Article: Vaginal Birth Safe Option After Multiple C/S
Vaginal Birth a Safe Option After Multiple C-Sections
Thu Apr 26, 2007 9:08 am (PST)
Dr Landon will be speaking at the ICAN Conference
Syracuse (NY) Sheraton University Hotel & Conference Center
April 20-22, 2007
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Vaginal Birth a Safe Option After Multiple C-Sections Posted 9/12/2006
COLUMBUS, Ohio - Very few, if any, obstetric topics have raised more discussion and controversy in the past several years than VBAC, or vaginal birth after cesarean section. Most studies on this subject have come from small, single institutions or have relied on birth certificate data with all of its inherent inaccuracies.
Mark Landon, M.D.
In his most recent analysis of multicenter data collected over four years, Dr. Mark Landon evaluated the risk of complication and success of VBAC in women who had undergone more than one prior cesarean delivery.
The 19-academic center study was led by Landon and conducted through the National Institutes of Health, Maternal Fetal Medicine Units Network. Its data included more than 45,000 patients with previous cesarean section, which included almost 18,000 women undergoing a trial of labor or an attempt at VBAC.
"This was the first large study of VBAC in which certain outcomes, such as uterine rupture, were studied prospectively," notes Landon, who serves as vice chairman of obstetrics and gynecology at the Ohio State University Medical Center.
Landon found that the risk of uterine rupture was 0.9 percent in cases of women with a history of multiple prior cesarean deliveries undergoing a trial of labor, compared with 0.7 percent in the cases of patients who had experienced only one previous cesarean delivery. These data challenge the notion that women with more than one prior cesarean are at dramatically increased risk for uterine rupture with a VBAC attempt.
"We looked at the outcomes associated with uterine rupture, including catastrophic outcomes such as stillbirth, or hypoxic brain injury to the baby," says Landon. "And the good news is that the vast majority of uterine ruptures fortunately are associated with healthy infants. The absolute risk of catastrophic rupture with poor outcome is, in fact, quite small."
Landon's study confirms that uterine rupture is the complication with the greatest risk attributable to trial of labor; however, it also shows the risk for uterine rupture is not significantly increased in women with multiple prior cesarean deliveries compared to a single prior operation.
"The study has confirmed that the majority of women with multiple prior cesarean deliveries undergoing trial of labor can expect to achieve a successful vaginal birth," says Landon, whose findings were published recently in the journal Obstetrics and Gynecology.
The benefits of VBAC include a faster recovery time and avoidance of the operative risks of cesarean section, which is a major operation.
"Beyond these obvious benefits, there seems to be a component that is not completely tangible," notes Landon. "It goes along with the experience of vaginal childbirth, which certain women value, and there is probably not a price that you could put on that for a certain subgroup of women."
Each case should be individualized, says Landon, in terms of the risks involved, the likelihood of success of VBAC, and the individual woman's desire to proceed with attempted vaginal delivery vs. cesarean section. "Future childbearing plans are important, since the risk of cesarean complications rises dramatically after three operations," according to Landon.
Landon advises that women should carefully research the topic of VBAC, looking for a physician who is willing to share data in an unbiased manner, who supports the concept of VBAC provided that a woman is an appropriate candidate, and who is willing to evaluate each case individually.
"About two-thirds of women who have had a previous cesarean delivery are actually candidates for VBAC," says Landon. "VBAC after multiple cesarean sections should remain an option for eligible women."
The Ohio State University Medical Center has consistently been named one of America's best hospitals by U.S. News & World Report magazine with nine specialty programs being listed as among the country's best in the most recent edition. Also, 173 faculty members are included in the most recent edition of the nationally acclaimed directory, "Best Doctors in America."
