There used to be an old saying that “Once a Cesarean, always a Cesarean,” implying that natural birth after a Cesarean, or “c-section” delivery would be difficult at best. But is this really accurate?

A new study published in the New England of Medicine points to a kernel of truth in the saying – researchers found that women who had had previous Cesarean deliveries were twice as likely to experience major complications when they opted for natural birth in subsequent deliveries.

A total of 6,138 women in Nova Scotia were studied by Doctor of the University of North Carolina in Chapel Hill, who found that 1.6% of the 3249 women who chose natural birth after Cesarean section did have complications which included hysterectomy, rupture of the uterus or operative surgery. Of the remaining 2,889 women who opted for another Cesarean, only 0.8% had major complications.

Does this suggest that natural births should be avoided by women who have previously had Cesareans? In the 1980′s and ’90′s, one out of every four American infants was delivered by Cesarean. This type of delivery became increasingly popular because of the perception that it was safer, and more predictable than natural birth.

However, Cesareans also scar the uterus, which may in turn cause complications for subsequent births. Therefore, physicians have been urged by professional organizations and the medical community to promote natural births and reduce the number of Cesareans performed.

In an accompanying editorial, Doctorl states that “reducing the rate of Cesarean section is a worthy goal, ” and cautions that the real truism that should be noted is: “once a Cesarean, always a scar.”