title: Is vaginal birth after cesarean safe? Experience at a community hospital.
abstract: OBJECTIVE
  We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital.
  
  
  METHODS
  A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754).
  
  
  RESULTS
  We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both.
  
  
  CONCLUSIONS
  A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals.
authors.affiliation: Department of Obstetrics and Gynecology, Metro West Medical Center, Framingham, Massachusetts, USA.
authors.forename: H
authors.initials: H
authors.lastname: Blanchette
authors.forename: M
authors.initials: M
authors.lastname: Blanchette
authors.forename: J
authors.initials: J
authors.lastname: McCabe
authors.forename: S
authors.initials: S
authors.lastname: Vincent
mesh_terms: D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000401:mortality; D007751:Labor, Induced / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012086:Reoperation; D012449:Safety; D014219:Trial of Labor; D014597:Uterine Rupture / Q000209:etiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*