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Carlton Pearse, MD, St. Luke's Hospital

More women may want to consider vaginal birth after cesarean

For years, the prevailing belief was that if a woman had one cesarean section delivery (C-section), all other babies she had should be born the same way. Today, however, research and medical experts are more supportive of the idea that a vaginal birth after cesarean (VBAC) is a reasonable option for many women.

Over the past 15 years, the VBAC rate has dipped from 25 percent to less than 10 percent. Among the reasons is fear of uterine rupture, which occurs when the baby breaks through the wall of the uterus. While it can be serious, studies have found it occurs in less than one percent of women attempting VBAC, thanks in part to improvements in C-section incisions. An unsuccessful VBAC also runs the risk of requiring an emergency C-section, which has a higher infection risk, although the risk is small.

An independent panel of the National Institutes of Health released recommendations in March that a vaginal birth after cesarean is a reasonable option for women with a prior cesarean delivery; that VBAC is worth considering, may be preferable for many women and should be more widely available. An estimated 60 to 80 percent of women who try VBAC have a successful vaginal delivery, but each woman, along with her physician, should weigh the risks and benefits of her situation.

Key factors to consider before attempting a VBAC include the type of incision from a previous C-section (some incisions have a higher risk of rupture), problems with the baby or placenta and certain medical conditions during pregnancy. Additionally, the VBAC success rate is reduced if there is a need to induce labor and most labor-inducing drugs increase uterine rupture risk.

Whatever a woman decides, she should be flexible, as the only true predictive factor for a successful VBAC is a previous vaginal birth. The success rate is almost 90 percent higher for women who have had at least one prior vaginal birth. It is also important to understand that C-sections and VBACs are not risk-free. Every birth process has some element of risk. Parents should know the risks of both, talk with their doctor and weigh their own preferences.

Carlton Pearse, MD, is chief of obstetrics and gynecology at St. Luke's Hospital. Call 314-576-0930 or visit his Physician Referral page.

This article was published in the St. Louis Post-Dispatch on June 3, 2010.