Vaginal Birth After Cesarean Group Research Articles

Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China.

There have been limited reports on the duration of labor progression in pregnant women undergoing vaginal birth after cesarean (VBAC). This study aimed to investigate the duration of labor progression during VBAC in Hubei, China. A total of 359 pregnant women undergoing VBAC were enrolled as the VBAC group, meeting the following criteria: singleton pregnancy, gestational age ≥ 37weeks, live birth, history of cesarean delivery, and a willingness to attempt a vaginal delivery. At the same time, 359 primiparas successfully undergoing vaginal delivery were randomly enrolled in the control group at a 1:1 ratio. Subsequently, the durations of the first, second, and third stages of labor were comparatively analyzed between the two groups. The duration of the first, second, and total stages of labor in the VBAC group was significantly shorter than that in the control group (p < 0.05). There was no significant difference in the duration of the third stage of labor between the two groups (p > 0.05). The amount of blood loss, the rate of postpartum hemorrhage (PPH), and episiotomy were higher in the VBAC group than in the control group (p < 0.05). The rate of labor analgesia and intrapartum fever in the VBAC group was significantly lower than that in the control group (p < 0.05). The duration of labor progression of the first, second, and total stages of VBAC is shorter than that in primiparous women in our observation in China.

Comparison of maternal and neonatal outcomes between vaginal birth after cesarean section and normal vaginal birth

Objective This study aimed to compare the outcomes of vaginal birth after cesarean (VBAC) with those of normal vaginal birth (NVB) in a tertiary hospital in China. Methods This retrospective cohort study analyzed 1,024 women who birthed vaginally between January 2019 and December 2020. The VBAC group (n = 512) included women with one previous cesarean, while the NVB group (n = 512) had no previous caesareans. All women used epidural analgesia. We assessed maternal and neonatal complications using descriptive statistics, chi-square tests, and logistic regression. Statistical analysis was performed using SPSS version 25.0. Results The VBAC group had an 87.5% success rate for vaginal birth under epidural analgesia, whereas the NVB group had a 100% success rate. A primary focus of the study was uterine rupture. Vaginal birth after cesarean was associated with a higher incidence of uterine rupture (0.8% vs 0%, p = 0.031), postpartum hemorrhage (6.6% vs 3.5%, p = 0.021) and the need for blood transfusions (2.7% vs 0.8%, p = 0.012) compared with NVB. There were no substantial differences in maternal infections, wound infections or perineal lacerations between the groups. Although neonatal outcomes were generally similar, the VBAC group experienced higher rates of 5-minute Apgar scores <7 (2.3% vs 0.6%, p = 0.009) and admissions to neonatal intensive care units (3.1% vs 1.2%, p = 0.016 Even after adjusting for confounders, VBAC remained an independent risk factor for several complications. Conclusion Although VBAC is feasible and mostly safe, it is associated with a higher risk of specific complications compared with NVB. Careful selection of candidates and close monitoring are essential for optimizing outcomes in VBAC cases.

Association Between Utilization of Digital Prenatal Services and Vaginal Birth After Cesarean.

Digital health services are a promising but understudied method for reducing common barriers to vaginal birth after cesarean (VBAC), including connection to facilities offering labor after cesarean and patient-centered counseling about mode of birth. This study assesses the relationship between use of digital prenatal services and VBAC. In this retrospective cohort study, we analyzed the use of digital prenatal services and mode of birth among users of an employer-sponsored digital women's and family digital health platform. All users had a prior cesarean birth. Users' self-reported data included demographics, medical history, and birth preferences. We used basic descriptive statistics and logistic regression models to assess the association between digital services utilization and VBAC, adjusting for key patient characteristics. Of 271 included users, 44 (16.2%) had a VBAC and 227 (83.8%) had a cesarean birth. Users of both groups were similar in age, race, and ethnicity. Fewer users in the VBAC group (5/44, 11.4%) as compared with the cesarean birth group (62/227, 27.3%) had a prepregnancy body mass index greater than or equal to 30 (P = 0.02). Likewise, more users in the VBAC group preferred vaginal birth (34/44, 77.3% vs 55/227, 24.2%; P < 0.01). In adjusted models, the services associated with VBAC were care advocate appointments (adjusted odds ratio [aOR], 7.67; 95% CI, 1.99-54.4), health care provider appointments (aOR, 1.12; 95% CI, 1.02-1.25), and resource reads (aOR, 1.05, 95% CI, 1.00-1.09). VBAC rates were higher for users who reported the digital health platform influenced aspects of their pregnancy and birth. Reducing cesarean birth rates is a national priority. Digital health services, particularly care coordination and education, are promising for accomplishing this goal through increasing rates of trial of labor after cesarean and subsequent VBAC rates.

