Comparison of a trial of labor with an elective second cesarean section

N Engl J Med. 1996 Sep 5;335(10):689-95. doi: 10.1056/NEJM199609053351001.


Background: In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery.

Methods: We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesarean section and had delivered a singleton live infant in the period from 1986 through 1992.

Results: A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. There were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (puerperal fever, a need for blood transfusion, or abdominal-wound infection). Although the overall rate of maternal complications did not differ significantly between women who chose a trial of labor and the women who elected cesarean section (odds ratio for the trial-of-labor group, 0.9; 95 percent confidence interval, 0.8 to 1.1), major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section.

Conclusion: Among pregnant women who have had a cesarean section, major maternal complications are almost twice as likely among those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean section.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Cesarean Section, Repeat* / adverse effects
  • Cesarean Section, Repeat* / statistics & numerical data
  • Female
  • Fetal Death / epidemiology
  • Fetal Death / etiology
  • Humans
  • Longitudinal Studies
  • Maternal Age
  • Obstetric Labor Complications / epidemiology
  • Obstetric Labor Complications / etiology
  • Odds Ratio
  • Parity
  • Pregnancy
  • Pregnancy, High-Risk
  • Puerperal Disorders / epidemiology
  • Puerperal Disorders / etiology
  • Risk Factors
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / etiology
  • Trial of Labor*
  • Vaginal Birth after Cesarean / adverse effects
  • Vaginal Birth after Cesarean / statistics & numerical data