Findings on C-sections stir controversy

WASHINGTON – Women who have delivered a baby by Caesarean section face a small risk of complications that could endanger the baby if they attempt a natural delivery the next time, a large new study has found.

The findings, the most definitive data so far on the safety of attempting a vaginal delivery after a Caesarean, immediately rekindled debate on the controversial issue.

Proponents of attempting a natural delivery said the findings should give doctors and women confidence that the risk is relatively low and most women and their babies will not experience major problems. But other experts said the findings underscore the dangers of attempting vaginal birth after a Caesarean and provide new evidence that women should not be encouraged to do so.

A Caesarean section is a surgical procedure that is performed to deliver a baby, usually when the mother or child is experiencing a complication that puts one or both of them at risk. For years, some doctors and natural birth advocates have encouraged women who had one Caesarean to try to avoid the cost, added recovery time and possible complications of the surgery by attempting to deliver their next child vaginally.

But the rate at which women had been attempting a vaginal birth after Caesarean began falling in the late 1990s following reports of life-threatening complications, most notably ruptures of the uterus.

The new study was organized and funded by the National Institute of Child Health and Human Development to provide better data on the actual risks associated with VBAC. Researchers compared 17,898 women who attempted a vaginal birth and 15,801 who underwent another Caesarean at 19 academic medical centers around the country.

Of the women who attempted a vaginal birth, 124 women – less than 1 percent – experienced a ruptured uterus, and seven babies suffered brain damage from a lack of oxygen due to complications during labor, including two who died. Women who attempted a vaginal birth were also more likely to develop an infection of the uterine lining. No serious problems occurred among women who had repeat Caesareans.

Overall, among the women who attempted a vaginal birth the risk of brain injury or death for the baby from a uterine rupture was about 1 in 2,000 deliveries, the researchers reported.