To begin with, I have some different stats on perinatal deaths from scar rupture and maternal deaths from cesarean surgery. “Step 6” of the CIMS systematic review, Evidence Basis for the Ten Steps of Mother-Friendly Care, downloadable for free at http://www.ingentaconnect.com/content/lamaze/jpe/2007/00000016/a00101s1;jsessionid=2o3j1upnso1ko.henrietta, reported a range of 1 to 4 per 10,000 excess perinatal deaths in women planning VBACs versus women planning repeat surgery. These numbers come from some systematic reviews and some big, recent studies. Converting to your way of reporting, this would be a range of 1 in 10,000 to 1 in 2500.

As for maternal deaths associated with repeat cesarean surgery, a large U.S. study reported a rate of 60 per 100,000, or 1 in 1666 in a population delivering between 1999 and 2002 (Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107(6):1226-32.). The hospitals involved in the study were university-associated centers, so presumably the care was top-notch. Compare this with the overall U.S. maternal death rate in 1999 associated with vaginal birth: 13 per 100,000 or 1 in 7692 (Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ 2003;52(2):1-8.). Bear in mind, too, that the maternal mortality rate in all vaginal births would include women who were very sick, and because the cesarean study only included women having cesarean deliveries, it would miss some deaths related to prior cesarean surgery such as deaths from ectopic pregnancy early on. It would also miss cesarean-related deaths occurring months or years later such as deaths from bowel torsion caused by cesarean adhesions.

The thing is that no matter how skilled the surgeon or how prepared the institution to handle an emergency, any surgery carries risks and accumulating cesarean surgeries increases those risks.

-- Henci