December 15, 2004

BY JIM RITTER Health Reporter

Once a woman has a Caesarean section, the odds are she'll automatically have C-sections for all later births.

A major study released Tuesday confirms that C-sections are safer in such cases. However, the risks of having a natural vaginal birth after a previous Caesarean, known as a VBAC, remain very low.

"It is safe both ways," said Dr. Atef Moawad of the University of Chicago, one of 19 centers that participated in the nationwide study to be published in the New England Journal of Medicine.

CAESAREAN STATS Caesarean rate in U.S., 1970: 5 percent Rate in 2003: 27 percent Percent of vaginal births after previous Caesarean (VBAC) in 1998: 31 percent VBAC rate in 2003: 11 percent Federal government's 2010 goal for VBAC rate: 37 percent Source: National Institutes of Health

A Caesarean leaves a scar on the uterus, which can tear in a later delivery and in rare cases cause brain damage or death in the baby. To avoid this risk, only 11 percent of U.S. women who had undergone previous C-sections had VBACs in 2003. Some smaller hospitals have stopped doing VBACs altogether, in part because they fear malpractice lawsuits if something goes wrong.

Researchers followed 17,898 women who had VBACs and 15,801 women who had Caesareans following an earlier Caesarean. Uterine ruptures occurred in 0.7 percent of VBACs, and there was likely brain damage in seven babies. There were no uterine ruptures in the Caesarean group.

Infant mortality

Thirteen babies died in the VBAC group and seven in the Caesarean group, but this difference was not statistically significant.

The risks are low enough to perhaps boost the slumping VBAC rate, said lead researcher Dr. Mark Landon of Ohio State University. "I think it will certainly open up the dialogue once again."

Overall, there's roughly a 1 in 1,000 chance that something serious will go wrong with a VBAC baby, said Dr. Alan Peaceman of Northwestern University and Northwestern Memorial Hospital.

"A lot of women say that's not a risk they're willing to take," he said.

However, Peaceman added that each Caesarean increases the risk that in subsequent pregnancies the placenta will implant over the scar and grow into the uterus. This can cause hemorrhaging, and in severe cases require a hysterectomy.

And, of course, it takes longer to recover from a Caesarean, at a time when the mother needs all her strength for her newborn. Moms typically spend four days in the hospital after a Caesarean, compared with two days following a vaginal birth.

Longer recovery

Maria Tomasch-Lee of Aurora had a Caesarean for her first child, but opted for a VBAC for her second. She hoped to have a VBAC for her third child, too. But her doctor said a VBAC would be too risky, so she had a Caesarean.

It took her six weeks to fully recover. It hurt to get up or to hold her baby on her belly, and she could feel the strain when she pushed the stroller.

"It's really hard to take care of a baby after a Caesarean," she said.

Contributing: AP