal health of women planning to have another cesarean section and those attempting vaginal delivery.
Of these, 45,579 women planned to have a cesarean section; another 28,464 women attempted vaginal delivery, of whom 28.4% underwent an emergency cesarean section.
Attention mothers who have had a C-section!
Women who opt for a cesarean section for their first child are more likely to experience serious complications when trying vaginal delivery compared to women who opt for a cesarean section again. These complications can include uterine rupture, blood loss, sepsis, surgical damage, and in some cases, even worse outcomes such as stillbirth.
That looks really scary. Does that mean I'll have to have a C-section?
Actually, ladies don't need to be overly nervous about this, because the absolute risk of complications from any delivery method is very small.
Overall, among women who attempt vaginal delivery, only 1.8% experience severe postpartum complications, and 8% of their babies are not healthy; while among women who have cesarean sections, only 0.8% experience severe postpartum complications, and 6.4% of their babies are not healthy.
Currently, PLOS's research results are limited to data analysis and have not yet identified the exact influencing factors.
Let's get down to business: Second child, C-section or vaginal delivery?
Some expectant mothers prefer vaginal delivery because they believe that babies born vaginally are healthier and smarter.
Some mothers prefer cesarean sections because they don't experience the intense pain of vaginal delivery.
If a mother had a C-section for her first child, is she required to have a C-section for her second child as well?
In recent years, foreign data has shown that if some expectant mothers have only minor physical abnormalities, but after examination they are deemed fit to attempt vaginal delivery, hospitals may recommend arranging a "trial vaginal delivery".
Huh? "Trial production"? Is it really that casual?
NO NO NO... It would be more accurate to say that "trial delivery" is a more cautious approach to having a baby.
Babies born via cesarean section may lack attention span, be more emotionally sensitive, and have poorer physiological adaptability because they are born without the stimulation of vaginal compression.
Moreover, a cesarean section will leave a scar on the expectant mother's abdomen, and the postpartum recovery period will be even more difficult.
Do you recall the fear of being dominated by pain?
Cesarean section is a major surgery. If not handled properly during the operation, it can easily lead to wound infection, amniotic fluid embolism, uterine damage and removal, or even maternal death.
Improper postoperative care can easily lead to symptoms such as chronic abdominal pain caused by pelvic adhesions.
If a woman chooses a cesarean section for her first child and then chooses a cesarean section for her second or subsequent children, she is more likely to experience intraoperative bleeding.
Therefore, if a second child can be delivered vaginally, it is generally a good choice. Moreover, when attempting vaginal delivery, hospitals will prepare for both possibilities and will switch to a cesarean section in case of any unexpected events during the trial of labor.
Performing a trial of labor under strict monitoring conditions can reduce the surgical risks associated with a repeat cesarean section, such as bleeding and infection.
Under what circumstances should a vaginal delivery be considered?
If a woman expecting her second child meets the following conditions, she can consider a vaginal delivery:
There were no indications for the previous cesarean section, and no new indications for cesarean section have emerged.
The sum of the fundal height and abdominal circumference of the mother is less than 144 cm;
Recent ultrasound examination results show that the mother's biparietal diameter is <9.5 cm, the thickness of the scar tissue in the lower segment of the uterus is ≥3.5 mm, and the estimated fetal weight is <3.5 kg;
The interval between this pregnancy and the previous cesarean section was more than 2 years.
The previous cesarean section incision was a transverse incision in the lower segment of the uterus, and the scar healed well without secondary infection;
No history of uterine perforation, uterine fibroid exudation, or surgical damage to the uterus;
The expectant mother and her family consented to a vaginal delivery and signed an informed consent form.
Having a baby is a big event for a family, so it's important to discuss it with your family. If you've had more than two cesarean sections, then you shouldn't consider trying vaginal delivery; just have a cesarean section!
That said, what is the success rate of trial production? It's hard to say, because the influencing factors are indeed quite complex.
Mainly includes:
The older the pregnant woman, the lower the success rate;
The lower the pregnant woman's body mass index, the higher the success rate;
The greater the gestational age and the higher the newborn's weight, the longer the gestational age, the lower the success rate.
Cervical condition is an important factor affecting the success rate of vaginal delivery; women with a flattened cervix have a higher success rate.
Pregnant women with a history of vaginal delivery have a higher success rate.
Therefore, the selection of trial production also requires thorough inspection and consideration of comprehensive factors.
Actually, there's no need to be fixated on a particular delivery method; just choose the one that suits your physical condition.
After all, the most important thing is for both mother and baby to live healthy and happy lives.
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