ABSTRACT
Standard practice after two or more lower-segment Caesarean sections is to recommend delivery by Caesarean section. This is based on the fact that the risk of uterine rupture during labour is significantly greater in these women. Increasingly, this approach has been questioned as there are no randomised trials to justify the reasoning behind this. Many practitioners are allowing a trial of vaginal delivery in well-selected cases after two lower-segment Caesarean sections, and the evidence emerging is in favour of such a pragmatic approach. However, before a patient is offered this choice, careful consideration must be given to her past obstetric history and the current pregnancy. It is only after appropriate counselling about the risks that this option should be allowed.
