An article published this month is the journal of the American College of Obstetrics and Gynecology recommends labor prior to a primary cesarean as a preventive measure against uterine rupture in future pregnancies.
A powerful argument against medical induction, the researchers tracked over 10,000 women from their primary c-section to the end of their second delivery. Of 10,160 women who had a trial of labor, 39 (0.38%) had a uterine rupture. Women whose primary cesarean delivery was planned or followed induction of labor had an increased risk of uterine rupture and this risk remained after adjustment for other factors. Women with a history of either spontaneous labor or vaginal birth had one uterine rupture for every 460 deliveries; women without this history who required induction or augmentation to proceed with a VBAC attempt had one uterine rupture for every 95 deliveries.
Conclusion: Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC.
Other findings: Augmentation is still bad for VBAC. The study also showed that women with a previous c-section who were induced or augmented for their trial of labor had a greater relative risk (4.24 fold) of uterine rupture.
The study authors convey a desire to see their research actually change the standard of care for all women. If implemented, this standard would likely lower the primary c-section rate in the first place. The authors state, “Our results can inform protocols for treating women who intend a first trial of labor,” …which means: let/encourage a women to spontaneously labor (don’t induce) and you can protect her uterus from damage, now and in the future.