Vaginal Birth After Cesarean Delivery (VBAC)

VAGINAL BIRTH AFTER CESAREAN DELIVERY (VBAC)

Cesarean deliveries may be performed as repeat procedures. Prior to the mid-1980s, it was believed that a previous cesarean delivery mandated that all subsequent deliveries be abdominal. Publication of data suggesting the safety of vaginal birth after cesarean (VBAC) led to a decade-long clinical trend away from the nearly 70-year-old adage: “Once a cesarean, always a cesarean.” Success rates of VBAC were found to be 60% to 80%. More recently, the pendulum has again swung, resulting in an increasing trend for patients and their physicians to opt for scheduled elec-tive repeat cesarean delivery.

The risks and benefits of a trial of labor versus repeat cesarean delivery should be discussed with the patient who has had a prior cesarean delivery. Although uterine rup-ture does occur more often with VBAC, the frequency is generally less than 1%.

The American College of Obstetricians and Gyne-cologists’ guidelines for trial of VBAC include the availabil-ity of a 24-hour blood bank, continuous electronic fetal heart rate monitoring, a physician capable of performing a cesarean delivery, in-house anesthesia services, and ability to meet a 30-minute “decision-to-incision” time frame if cesarean delivery becomes necessary. Box 8.1 summarizes clinical considerations for VBAC.