The risk of complications from vaginal births after C-sections -- known as VBACs -- is actually quite small, according to the most definitive study on the subject.
Liability concerns have spurred a growing number of U.S. doctors and hospitals to ban VBACs. In 2002, only 12.6% of pregnant women with a prior cesarean section delivered vaginally. That's only one-third of the government's goal of 37% by 2010. Meanwhile, the overall C-section rate in the USA has climbed to its highest level ever -- 26.1% in 2002.
Most women who attempt VBACs are successful, but labor can cause the uterine scar from their prior C-section to tear or rupture. In extreme cases, that can lead to a baby's death from lack of oxygen. Since 1999, the American College of Obstetricians and Gynecologists has advised that hospitals allow VBACs only if they have the staff to perform a C-section immediately.
But the findings should reassure women who want to attempt a VBAC, says lead author Mark Landon, an Ohio State University OB-GYN, who presented the findings at a Society for Maternal-Fetal Medicine meeting last week in New Orleans.
Of 17,902 women who attempted to deliver vaginally after a prior C-section, only 128 had a symptomatic uterine tear or rupture. None of the 15,801 VBAC candidates who chose to deliver by a planned repeat C-section ruptured. But ''even with catastrophic uterine rupture, most babies survive and survive intact,'' Landon says.
Eight full-term babies whose mothers had a rupture suffered brain damage from lack of oxygen, but so did five whose mothers did not have a rupture. Women who tried a VBAC were more likely to get an infection or need a transfusion than planned C-section patients, but the overall risk was low.
The four-year study, sponsored by the National Institute for Child Health and Human Development, has two major advantages over previous studies: It focused on 19 academic medical centers instead of just one, and trained research nurses gathered information during labor and delivery.
Previous studies collected data long after the fact from medical records or birth certificates, which aren't always complete or accurate.
Dartmouth OB-GYN Michele Lauria, co-founder of the Vermont/New Hampshire VBAC Project, called the new findings ''firm, indisputable data about the risks. I think it's wonderful for women.''
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