A trial of labor
was allowed in 1,008 of these patients and 92.2% delivered vaginally.
Increased success of trial of labor
after previous vaginal birth after cesarean.
Leveno et al., "Maternal and perinatal outcomes as sociated with a trial of labor
after prior cesarean delivery," The New England Journal of Medicine, vol.
Both the American College of Obstetricians and Gynecologists and the Society of Obstetricians and Gynecologists of Canada state that women with 1 previous low-transverse cesarean section should be offered a trial of labor
after appropriate counseling of the risks and benefits.
Uterine rupture during trial of labor
after previous cesarean section.
Oxytocin dose and the risk of uterine rupture in trial of labor
Specific outcomes of interest regarding trial of labor
after c/section are successful VBAC, uterine rupture, hysterectomy, maternal mortality and neonatal outcomes.
A 4-year observational study of 45,988 pregnant women with a prior cesarean section who underwent either a trial of labor
or elective C-section answered an important question about the risks of inducing labor with Pitocin (synthetic oxytocin) that had been left hanging by previous studies of vaginal births after cesarean section.
How risky is a trial of labor
after cesarean delivery for uterine rupture and other patient-oriented outcomes?
The authors report that the risk of uterine rupture for women who chose a trial of labor
(who planned a VBAC with spontaneous onset of labor is 5.2 per 1000 (0.5 percent) (3).
Our obstetricians feel the safest way to reduce the c-section rate is to have a "trial of labor
" for vaginal delivery on women who have had a prior c-section, unless there is some underlying medical condition that would preclude vaginal delivery.
For example, VBAC rates substantially reflect the number of women offered trial of labor
, which has been increasingly encouraged since 1982 (7).