VBAC Safety: A Closer Look at the 2002 JAMA Study

The absolute difference in mortality is small. Even if it is real, which seems doubtful, it amounts to one baby in a thousand. Moreover, the mortality rate differs from the rate in mothers with only vaginal births by less than that and is similar to the rate in first-time mothers. Even one avoidable loss in a thousand matters, but to put this number in perspective, the chance of losing a baby as a result of amniocentesis may be as high as 1 in 200 (9). No one is recommending banning amniocentesis for this reason. A one-in-a-thousand difference isn't enough to justify a policy recommendation, let alone scary articles about the dangers of VBAC. What's more, it's misleading.

Looking at death rates after 37 weeks doesn't tell the whole story.
The Scottish study only looked at the tip of the cesarean iceberg. As the number of cesareans increases, so do the odds of infertility, miscarriage, ectopic pregnancy (embryo implants outside of the womb), placenta previa (placenta overlays the cervix), placental abruption, and placenta accreta (placenta grows into and sometimes through the uterine muscular wall) (7). Babies born by cesarean are also more likely to have respiratory problems, including persistent pulmonary hypertension, which can kill (7). A Swiss study of 29,000 women with prior cesareans reported deaths after 28 weeks of pregnancy in normally formed infants. Nine were due to placental abruption, one to placenta previa, and six to uterine rupture, of which one was in the planned cesarean group (11). That same study found that the chance of uterine rupture during pregnancy with a scarred uterus was 2 per 1,000, but it was one per 10,000 in 226,000 women with no uterine scar (11). That's 20 times more. To repeatedly subject women to the gantlet of C-section risks when 75 percent of them will birth vaginally if given the chance makes no sense. The real take-home message of this study is: "To improve infant outcomes, don't do more repeat cesareans; do fewer first ones."

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