Consequences of information exchanges of vulnerable women on Facebook: An “information grounds” study informing value co‐creation and ICT4D research

AbstractInformation and communication technology for development (ICT4D) research sporadically leverages information science scholarship. Our qualitative study employs the “information grounds” (IG) lens to investigate the consequences of information exchanges by pregnant women on Facebook, who are vulnerable in the doctor‐centric birth culture in rural America. The thematic analysis of in‐depth interviews with members and administrators of the Vaginal Birth After Cesarean (VBAC) group shows that positive consequences outweigh negative consequences of information exchanges and lead to the following progression of outcomes: (a) VBAC group as an information ground, (b) social capital (e.g., cognitive, structural, and relational capital) built on the information ground, (c) seven emergent properties of the information ground, and (d) value co‐created (e.g., local, affordable, timely, enduring, and reliable support) by VBAC group members. The IG lens reveals the following roles of Facebook, an ICT, in development: (a) a linker that lets people with similar needs and interests convene and shapes their interactions, (b) a prerequisite to building an online, “third place” for social interactions, and (c) an apparatus for ubiquitously seeking, searching, sharing, and storing information in multiple formats and controlling its flow on the VBAC group. This paper fills in six gaps in the ICT4D research.

Spontaneous labor patterns among women attempting vaginal birth after cesarean delivery

Objective This study evaluated spontaneous labor patterns among women achieving a vaginal birth after cesarean (VBAC), without a previous vaginal delivery in relation to nulliparous women. Methods This historical cohort study included 422 women attempting VBAC and 150 nulliparas. We examined time intervals for each centimeter of cervical dilation and compared labor progression in 321 women who achieved spontaneous VBAC and 147 nulliparous women achieving a spontaneous vaginal delivery. Epidural anesthesia use, delivery mode, cord arterial pH and 5-minute Apgar score were also compared. Findings Women in the VBAC group compared to nulliparous women had similar durations of first (4–10 cm: 4:22 (00:54–13:10) h vs. 4:47 (1:10–15:10) h, p = .61), second (1:07 (8:00–3:21), vs. 1:34 (10:00–3:40), p = .124) and third stages of labor (10:00 (2:00–22:00) vs. 08:00 (3:24–22:12), p = .788). When comparing women who had epidural analgesia to those who did not, no differences were found between the groups regarding durations of first and second stages of labor. Interestingly, among parturients without epidural anesthesia only, the VBAC group had shorter second stage compared to the nulliparous (00:19 (0:04–1:59) vs. 00:47 (0:08–2:09), p = .023). Conclusion Labor patterns among women achieving spontaneous VBAC are similar to those of nulliparous women with spontaneous vaginal deliveries.

Higher risk of hemorrhage and maternal morbidity in vaginal birth after second stage of labor C-section.

