Vaginal births after cesarean are safe for most women

Research Activities, February 2011, No. 366

Nearly one-third of all babies are delivered by cesarean each year in the United States. This number continues to climb despite the Healthy People 2010 goal of reducing the cesarean delivery rate to 15 percent. One reason for the continued increase is because once a woman delivers by cesarean, she may be wary of attempting a vaginal birth for subsequent deliveries.

In advance of the 2010 National Institutes of Health (NIH) Consensus Development Conference titled Vaginal Birth After Cesarean: New Insights, the Oregon Evidence-based Practice Center conducted a literature review to determine the risks and benefits of vaginal birth after cesarean (VBAC) and cesarean. The researchers found that VBAC was a safe, reasonable choice for most women who had delivered by cesarean previously. Using estimates gathered during the literature review, the authors predict that in a group of 100,000 women attempting VBAC, 4 would die; 468 would suffer uterine rupture, a potentially life-threatening complication often associated with VBAC; and 133 babies would die. Conversely, in a group of 100,000 women undergoing cesarean, 13 would die, 26 would suffer uterine ruptures, and 50 babies would die.

The NIH Consensus Development Statement suggests that given the data offered in this report and other sources, VBAC is a reasonable option for women who have had one prior low transverse uterine incision. The statement's authors also recognize that though VBAC may be safe for the mother, it poses risks for the baby. They recommend clinicians inform the mother of her options so she can share in the decisionmaking about her child's birth. This study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-07-10057).

See "Vaginal birth after cesarean: New insights on maternal and neonatal outcomes," by Jeanne-Marie Guise, M.D, M.P.H., Mary Anna Denman, M.D., Cathy Emeis, Ph.D., C.N.M., and others in the June 6, 2010, Obstetrics and Gynecology 115(6), pp. 1267-1278.

Current as of February 2011
Internet Citation: Vaginal births after cesarean are safe for most women: Research Activities, February 2011, No. 366. February 2011. Agency for Healthcare Research and Quality, Rockville, MD.