VBAC: Safer than you think

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August 2002 · Vol. 14, No. 8

VBAC:
Safer than you think

The pendulum continues to swing between these 2 delivery options. Has it swung too far toward elective cesarean?

ELLEN MOZURKEWICH, MD, MS

Dr. Mozurkewich is a lecturer in the department of OBG at the University of Michigan in Ann Arbor, Mich.

KEY POINTS

Although the risk of uterine rupture and fetal complications may be slightly increased with a trial of labor (TOL), the overall incidence of these complications is low.
In a recent meta-analysis involving 47,682 women, a TOL produced more favorable maternal outcomes than elective repeat cesarean (ERC). Women choosing TOL also were much less likely to undergo hysterectomy than those selecting ERC.
Many investigators remain reluctant to recommend induction of labor in the setting of vaginal birth after cesarean section (VBAC), fearing an increased risk of uterine rupture when oxytocic agents are used.
Between 374 and 809 women would need to undergo ERC to prevent 1 uterine rupture, and between 693 and 3,332 women would need to undergo ERC to prevent 1 perinatal death attributable to a TOL.

Despite numerous studies detailing the safety and efficacy of attempted vaginal birth after cesarean (VBAC), the strategy remains controversial. Many obstetricians are retreating from the assumption that this mode of delivery is safer than elective repeat cesarean (ERC) for most women with 1 or 2 prior cesarean sections. This shift in attitude springs in part from a decreased societal tolerance of risk and in part from a misinterpretation of current data.

Here, I review a large body of literature supporting the contention that a trial of labor (TOL) yields a more favorable maternal risk profile than ERC. Although the risk of uterine rupture and fetal complications may be slightly increased with a TOL, the overall incidence of these complications is reassuringly low.

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VBAC:Safer than you think

VBAC:
Safer than you think