Risk is low to labor after cesarean

One of the downsides for mothers who give birth to a child by cesarean section is that once a cesarean has been done, all subsequent births are traditionally delivered by this method. When I was trained during the 1980s, only 3 percent of women attempted normal labor and delivery after a cesarean. The reason for this was concern that the stress of contractions on the surgical scar of the uterus might result in rupture.

Despite this, many physicians felt that labor after cesarean (known as vaginal birth after cesarean, or VBAC) was safe, and should be attempted. By 1996, the VBAC rate had risen to 28%. But with some negative reports of increased risk, the VBAC rate eventually dropped back to 13% by 2002. The controversy continued.

In an attempt to resolve the question, a major study was undertaken in nine academic medical centers around the country. 18,000 women were monitored as they attempted VBAC. Their outcomes were compared to 15,801 women who had had cesarean, and therefore, decided to stick with that mode of delivery and not try a labor. The complication rates were compared between the two groups.

Out of the nearly 18,000 women who underwent VBAC, 124 experienced rupture of the uterus. This was compared to zero in the C-section group. In addition, 12 babies in the VBAC group experienced brain injury from a lack of oxygen (seven of these were believed to be due to uterine rupture while the rest were for other causes). This was compared to no brain injured babies in the C-section group.

Despite the greater safety rate amongst the C-section group, the complication rate for VBAC is still considered well within the acceptable range, and therefore a safe alternative. The rate of uterine rupture is still less than 0.7% and of brain injury less than 0.07%, or less than one in a thousand.

Obviously, if one can choose zero risk, why not do it? But, I recall seeing other studies that have not shown an absolutely zero risk for brain injury or death to babies born by C Section. In addition, there are other possible complications to surgery such as a higher incidence of infection in the womb, as well as scar tissue, either of which may potentially contribute to future infertility. Stay tuned.

Landon, M. B., J. C. Hauth, et al. (2004). “Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery.” New England Journal of Medicine 351(25): 2581-9.

Posted on 10/17/2006 under Christian Health & Medicine, Maternity/Infant care. Comments RSS feed.
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