Vaginal Delivery after Cesarean Section — Is the Risk Acceptable?

Abstract

Nearly 40 years ago, Douglas et al. documented the risk of uterine rupture during a trial of labor after cesarean section.¹ Among more than 2000 women with scars from prior cesarean sections, uterine rupture occurred during labor in just over 1 percent, and more than a third of the fetuses in those cases died. The authors concluded, “Probably the most vehement objections to the policy of vaginal delivery after cesarean section allude to the occurrence of catastrophic ruptures of the uterine scar.” That experience, coupled with the mantra “Once a cesarean, always a cesarean,” cast the practice of vaginal delivery . . .