When making the choice to have a trial of labor after cesarean, it is important to weigh the risks versus the benefit.

There is less maternal morbidity in women having a vaginal delivery after a cesarean, provided the services are performed in a hospital with appropriate facilities, the previous uterine incision is known to be a low transverse scar, and there are no confounding contraindication such as maternal illness or malpresentation.

Studies by Phelan etal (1987) and Lawson (1987) show that the overall success rate for vaginal deliveries after 2 or more cesareans varies little from women with one previous cesarean (58%-81%). The rate of uterine dehiscence is slightly higher in women having more than one previous cesarean (0-3.8% for 2 or more cesarean and 0.4-2.8% with 1 previous cesarean). These dehiscence were all asymptomatic without serious sequelae and no maternal or perinatal mortality was associated with the labor trials of women who had more than one cesarean.

The conclusion of these studies was that though the number of cases is still small the available evidence does not suggest that the woman who has had more than one previous cesarean section should be treated any differently from the woman who has had only one cesarean section.

Nurse-midwives, working in collaboration with physicians, provide care to women seeking a vaginal delivery after cesarean. Not all physicians and nurse-midwives will feel equally comfortable with providing this service. You are still early in your pregnancy, so you have some time to interview providers. I would recommend you interview the nurse-midwife first and specifically discuss with her what sort of success she has had with vaginal trial of labor. I would also recommend that you openly discuss with her your previous birthing experiences so that she may become aware of any features that may contribute to or prevent potential success in your trial.

It is important that she have a good consulting relationship with a physician. Once you have chosen a nurse-midwife provider, I would also recommend you request to speak with her physician consultant and share with the physician your commitment to a vaginal trial of labor.

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