Panel Finds Vaginal Birth After Cesarean Is Usually Safe

NIH panel says 'trial of labor' is worth considering; may be preferable for many women
By Beth Gilbert
HealthDay Reporter

THURSDAY, March 11 (HealthDay News) -- Most women who have had a cesarean section can safely undergo a subsequent vaginal delivery, according to an independent panel convened by the National Institutes of Health.

Current medical practice and fear of lawsuits often prevent women from having a vaginal delivery after a cesarean section, the panel said. Women who have had a cesarean section are likely to have cesarean deliveries in the future. Over the past 15 years in the United States, the rate of vaginal birth after a cesarean section has decreased from 30 percent to about 10 percent, the panel chairman said at a March 10 press conference.

Current evidence suggests vaginal birth after cesarean section is a reasonable option for many women and, according to the panel's announcement, research shows that a "trial of labor" is successful in nearly 75 percent of cases. In addition, maternal mortality is lower for women who have a trial of labor, regardless of whether they end up delivering vaginally or by cesarean section. However, women who have an unsuccessful trial of labor and do undergo a repeat cesarean section have higher morbidity than those who have a successful vaginal birth after a previous cesarean delivery.

"Declining vaginal-birth-after-cesarean rates and increasing cesarean delivery rates over the last 15 years would seem to indicate that planned repeat cesarean delivery is preferable to a trial of labor. But the currently available evidence suggests a very different picture: a trial of labor is worth considering and may be preferable for many women," panel chair, Gary Cunningham, M.D., of the University of Texas Southwestern Medical Center in Dallas, said in a news release.

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