Medical professionals have cautioned against attempting labour and vaginal delivery after undergoing two previous caesarean sections, citing the high risk of uterine rupture, severe bleeding, and potential loss of both mother and child.
According to specialists in maternal health, such deliveries not only increase the likelihood of maternal mortality but also pose serious risks to the baby, including head compression and inadequate oxygen supply, which could result in congenital complications.
Despite these dangers, many Nigerian women continue to resist undergoing repeat CS due to societal stigma, preferring to attempt vaginal birth instead.
However, medical experts strongly advise against this, emphasizing that bleeding before, during, and after delivery remains the leading cause of maternal mortality in Nigeria.
Nigeria has one of the highest maternal mortality rates in Africa. The 2018 Nigeria Demographic and Health Survey reported an MMR of 512 deaths per 100,000 live births.
Globally, postpartum haemorrhage affects approximately 14 million women annually, contributing to about 70,000 maternal deaths, according to the World Health Organization.
A recent WHO study further highlighted that severe bleeding and hypertensive disorders, such as preeclampsia, were the leading causes of maternal deaths worldwide, accounting for 80,000 and 50,000 fatalities respectively in 2020.
The findings indicated a widespread lack of access to essential maternal healthcare services.
In separate interviews with The PUNCH Healthwise, maternal health experts emphasized the need for expectant mothers to register for antenatal care and opt for delivery in well-equipped healthcare facilities staffed with skilled birth attendants to minimize risks and ensure optimal care.
A recent UK-based study on “Trial of Labour Following Two Previous Caesarean Sections” found that women attempting vaginal delivery after two CS procedures faced an increased risk of uterine infection (endometritis), sepsis, and adverse neonatal outcomes.
Providing further insight, an expert in Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Professor Aniekan Abasiattai, explained that after a CS, the surgical incision heals to form a scar.
During subsequent pregnancies, labour contractions exert pressure on this scar, increasing the risk of rupture and excessive bleeding.
“Now, after two caesarean sections, because of the increased risk of rupture of the scar, which is much more than that of a previous caesarean delivery, in this environment, we usually do not allow our patients to attempt a vaginal delivery after two previous caesarean sections. That’s the standard in this country,” he stated.
While acknowledging that some international studies report successful vaginal deliveries after two CS procedures, he emphasized that this is not an accepted medical practice in Nigeria due to the heightened risk of infection and complications.
Discussing the dangers to infants, Abasiattai warned that uterine rupture severely affects the baby’s oxygen supply, leading to hypoxia (oxygen deprivation), which significantly increases foetal mortality rates.
“When the uterus ruptures, it cuts off and the baby becomes affected directly. Low oxygen transfer, hypoxia sets in, and the rate of death or foetal mortality is quite high. Even in some instances, more than 50 per cent following rupture of the scarred uterus,” he explained.
He stressed that in cases where rupture occurs, immediate surgical intervention is needed to control haemorrhage, repair the uterus, or deliver the baby via emergency surgery.
Backing this stance, a specialist in Obstetrics and Gynaecology at Obafemi Awolowo University, Ile-Ife, Osun State, Professor Ernest Orji, likened the situation to sending a “wounded soldier to battle”, stating that the risks associated with labour after two CS procedures are dangerously high.
“It’s risky because the womb has been cut two times, and they say you don’t use a wounded soldier to go to battle. The chances of tearing or rupturing during labour are high,” he warned.
He added that while some women have attempted vaginal delivery after two CS procedures without complications, such outcomes are rare and do not justify the significant risk of death, excessive bleeding, or emergency hysterectomy (removal of the womb).
Risk of Hysterectomy and Infant Brain Damage
Orji further explained that in severe cases, the ruptured uterus may be beyond repair, necessitating its removal to save the mother’s life.
“The first danger is that the womb can tear and when that happens, the baby may die depending on the site of the tear. The tear would make the woman start bleeding and when the bleeding is too much, she can bleed and die,” he stated.
He added that even if the mother survives, the baby could suffer brain damage due to head compression during labour, potentially affecting intellectual development later in life.
Both experts urged women who have undergone multiple CS procedures to avoid delivering at unregulated health facilities and to seek proper medical supervision to prevent complications.
With Nigeria already struggling with high maternal and infant mortality rates, medical professionals stress that adherence to safer childbirth practices, including scheduled caesarean sections when necessary—remains crucial in safeguarding the lives of mothers and their babies.
