National Institutes of Health Consensus Development Conference Statement

Uterine Rupture and Pregnancy Current Vision: Scientific Evidence and Consensus with the Patient

“…We know the benefits of vaginal delivery, and we must offer it to patients with previous caesarean showing no apparent risk factors in the prenatal visit. We have to keep in mind the high success rate of vaginal birth after caesarean (74%, reaching 83% if there has been a previous vaginal delivery) [16], but we must be aware and cautious in handling delivery of these patients, paying attention to the signs and symptoms of alarm. The safest model would be the patient with one prior low transverse uterine incision, an interval intergenesic more than 18 months, no prior and no alterations observed by ultrasound placenta, no macrosomia and fetus with a cephalic presentation.…”

A one year study on evaluation of pattern of caesarean section and its outcome before and after introduction of Janani Suraksha Yojna and maternal ambulances services

“…27 Subsequent logistical and liability concerns led many hospitals to enact overt or de facto bans of VBAC. 28 As a result, the rate at which VBAC was attempted fell from 28.3% in 1996 to less than 10% in 2010. [26][27][28] There were controversial findings on the risks and benefits of trial of labour and elective repeat CS, and little or no evidence on short-or long-term neonatal outcomes after trial of labour compared to elective repeat CS.…”

“…28 As a result, the rate at which VBAC was attempted fell from 28.3% in 1996 to less than 10% in 2010. [26][27][28] There were controversial findings on the risks and benefits of trial of labour and elective repeat CS, and little or no evidence on short-or long-term neonatal outcomes after trial of labour compared to elective repeat CS. 29 Notwithstanding, enhanced access to VBAC has been recommended based on current findings on the safety of VBAC compared to repeat CS, indicating that 60% to 80% of women can achieve a safe vaginal delivery after a previous lower uterine segment CS.…”

The Ethics of Vaginal Birth after Cesarean

“…In March 2010, the NIH released another consensus statement on VBAC, expressing concern about the limited access women have to clinicians and facilities willing to offer a trial of labor after cesarean and calling for various stakeholders to work together to mitigate or eliminate these barriers. 4 In August 2010, ACOG released new practice VBAC guidelines that were more permissive than the previous guidelines, but failed to address what many (including ACOG) recognized as a major barrier to access-the requirement that anesthesia and surgery be "immediately available." 5 This means that any provider/hospital wishing to offer VBAC must be prepared to do emergency surgery.…”

“…It concluded that, "Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision." 14 A primary concern raised by obstetricians when considering a trial of labor after cesarean is the possibility of uterine rupture. According to ACOG's own statistics, however, when the woman has a low transverse uterine incision, the risk of uterine rupture is less than 1 percent, 15 and in the studies reviewed by the NIH group, there were no maternal deaths as a result of uterine rupture.…”