After enduring 44 hours of labor with her first child, when Mistie Thompson finally began to push, the baby crowned almost immediately. But after two hours of pushing and an attempted vacuum extraction, she didn't budge. The baby was delivered by C-section, during which the epidural didn't work properly, so Thompson was given Versed. She woke up in recovery having no idea what happened.

"I was determined to have a different experience with my next child," says Thompson, a St. Louis, Mo., resident. "Or at least, to actually remember my child's birth!" Because of this, she did an enormous amount of research about VBAC, or vaginal birth after Cesarean.

As Thompson discovered, the topic of VBAC is a controversial one. Federal reports in the 1980s and 1990s promoted VBAC as a safe and reasonable alternative. In 1994 and 1995, the American College of Obstetricians and Gynecologists (ACOG) stated that a woman with one previous Cesarean delivery with a lower uterine segment incision should be counseled and encouraged to undergo a trial of labor in her current pregnancy.

In 1999, the position was revised to say "...because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care."

An increasing number of studies have shown that a woman's risk of a ruptured uterus during a VBAC is about three-quarters of 1 percent, or seven out of every 1,000 cases, says Tina Cassidy, a Boston-based author of Birth: The Surprising History of How We Are Born (Atlantic Monthly Press, 2006), which addresses the VBAC issue in detail. If the uterus ruptures, there's a 5 percent chance the fetus will suffer oxygen deprivation or death. The risk of the mother dying is even lower. "Not particularly shocking data, but it's plenty worrying to obstetricians, who expect to eventually contend with a complication, and therefore, a lawsuit," Cassidy says.

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