It’s still hard for me to believe that in 2006 the National Institutes of Health State-of-the-Science Conference on Cesarean Delivery on Maternal Request concluded that we need “more research” in order to compare the outcomes from vaginal birth to the outcomes from cesarean delivery. Since that time, however, there have been numerous studies documenting the increased risks to both mothers and babies with cesarean delivery. One more study has been published this month in Obstetrics and Gynecology. The objective of this study was to look at the outcomes of newborns born by elective repeat cesarean delivery compared with VBAC in women with one previous cesarean delivery and to evaluate the cost differences between elective repeat cesarean and VBAC. The authors found that in comparison with VBAC, newborns born after elective repeat cesarean delivery have SIGNIFICANTLY higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay. The costs of elective repeat cesarean were significantly greater than VBAC. Failed VBAC accounted for the highest total costs (delivery and NICU.) Not surprisingly, failed VBAC was associated with labor induction and chorioamnionitis. The authors also found that the greatest number of amniocenteses for fetal lung maturity were performed for those newborns who had elective repeat cesarean delivery without labor. However, these newborns had high rates of respiratory morbidity and NICU admission, indicating that surfactant deficiency may NOT be the sole cause of respiratory distress seen after elective cesarean delivery. Indeed, other researchers have speculated that hormonal changes that occur in the days prior to labor are critical in enhancing lung maturity and preparing the fetal lungs for air breathing. In addition, catecholamines released during labor likely play an important role in both clearance of fetal lung fluid and glycemic control after birth. More evidence supporting the wisdom of allowing labor to begin on its own and promoting the increased availability of VBAC.
