Normal birth safe after Caesareans, U.S. panel agrees

WASHINGTON (Reuters) - Having a normal vaginal birth after previous babies were delivered surgically is perfectly safe and women should have the option, independent experts told the National Institutes of Health on Wednesday.

They said there is no good reason to force a woman who has had one Caesarean section to repeat such operations if she wants to try having later babies more naturally.

The experts cited "rigorous research" showing that at least trying natural labour is successful in nearly 75 percent of cases, and women are less likely to die if they are allowed to labour naturally for a while, even if they end up delivering surgically.

"Declining vaginal birth after Caesarean rates and increasing Caesarean delivery rates over the last 15 years would seem to indicate that planned repeat Caesarean delivery is preferable to a trial of labour," Dr. F. Gary Cunningham, chairman of the NIH expert panel, said in a statement.

"But the currently available evidence suggests a very different picture: a trial of labour is worth considering and may be preferable for many women," added Cunningham, the chairman of obstetrics and gynaecology at the University of Texas Southwestern Medical Centre at Dallas.

The panel cited two recent surveys of hospital administrators that showed 30 percent of hospitals had stopped offering women the option of trying labour if they had undergone one Caesarean. Some doctors fear that the incisions from the first operation could burst open during the pressure of contractions, endangering mother and baby.

But studies have shown the rate of rupture is less than 1 percent.

The American College of Obstetrics and Gynaecology does not recommend vaginal delivery for women who have had three or more C-sections.

Rates of Caesarean sections have risen steadily in the United States, from 20.7 percent of births in 1996 to 31.1 percent in 2006. And nearly 40 percent of the Caesareans performed in the United States each year involve women who have had previous C-sections.

The issue has become controversial, with some lobby groups pressing hard for women to be given the option of having vaginal birth after Caesarean, or VBAC.

"There's still a lot we don't know about which women will be successful in having a VBAC, but we believe it's essential that women's desires and preferences be respected throughout the decision-making process," Cunningham said.

The report is available consensus.nih.gov.

(Editing by Doina Chiacu)