Once a C, Always a C?
To C or Not to C
To C or not to C continued...
"There seem to be significant benefits to the mother from a
trial of labor," Mozurkewich tells WebMD. "But there may also be a
small, increased risk to the baby." In the review, University of Michigan
and University of Toronto researchers looked back at data that documented the
outcomes of nearly 48,000 women who had had babies after a previous c-section.
While the rates of uterine rupture were twofold higher in the women who
attempted VBAC, the review suggested that overall, the risk was low -- roughly
four in 1,000 (0.4%) trials of labor resulted in uterine rupture vs. two in
1,000 (0.2%) for elective repeat cesareans. Yet if uterine rupture does occur,
it can be catastrophic -- the baby must be delivered by emergency c-section
within about 18 minutes to avoid neurological damage or even death.
The review also suggests that, while the relative risk is not
quite as high as that for uterine rupture, there is an increased risk of fetal
mortality for the trial of labor group (roughly six cases in 1,000 or 0.6%) vs.
those who got elective repeat cesareans (about three in 1,000 or 0.3%).
Because of these risks, women may opt for elective c-sections,
thinking them safer. "Doctors can talk women out of VBAC when they mention
the risk of uterine rupture. The risk has to be presented in context," says
Jean C. Hundley, MD, of WomenKind Ob/Gyn Associates at Mercy Hospital in
Baltimore. "Elective cesarean deliveries are not risk-free either. It's a
major surgery." Complications related to the use of anesthesia, infection,
accidental perforation of other structures such as the bowel or bladder, and
uncontrolled blood loss due to the severing of a uterine artery are all
possibilities with elective cesarean.
A time and place for each
As the study indicated, women considered to be in the low-risk
group have a 60% to 80% success rate with VBAC, says Michael D. Randell, MD,
FACOG, an obstetrician and gynecologist at Northside Hospital in Atlanta. If a
woman had her initial cesarean because of a one-time problem -- such as the
baby's position (feet first, for example), or placenta previa (where the
placenta obstructs the cervical opening) -- her odds of having a successful
VBAC are good.