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    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.

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