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Related Experiment Video

Updated: May 15, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?

External Cephalic Version: Is it an Effective and Safe Procedure?

Published on: June 6, 2020

Quantifying VBAC risk: muddying the waters.

Andrew Kotaska¹

¹Department of Obstetrics and Gynecology, Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada.

Birth (Berkeley, Calif.)

|January 4, 2013

Summary

This summary is machine-generated.

The Landon et al study provides reliable data on vaginal birth after cesarean (VBAC) risks and success. The Crowther et al study is smaller, less valid, and its findings on VBAC complications are questionable.

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine
Reproductive Health

Background:

Vaginal birth after cesarean (VBAC) is a critical decision for women with prior cesarean delivery.
Comparing VBAC with elective repeat cesarean delivery requires robust evidence on risks and success rates.

Purpose of the Study:

To compare the quality and findings of two prospective trials on planned VBAC versus elective cesarean section.
To determine which study provides more reliable data for clinical decision-making regarding delivery mode after cesarean.

Main Methods:

Comparative analysis of two prospective trials: Landon et al. (33,000 women) and Crowther et al. (2,300 women).
Evaluation of study size, data abstraction rigor, outcome verification, and methodological validity (e.g., randomization, intention-to-treat principle).

Main Results:

The Landon et al. study (NICHHD) is over 10 times larger and of higher quality than the Crowther et al. study.
Crowther et al. reported questionable increased risks for fetal death and serious infant outcomes, with limited supporting evidence.
Methodological flaws in the Crowther et al. study, including pseudorandomization, undermine its internal validity.

Conclusions:

The Landon et al. (NICHHD) publications offer more reliable estimates of VBAC risks and success across diverse clinical situations.
Women eligible for a trial of labor should utilize the higher-quality data from Landon et al. for informed decisions about planned delivery mode after cesarean.