Newish review article on safety of VBAC

...which basically concludes that studies to date
suck and we still don't know what we ought to know, particularly
about the impact on the baby (not that this will cause any
moderation of the anti-VBAC policies currently in force :-( ):

Obstet Gynecol. 2004 Mar;103(3):420-9.
Safety of vaginal birth after cesarean: a systematic review.
Guise JM, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M.
Department of Obstetrics and Gynecology, Evidence-based Practice
Center, Oregon Health & Science University, UHN-50, 3181 SW
Sam Jackson Park Road, Portland, OR 97239-3098, USA.


OBJECTIVE: To evaluate the benefits and harms of vaginal birth after
cesarean compared with repeat cesarean delivery. DATA SOURCES: The
computerized databases MEDLINE, EMBASE, HealthSTAR, Cochrane CENTRAL,
and National Centre for Reviews and Dissemination Database of Abstracts
of Reviews of Effectiveness, along with reference lists and national
experts, were used to conduct this review. METHODS OF STUDY SELECTION:
All studies that reported data for maternal or infant outcomes in women
with prior cesarean delivery were eligible. Methodological quality was
evaluated for each study with the criteria of the United States
Preventive Services Task Force and the National Health Service Centre
for Reviews and Dissemination. Twenty of 6,828 potentially relevant
articles (55,506 patients) were included in the analysis. TABULATION,
INTEGRATION, AND RESULTS: Two authors independently abstracted
information on study design, sample size, participant characteristics,
and maternal and fetal health outcomes by using a standardized protocol.
Rates of vaginal delivery in women undergoing a trial of labor ranged
from 60% to 82%. There was no significant difference in maternal deaths
or hysterectomy between trial of labor and repeat cesarean. Uterine
rupture was more common in the trial-of-labor group, but rates of
asymptomatic uterine dehiscence did not differ. Studies conflicted on
the effect of induction of labor on these outcomes. Data regarding
infant outcomes were poor. CONCLUSION: Safety in childbirth for women
with prior cesarean is a major public health concern. Methodological
deficiencies in the literature evaluating the relative safety of vaginal
birth after cesarean compared with repeat cesarean delivery are
striking. The identification of high-risk and low-risk groups of women
and settings for morbidity remains a key research priority.