Vaginal Birth After Cesarean (VBAC): Summary

In 2000, 22.9 percent of all births in the United States occurred by CD. This rate is the highest total CD rate reported since data collection began in 1989. The vaginal birth after cesarean (VBAC) rate, defined as the proportion of women with a prior CD who delivered vaginally, steadily increased from 1989 to 1996. As allowing TOL became more common, practice variation became a larger concern, e.g., expanding criteria for eligibility and medical induction, and for augmentation of labor. In parallel with this liberalization of criteria and management, highly publicized articles suggested that maternal and fetal risks were perceived to be increasing. Subsequently, the VBAC rate has decreased 27 percent from 1996 to 2000. Currently, a crisis in malpractice rates is decreasing the availability of maternity care providers and raising concerns that patients may have limited options, less access to care, and perhaps be at increased risk for complications.