This study evaluated the association between timing and indication for previous cesarean section (C-section) and its association with postpartum risks for adverse maternal outcomes, primarily postpartum hemorrhage (PPH) in vaginal birth after cesarean (VBAC). This retrospective case-control study examined women following term vaginal delivery in a university-affiliated medical center between 2008 and 2018. Postpartum complications were compared between women who had their first VBAC and a control group comprised of women who had vaginal delivery without prior C-section. Additional analysis was performed to evaluate the association between the timing of previous C-section and the severity of postpartum adverse outcomes. Of the women meeting the inclusion criteria (n = 2879), 1,455 had VBAC and 1,424 were in the control group. Overall, significant postpartum complications, primarily PPH, were observed in the VBAC group compared to controls. Women who underwent C-section during second-stage of labor experienced higher PPH rates and increased drop in hemoglobin levels compared to women who underwent C-section during the first stage of labor or an elective C-Sect.(4.3 ± 0.9g/dL vs. 2.8 ± 1.1g/dL vs. 2.4 ± 0.8, p = 0.033). Concomitant increased need for blood transfusion (8.1% vs. 3.5% vs. 2.9%, respectively, p < 0.0001) and uterine atony (12.6% vs. 6.2% vs. 4.4%, respectively, p = 0.009) were also observed. No significant differences were demonstrated in other postpartum adverse effects evaluated. VBAC is associated with higher rates of postpartum complications, primarily PPH. The risk is significantly increased in VBAC following a second stage cesarean section. This data should be taken into consideration in the management of laboring women after C-section.

Role of gatekeeping on Facebook in creating information benefits for vulnerable, pregnant women in the rural United States

PurposeThe purpose of this study is to investigate why and how gatekeepers on social networking sites (SNS) create what types of information benefits for gated, vulnerable, pregnant women in the rural United States.Design/methodology/approachThis qualitative study adopts “network gatekeeping” as a theoretical lens to implement a combination of deductive and inductive qualitative approaches for analyzing in-depth interviews with members and administrators of a Vaginal Birth After Cesarean (VBAC) Group on Facebook with a membership of over 500 pregnant women in rural Appalachia in the United States.FindingsThe VBAC group administrators' (a) vision of transforming the existing doctor-centric birth culture to a more mother-centric birth culture in the rural United States, (b) expertise and experience in healthcare and (c) valuing scientific, evidence-based information lead to recurring, authoritative but evolving manifestations of combinations of nine network gatekeeping mechanisms. Implementations of nine network gatekeeping mechanisms (i.e. localization, infrastructure, cost effect, channeling, censorship, regulation, editorial, user-interaction and value adding mechanisms) help VBAC group administrators control interactions and information on the group, thereby creating 16 information benefits for the gated, vulnerable women before, during and after pregnancy.Originality/valueThis sociological study of network gatekeeping posits and proves an “information value chain” (i.e. Why to create information benefits? – How to create information benefits? – What types of information benefits?) for vulnerable, pregnant women on Facebook. Rarely any study shows the role of network gatekeeping mechanisms in implementing an information value chain.

Risk of Uterine Rupture with Vaginal Birth after Cesarean in Twin Gestations.

Background Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods. Objective The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Study Design. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI). Results 4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54–25.17). Conclusion Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.

386 Timing of previous cesarean section affects postpartum hemorrhage and maternal morbidity following sequential vaginal birth

Women following vaginal birth after cesarean (VBAC) benefit from lower morbidities and reduced risks for future pregnancies, with the expense of higher rates of post partum complications including post-partum hemorrhage (PPH). This study aimed to investigate the association between the timing of previous cesarean section (CS) and the risk of post-partum adverse maternal outcomes following a subsequent successful VBAC. Retrospective case-control study of women following term vaginal delivery in a university-affiliated medical center between 2008-2018. Post-partum complications were compared between women who had their first VBAC and a control group of women following a vaginal delivery without a prior CS. Additional analysis was performed to evaluate the association between the timing of previous CS and the severity of post-partum adverse outcomes. 2879 women met inclusion criteria , 1455 had VBAC and 1424 had a vaginal delivery without a prior CS. Overall, significant post-partum complications, primarily PPH, were observed in the VBAC group compared to controls. Women with previous CS during the 2nd stage of labor presented a higher rate of PPH with a higher drop in hemoglobin levels when compared to women who underwent either emergent CS during 1st stage of labor or an elective CS (4.3±0.9g/dL vs. 2.8±1.1g/dL vs. 2.4±0.8g/dL, respectively, p=0.033). A concomitant increase in the need for blood transfusion (8.1% vs. 3.5% vs. 2.9%, respectively, p< 0.0001) and uterine atony rates (12.6% vs. 6.2% vs. 4.4%, respectively, p=0.009) was also noted. No significant differences were shown in duration of hospitalization, rate of uterine revision, vacuum assisted deliveries, postpartum urinary retention, endometritis, and obstetric and anal sphincter injuries (OASIS) (Table 1). VBAC is associated with an increased rate of post-partum complications, primarily PPH. The risk is significantly increased in women who were previously operated during the 2nd stage of labor (Figure 1). These data should be considered when counseling women for trial of labor after cesarean (TOLAC).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

