Dr. Mark B. Landon, the Primary Author, is a specialist in Obstetrics/Gynecology-Maternal and Fetal Medicine at the James Cancer Hospital of the Ohio State University Medical Center and a Professor of Obstetrics and Gynecology at the Ohio State University College of Medicine and Public Health.

1. Dr. Landon, what motivated you and your colleagues to pursue this line of research on the maternal and perinatal outcomes related to trial of labor as compared to repeated cesarean delivery?

"Our motivation to collect data concerning outcomes with trial of labor for women with prior c-section stemmed from the understanding that despite hundreds of studies on the subject, reliable data concerning uncommon complications was simply lacking. Most of the previous data on this subject has come from retrospective single center studies or is drawn from birth certificates. This methodology is faulty, particularly with respect to the diagnosis of uterine rupture (the principal serious complication of attempted vaginal delivery following prior c-section). It has thus left obstetricians with inadequate information for counseling women who might choose the method of childbirth in a subsequent pregnancy."

2. What do you hope will follow this research? Do you expect to see local, regional, or national changes in counseling for women on choices of delivery?

"We certainly would hope that our data will be used to more effectively counsel women regarding the risks of attempted VBAC. The counseling process should include some estimates of risk and should not be a subjective or biased presentation based on anecdotes. At present, there have been inadequate data from which to discuss risks of brain damage (hypoxic ischemic encephalopathy) as a result of uterine rupture. Our study attaches some real numbers to this fortunately uncommon complication."

3. Lastly, what message would you like current premed and medical students to learn from the methods and results of your research?

"Current students should understand that this is not a randomized trial - the gold standard for clinical research. Thus, not surprisingly, the study groups are not comparable with respect to many variables (see Table 1). In performing comparisons, it was thus necessary to perform multivariable logistic analyses to control for these differences. This helps eliminate the possibility that our findings were not due simply to an inherent difference between the trial of labor and the elective repeat cesarean groups. The students should take note of the enormity of the undertaking of this study. Unlike other large scale studies on this subject, we prospectively gathered information from medical records which reduces the chance for error."