Vaginal Birth After Previous Cesarean Delivery

Between 1970 and 2007, the cesarean delivery rate in the United States increased dramatically from 5% to more than 31% (6, 7). This increase was a result of several changes in the practice environment, including the introduction of electronic fetal monitoring and the decrease in use of vaginal breech deliveries and forceps deliveries (8–10). The increase in cesarean delivery rates was partly perpetuated by the dictum “once a cesarean always a cesarean” (11). In the 1970s, however, some began to reconsider this paradigm, and accumulated data have since supported TOLAC as a reasonable approach in selected pregnancies (4, 5, 12–14). This change in approach and recommendations favoring TOLAC was reflected in increased VBAC rates (VBAC per 100 women with a prior cesarean delivery) from just more than 5% in 1985 to 28.3% by 1996. The overall cesarean delivery rate decreased to approximately 20% by 1996 (15). Yet, as the number of women pursuing TOLAC increased, so did the number of reports of uterine rupture and other complications during TOLAC (16–18). In part, these reports, and the professional liability pressures they engendered, have resulted in a reversal of VBAC and cesarean delivery trends. By 2006, the VBAC rate had decreased to 8.5% and the total cesarean delivery rate had increased to 31.1% (15, 19, 20). In some hospitals, TOLAC is no longer offered. Vaginal Birth After Previous Cesarean Delivery