Medical experts are sounding the alarm over the potentially fatal risks of attempting vaginal delivery after two prior caesarean sections (CS), in the backdrop of Nigeria’s persistent high maternal mortality rate. This is especially troubling in Nigeria, where social pressure often glorifies vaginal delivery as a badge of strength and femininity and shames CS. This mindset has led some women to take risky decisions, including trial of labor after multiple surgeries, which experts say can have catastrophic outcomes. Health professionals are warning that such attempts can lead to uterine rupture, severe bleeding, and even death for both mother and baby.
The most dreaded consequence of vaginal birth after cesarean (VBAC) is uterine rupture, which happens when the scar from a prior C-section tears open during labor. Though the absolute risk could appear minor in numbers, its consequences could be catastrophic. When the uterus ruptures, it causes massive internal bleeding, often cutting off the baby’s oxygen supply. In the absence of prompt surgical intervention, these situations often result in maternal mortality or stillbirth. In fact, Maternal Health experts reported that more than half of the babies do not survive these ruptures while mothers often lose their uterus—or sometimes their lives—in the process.
Nigeria’s poor healthcare systems heighten delivery risks.
In Nigeria’s underfunded healthcare system, where life-saving measures like blood transfusions or rapid surgery may not be readily available, the risks are considerably higher. Professor Aniekan Abasiattai of the University of Uyo, who spoke to PUNCH Healthwise, noted that while other nations with highly developed healthcare systems may occasionally record successful vaginal births following two C-sections, the situation in Nigeria is very different. “It is unsafe to attempt vaginal delivery after two caesarean sections in our environment, with our current resources and emergency care gaps,” he stated.
Regardless of the belief that vaginal delivery is more natural or culturally preferred, experts argue that the decision must be based on science and safety, not stigma. According to studies, up to 75% of women who have had one previous caesarean section can have a healthy vaginal birth following a single CS. However, following two or more cesarean deliveries, the chances of success dramatically decrease, reaching about 50%. Yet, these figures rely on close medical supervision, skilled staff, and quick access to surgical facilities—all of which are frequently absent from many Nigerian hospitals, especially those in rural regions.
Stigma and cultural pressure fuel risky childbirth choices.
Experts argue that in most situations, especially in resource-constrained environments like Nigeria, the risks—specifically uterine rupture—become much higher. Moreover, a recent study titled “Trial of labor following two previous caesarean sections – A UK cohort study” found that women undergoing trial of labor after two prior caesarean procedures (TOLA2C) have an increased risk of postnatal sepsis or endometritis. Regrettably, the stigma associated with CS in Nigeria still influences risky choices. Spouses, in-laws, and even friends put pressure on many women to avoid repeat CS procedures, particularly in rural or traditional societies.
This harmful narrative has influenced many women to attempt vaginal births against medical advice, often with disastrous consequences. As such, maternal mortality remains one of Nigeria’s most pressing health issues. The World Health Organization (WHO) reports that the country has one of the worst rates of maternal fatalities in Africa, with 1,047 maternal deaths per 100,000 live births in 2020, an almost 14% rise from 2017. The leading cause of these deaths is excessive bleeding during or after childbirth, precisely the kind of complication that can result from a ruptured uterus.
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Considering this situation, medical experts are urging the public to shift their opinion of cesarean delivery from one of failure to one of life-saving medical intervention. They encouraged women, families, and communities to trust medical advice, instead of giving in to misconceptions or false beliefs about childbirth. For women with a history of two or more C-sections, opting for a planned repeat caesarean is the safest option and is not just a matter of preference—it is a critical, life-saving decision.