Repeat cesarean or a trial of labor
Both are reasonable. Neither is risk free.
If you have had one cesarean with a side-to-side lower uterine cut, you generally have two options: a scheduled repeat cesarean, or a trial of labor with the aim of a vaginal birth. Most published series report vaginal birth in 60% to 80% of women who attempt labor.
In the largest prospective study, 45,988 women were followed. Comparing trial of labor with scheduled repeat cesarean:
| Outcome | Trial of labor | Scheduled repeat cesarean |
|---|---|---|
| Uterine rupture | 0.7% | Essentially none |
| Uterine infection | 2.9% | 1.8% |
| Blood transfusion | 1.7% | 1.0% |
| Hysterectomy | 0.2% | 0.3% |
| Maternal death | 0.02% | 0.04% |
| Newborn brain injury from oxygen loss | 12 babies | 0 babies |
The trade is real and it is not one-sided. A trial of labor carries a small risk of rupture and a very small risk of newborn brain injury. A repeat cesarean carries surgical risk now and much larger risks in future pregnancies.
Where this comes from:
269. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581-2589.
287. American College of Obstetricians and Gynecologists. Vaginal birth after cesarean delivery. ACOG Practice Bulletin No. 205. Obstet Gynecol. 2019;133(2):e110-e127.
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