VBAC: Your VBAC Companion

Be thankful you're having your VBAC today. Although VBACs -- it stands for vaginal birth after cesarean and is pronounced "vee-back" -- have been occurring all over the United States in tiny numbers for most of this century, the medical profession now welcomes VBACs with unprecedented enthusiasm. In 1995 (the latest available year), 35.5 percent of U.S. women who had previously given birth by cesarean had vaginal births subsequently -- almost six times the rate of a decade before. And the number of VBACs in this country keeps climbing, pushed upward by some combination of medical research, consumer desire, and insurance company directives.

A Brief History of Cesareans and VBACs
For the past 70 years, the adage "Once a cesarean, always a cesarean" has dominated childbirth practices in this country, for several reasons. First of all, not many cesareans took place for most of this period (in 1965 the U.S. cesarean rate was 4.5 percent, for example, as compared to 24.7 percent in 1988), and doctors tended to perform them in dire circumstances. An "unnecessary" cesarean was unimaginable years ago. In addition, until the 1980s cesareans were often performed with the classical "up and down" incision, from the belly button down to the pubic bone. Even today this type of incision is considered incompatible with a VBAC, because of concerns that a scar of this type could rupture more easily during the hard contractions of labor. Since the mid-1980s, 99 percent of cesarean scars are of the VBAC-friendly, side-to-side lower incision known as the "bikini cut."

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