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American Morning

Vaginal Birth After Cesarean Holds Risks

Aired July 05, 2001 - 11:39   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BRIAN NELSON, CNN ANCHOR: There's some new research out today suggesting that vaginal childbirth after a C-section can be risky business for both Mom and for Baby.

CNN's Dr. Sanjay Gupta is here with that explanation.

Sanjay, tell us more about the study and the risks.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Sure. It was a big study. They looked at 20,000 women who had previously had delivery by cesarean section and now they were having their second child, either by cesarean or by what's called VBAC, which stands for Vaginal Birth After Cesarean. I should point out at the onset that only 91 of these 20,000 women had a serious complication known as uterine rupture.

What the study goes on to highlight is it's three times more likely to have a uterine rupture if your second delivery was by VBAC, compared to cesarean section.

It also points out it's 15 times more likely to have this uterine rupture if you are actually induced, with some of these inducing drugs, to labor. So if a woman's induced after having had a previous cesarean, she's 15 times more likely to rupture her uterus.

NELSON: Let's talk about the history on this. For a number of years, it has been the case that if you have had a cesarean, you do not go back to vaginal birth, right?

GUPTA: Right.

NELSON: What changed?

GUPTA: That was the mantra for a long time: Once a cesarean, always a cesarean. I think a lot of data had sort of been accumulated. A lot of research had been performed showing that, in fact, it was OK and safe to perform a vaginal delivery after cesarean section. The theory, Brian, is that a lot of the uterine wall may actually be not as strong as it was after having had a cesarean section, so vaginal delivery might be dangerous after that.

But the research at that time didn't show that necessarily to be the case. Now we have this new study that shows 91 of the 20,000 women had uterine ruptures, but even those numbers are very small -- that's less than 0.5 percent. NELSON: What was it that encouraged women to go back to vaginal births after cesareans?

GUPTA: I think a lot of that is just preference. There is a maternal child relationship -- a lot of the young moms want to have their baby given naturally, by the vaginal delivery, either the first time or the second time around. If they couldn't have it the first time, then certainly the second time.

NELSON: So the bottom line here, as you sit here as a doctor, what advice would you give prospective mothers.

GUPTA: I think it's important, as always, to check with your obstetrician about the possibilities of either a cesarean or a vaginal delivery. It's important to know that there probably isn't an absolute right either way.

But probably the one interesting statistic that came out of this paper was that if your labor is induced the second time -- had a cesarean section the first time -- your second child -- and the labor's induced, that could potentially be dangerous, although it's very, very rare.

NELSON: Thank you, Dr. Sanjay Gupta, for your illuminations on this rather complicated signature.

GUPTA: Thank you.

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