A fantastic article if you are a woman who has had multiple cesareans but still wish to VBAC!

-Rachel

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Study backs natural birth after C-section

Posted 6/29/2006 9:28 PM ET

By Rita Rubin, USA TODAY

A study out today could lead to an increase in the number of pregnant women
who try for a vaginal birth after a cesarean section, a type of delivery
called a VBAC.

The study, published in Obstetrics & Gynecology, involved 17,890 women with
a prior C-section who delivered at one of 19 academic U.S. medical centers
from 1999 through 2002.

It found that those who'd had multiple C-sections were no more likely to
have a uterine tear, or rupture, than those who'd had only one C-section.
Ruptures occurred in nine of 975 women with multiple previous C-sections, or
0.9%, and 115 of 16,915 women with just one prior C-section, or 0.7%. Women
with multiple C-sections were more likely to need a blood transfusion or a
hysterectomy if they tried for a VBAC, but their actual risk was just 3.2%
and 0.6% respectively.

"I think most practitioners have with time shied away from offering VBAC to
women with multiple prior cesareans because of a perceived risk of uterine
rupture," says lead author Mark Landon, a professor of obstetrics and
gynecology at The Ohio State University in Columbus. If such women have an
increased risk of rupture, it must be quite small, Landon said.

Gary Hankins, chairman of the American College of Obstetricians and
Gynecologists' obstetrics practice committee, said he expects his group will
now revise its VBAC advice for women who've had multiple C-sections.

In 2004, Hankins' committee said that the only women with multiple
C-sections who are candidates for a VBAC are those with a prior vaginal
delivery. The new study found that having a prior vaginal delivery made no
difference.

VBAC has become one of the most hotly debated topics in obstetrics. In 1999,
the obstetricians and gynecologists group advised that it only be allowed in
hospitals with an "immediately available" surgical team. That guideline
stemmed from concerns about the risk of a potentially catastrophic rupture
in laboring women with a C-section scar on their uterus.

By 2004, the VBAC rate had dropped to 9.2%. Many hospitals and doctors would
not allow any woman to attempt one.

"I think the important message from Landon's paper, and from our work, is
that VBAC in women with multiple prior C-sections is very reasonable," says
George Macones, chairman of the Department of Obstetrics and Gynecology at
Washington University in St. Louis and author of a study last year that
found only a small increased rupture risk in such women.