Vaginal Birth After Cesarean Delivery
Vaginal Birth After Cesarean Delivery Introduction
In 1916, one doctor, EB Cragin, advised the New York Association of Obstetricians and Gynecologists, "Once a cesarean, always a cesarean." For the next 60 years, most obstetricians advised their patients accordingly. This was believed to be the safest management for women who had previously had a cesarean delivery.
Cesarean delivery, also known as cesarean section, is major abdominal surgery involving two incisions (cuts): One is an incision through the skin and abdominal wall and the second is an incision opening the uterus to deliver the baby. While at times necessary, especially in emergencies or for the safety of the mother or the baby, cesarean childbirth is not a procedure to be undertaken lightly by the doctor or the expectant mother. Many women who have had cesarean deliveries wish to deliver their next baby vaginally if possible. Vaginal childbirth occurs when the baby is delivered through the birth canal and vagina.
By 1988, 25% of all babies were delivered by cesarean. Only 3% of babies were delivered vaginally if the mother had undergone a cesarean delivery before. To curb the increasing rate of cesarean birth, both the US National Institutes of Health (NIH) and the American College of Obstetricians and Gynecologists (ACOG) encouraged doctors to allow a woman to try to deliver her baby vaginally if she had undergone a prior cesarean delivery.
Now it is accepted practice that a woman would attempt what is called "a trial of labor" to deliver naturally with her next delivery, under certain conditions, after having had a baby through cesarean childbirth. Many women now have a successful vaginal birth after cesarean delivery (known as VBAC). If the trial of labor is unsuccessful, the woman then undergoes a cesarean birth. About 70% of women who wish to try will successfully deliver vaginally after a cesarean birth.
Yet, the number of cesarean deliveries continues to increase, with latest numbers indicating that 27.6% of all births in the United States are by cesarean - the highest percentage ever reported. However, the rate of VBAC decreased to 10.6% in 2003. Among women with a previous cesarean delivery, the likelihood that subsequent deliveries would be cesarean was about 90% in 2003.
Harish M Sehdev, MD
Bryan D Cowan, MD
Mary L Windle, PharmD
Lee P Shulman, MD
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