The decline of VBAC: hearing hoofbeats, thinking zebras

Originally posted on Common Sense Family Doctor on March 10, 2010. Since then, the U.S. trial of labor after cesarean rate has risen from 14.4% to 19.6% and VBAC success rates have improved from 68.5% to 74.3%.

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My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal birth after Cesarean section (VBAC), delivered by a certified nurse midwife. Although more than three-quarters of women who choose a trial of labor over a repeat Cesarean section successfully deliver vaginally, studies showing slightly elevated risks of rupture or infection of the uterus with VBAC, pressure from insurance companies concerned about lawsuits, and restrictive medical guidelines discourage most women from even trying. After reaching a high in 1996 of 28.3 percent of women who previously delivered by Cesarean, the national VBAC rate today is fewer than 1 in 10. As a result of all of these repeat Cesareans, 1 in 3 births in the U.S. today occur by Cesarean.