VBAC or not VBAC? Improvement of performance and outcome indexes with the promotion of care safety

Abstract Background In a multidisciplinary approach to Quality Management System and humanization of care, we aimed at evaluating the characteristics that influence the request of women to carry out Vaginal Birth after Cesarean (VBAC). Methods Skills have been improved, with the use of tests on dummies and case by case assessments. For the psychological-motivational study we have adopted: Informed consent, Semi-structured interview and Big Five Questionnaire. The women were recruited by both Gemelli and Cristo Re Hospital: the women following the counseling decided to undergo a second Caesarean Section (CS) (41, control group) and women who decided to complete a VBAC (22, experimental group). Results The analysis of the data shows that the women of the VBAC group are in the average between 31-35 years (57%), 80% has an education = or &amp;gt; at the 3rd level and the choice of the VBAC was conditioned by the partner (64%). The women of the control group are in average &amp;gt; 35 years (51%), 60% have a higher average education and the influence on the choice is oriented by the gynecologist/obstetrician (64%). From the personality test a statistically significant difference emerges between the dimensions Energy and Mental Opening. Past experience influences the choice of the next birth: women who are inclined to a second CS considered the previous CS as a positive event (66%) while only 36% in the VBAC group; 64% of this was the recovery of the painful post-surgery and a certain type of difficulty in the care of the child, in breastfeeding, of having suffered from post-partum mood alterations, which is why they chose to undertake a Trial of Labor After Cesarean. Conclusions The deeper knowledge of women as well as the preparation and safety of the same operators has shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team, leading to an improvement in outcomes and performance indexes. Key messages The promotion of care safety also improves the performance indexes through continuous training to the operators and the study of psychological aspects that lead to the choice to carry out a VBAC. Good Clinical Practice shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team.

A study of the determinants of success of trial of labour after cesarean (TOLAC) in a tertiary centre of Haryana

A study of the determinants of success of trial of labour after cesarean (TOLAC) in a tertiary centre of Haryana - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.067, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Delivery modes and their influencing factors of pregnant women with previous cesarean section: a retrospective study of 474 gravidas

Objective To investigate the safety of vaginal delivery in gravidas with previous cesarean section and its influencing factors. Methods Four hundred and seventy-four full-term gravidas who received cesarean section at the Department of Obstetrics and Gynecology of Peking University First Hospital from January 1, 2012 to August 31, 2014 were enrolled in this study. Among those subjects, 38 who underwent successful vaginal delivery were grouped into vaginal birth after cesarean (VBAC) group, and the other 436 accepting repeated cesarean section were grouped into cesarean group. Delivery outcomes and maternal/neonatal complications of the two groups were retrospectively analyzed with two-sample t-test and Chi-square test. Results Among the 45 patients (9.5%) who attempted VBAC, seven underwent cesarean section for suspected fetal distress and the other 38 (84.4%) succeeded in vaginal birth without uterine rupture. The amount of postpartum hemorrhage in patients of cesarean group was more than that of VBAC group [(330.8±94.8) vs (257.7±199.7) ml, t=2.021, P<0.01] after exclusion of three patients with dangerous placenta previa, and the postpartum hospital stay was shorter than that of cesarean group [(2.5±1.4) vs (4.5±1.3) d, t=7.952, P<0.01]. There were three newborns with neonatal asphyxia, twelve with neonatal infections and forty transferred to the Pediatrics Department following cesarean section. Besides, complications of headache and urinary retention occurred in 20 and 32 mothers after cesarean section, respectively. However, no complication occurred in VBAC group. Sixty-three cesarean sections were indicated as thin lower uterine segment and among them, fourteen (22.2%) had muscular rupture. Among the six patients who complained of tenderness in lower uterine segment, three were found having muscular rupture during cesarean section. Conclusion VBAC is an option for gravidas with history of cesarean section only if they meet the criteria for VBAC attempt. VBAC could lower the cesarean section rate without increase the incidence of complications. The rate of trial of labor after cesarean was low, patients education should be strengthened to increase it. Key words: Vaginal birth after cesarean; Trial of labor; Premature rupture of fetal membranes; Natural childbirth

