Vaginal Birth After Cesarean: The Facts

After years of slowly moving in the direction of establishing VBAC as the norm, prominent obstetricians and the American College of Obstetricians and Gynecologists (ACOG) did an about-face in the mid 1990s and began promoting elective repeat cesarean. As a result, the VBAC rate, which had steadily risen since 1980, fell from a peak of 28 percent in 1996 to 21 percent in 2000, a decline of 27 percent (23). The anti-VBAC campaign has had two prongs: the claim that planned repeat cesarean is as safe or nearly as safe for the mother and safer for the baby and the institution of criteria in the name of safety that act as a barrier to VBACs. (1,16). What changed?

Obstetricians have openly admitted that one reason for the turn around is reducing liability stemming from the scar giving way during labor, a concern that arose from some successful malpractice suits involving VBACs (1,29). This self-confessed incentive provides a powerful motive for bias, conscious or unconscious, against VBAC and a cause for skepticism of statements and policies favoring elective cesareans.

I contend that nothing changed. It remains as true as it ever did that VBAC is as safe as planned cesarean for the baby, safer for the mother, and much safer for any future pregnancies. Here is the research that backs my contention. You decide who’s right.

When is a repeat cesarean not necessary?
Doctors may cite the following as reasons for planned cesarean, but none are true disqualifiers for VBAC. Obstetricians also give rationales that have no basis in the research. These include indications such as mother past her due date, cervix not ready for labor at the due date, baby’s head still high at full term (22):

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