Laboring over delivery

A new study adds to evidence supporting VBAC

One Caesarean birth was enough for Wilmette mom Julie Lambert. She wanted to try natural birth the second-and third-time around.

After switching from an obstetrician to a midwife, Lambert gave birth to two healthy children, in 2003 and this April, both times avoiding a C-section.

Other moms considering a vaginal birth after Caesarean, or VBAC, now have more information to help them make their decision. A study recently published in Obstetrics & Gynecology showed a low risk of uterine rupture with VBAC, a concern many mothers have when debating labor after a C-section.

Many people assume women with more than one previous C-section have a much greater risk of uterine rupture than those with only one prior C-section, according to Dr. Mark Landon. He is the lead author of the study and professor and vice-chairman in the department of obstetrics and gynecology at the Ohio State University College of Medicine.

"Our analysis revealed that the rate of uterine rupture was not statistically higher," Landon says. The average risk for all women involved was between .5 and .7 percent.

The study included 17,890 women who gave birth from 1999 to 2002 after at least one prior C-section.

"Our job as physicians isn't necessarily to tell women what to do but appraise them of the risks and benefits and help them assess what's best for them," says Dr. Alan Peaceman, a co-investigator with the study, professor of obstetrics and gynecology at Northwestern University Medical School and chief of maternal fetal medicine at Northwestern Memorial Hospital. Recommendations should be tailored to individuals, he says.

Even though studies show VBAC as a viable option for many mothers, it's unclear whether the VBAC rate, which has dropped in the last decade, will be affected by the research, Peaceman says.

"There are economic and liability factors which have little to do with quality of care or medical evidence, yet these factors ... clearly influence obstetrical decision-making," says Landon.

After her experiences with VBAC, Lambert advises moms to find a doctor or midwife who will consider their wants regarding a child's birth. Lambert is now a co-leader of the Chicago chapter of International Cesarean Awareness Network, a nonprofit group with the goal of preventing unnecessary Caesarean sections.

"It's very important that they are on the same page as their care provider. Keep looking if you're not comfortable, because there are people out there who do believe women can have a natural birth after C-section," she says.

For more information, e-mail

Jennifer Gilbert

Kids Eat Chicago

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