Analysis of factors affecting vaginal birth after cesarean

To investigate the factors affecting the vaginal birth after cesarean (VBAC). Totaly 298 women who underwent trial of labor after cesarean section (TOLAC) from Jan 2015 to Dec 2015 were recruited from Beijing Obstetrics and Gynecology Hospital, FuXing Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, the Second Affiliated Hospital of Chongqing Medical University and the People's Hospital of Chengyang District of Qingdao. The maternal age, the interval from the last cesarean section, the body mass index (BMI) before pregnancy, the weight gain during pregnancy, the way into labor, the Bishop score before labor, the gestational age and the birth weight of the neonate were recorded in a self-made form. The factors affecting VBAC were analyzed by univariate analysis and multivariable logistic regression. (1)The incidence of VBAC, uterine rupture, postpartum hemorrhage and neonatal asphyxia were 70.5% (210/298), 2.7% (8/298), 9.4% (28/298) and 1.3% (4/298), respectively. No maternal death and perinatal death occurred. (2)The univariate analysis suggested that the maternal age, the BMI before pregnancy, the Bishop score before labor, the labor induction, the gestational age at delivery and the neonatal weight were factors affecting VBAC. The maternal age and the Bishop score before labor were significantly higher in the VBAC group than in the unsuccessful TOLAC group(P<0.05). While the BMI before pregnancy, the induction rate, the gestational weeks at delivery and the birth weight of the neonate were significantly lower in the VBAC group than in the unsuccessful TOLAC group (P<0.05). Multivariable logistic regression analysis showed that successful VBAC was affected by the maternal age, the BMI before pregnancy, the Bishop score before labor and the birth weight of the neonates(P<0.05). The maternal age, the BMI before pregnancy, the Bishop score before labor and the birth weight of neonate are the main factors affecting VBAC.

Analysis of the delivery mode results of repregnancy after cesarean section

Objective To explore the best choice mode of repregnancy after cesarean section.Methods 312 cases with repregnancy after cesarean section were divided into the repeat cesarean section (RCS) group (210 cases),vaginal birth after cesarean(VBAC) group (102 cases),and the first time cesarean(PCS)group(210 cases).The maternity delivery mode and outcome were observed and the relevant conditions (postpartum hemorrhage,the average length of hospital stay and hospital costs,etc.) were compared among the three groups.Results The trial production was in 144 cases,and vaginal delivery in 102 cases,the success rate was 70.83％.168 cases with direct vaginal delivery,the success rate was 53.85％.The postpartum hemorrhage of RCS group[(310.5 ± 30.2)ml] was significantly higher than that of VBAC group [(143.5 ± 25.2) ml] (U =7.55,P ＜ 0.01) and PCS group [(244.2 ± 28.3) ml] (U =20.4,P ＜ 0.05).The hospital stay time of RCS group [(7.5 ± 0.2) d] was significantly more than that of VBAC group[(3.0 ±0.3)d] (U =25.50,P ＜0.01)and PCS group[(6.6 ±0.6)d] (U=16.7,P ＜0.05).The hospitalization costs of RCS group [(4 451.5 ± 62.4) yuan] was significantly higher than that of VBAC group [(1 223.6±12.3)yuan](U=71.5,P＜0.01) and PCS group[(3 756.4± 54.6)d](U=25.2,P＜0.01).Conclusion Repregnancy after cesarean section is not absolute indications for cesarean section,vaginal birth is safe and feasible as long as the medical intensive care effectively,and it can reduce the rate of cesarean section. Key words: Caesarean section ; Pregnancy; Parturition

Deciding on route of delivery for obese women with a prior cesarean delivery

OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at ≥36 weeks' gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P = .02), endometritis (6.6% vs 0%, P = .06), and composite puerperal infection (24.6% vs 8.2%, P = .01). Mean cost of care was similar for mothers ($4439 vs $4427, P = .95), infants ($1241 vs $1422, P = .49), and mother-infant pairs ($5680 vs $5851, P = .64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.

Vaginal birth after cesarean: an appraisal of fetal risk

Objective: To expand on prior investigations and further evaluate the fetal risk associated with vaginal birth after cesarean (VBAC) by examining the incidence not only of a depressed Apgar score at 5 minutes but also of fetal acidemia. Methods: Between January 1, 1991, and December 31, 1996, the following groups of patients who delivered a singleton fetus with birth weight greater than 750 g were identified: 2082 patients with one or more prior cesarean deliveries who were allowed a trial of labor, 1677 of whom delivered vaginally and 405 of whom delivered by repeat cesarean; 920 patients delivered by elective repeat cesarean; 22,863 patients without a prior cesarean who delivered vaginally; and 2432 patients delivered by primary cesarean after laboring. Umbilical cord arterial blood gases were obtained in 88.3% of these deliveries. Comparisons of Apgar scores at 5 minutes and umbilical cord arterial pH measurements were made between groups with χ 2 or Fisher exact test, and odds ratios (ORs) were calculated. Results: The only significant differences were noted between those patients who delivered vaginally after a prior cesarean and those patients who delivered vaginally without a prior cesarean. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes less than 7 (OR 1.52) or an umbilical arterial pH less than 7.1 (OR 1.69). Those neonates, however, were not at greater risk for an Apgar score less than 4 or a pH less than 7.0. Conclusion: Our experience suggests that VBAC poses a low level of fetal risk, although a much larger sample size would be required to exclude a two-fold increase in potentially damaging fetal acidemia.

Vaginal Birth After Cesarean

In Brief Objective To expand on prior investigations and further evaluate the fetal risk associated with vaginal birth after cesarean (VBAC) by examining the incidence not only of a depressed Apgar score at 5 minutes but also of fetal acidemia. Methods Between January 1, 1991, and December 31, 1996, the following groups of patients who delivered a singleton fetus with birth weight greater than 750 g were identified: 2082 patients with one or more prior cesarean deliveries who were allowed a trial of labor, 1677 of whom delivered vaginally and 405 of whom delivered by repeat cesarean; 920 patients delivered by elective repeat cesarean; 22,863 patients without a prior cesarean who delivered vaginally; and 2432 patients delivered by primary cesarean after laboring. Umbilical cord arterial blood gases were obtained in 88.3% of these deliveries. Comparisons of Apgar scores at 5 minutes and umbilical cord arterial pH measurements were made between groups with χ2 or Fisher exact test, and odds ratios (ORs) were calculated. Results The only significant differences were noted between those patients who delivered vaginally after a prior cesarean and those patients who delivered vaginally without a prior cesarean. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes less than 7 (OR 1.52) or an umbilical arterial pH less than 7.1 (OR 1.69). Those neonates, however, were not at greater risk for an Apgar score less than 4 or a pH less than 7.0. Conclusion Our experience suggests that VBAC poses a low level of fetal risk, although a much larger sample size would be required to exclude a two-fold increase in potentially damaging fetal acidemia. Vaginal birth after cesarean poses a low level of risk of potentially damaging fetal acidemia.