49. Vaginal Birth after Cesarean Delivery

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. Mark B. Landon MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch49

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Landon, M. B. (2012) Vaginal Birth after Cesarean Delivery, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch49

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • vaginal birth after cesarean delivery;
  • increased TOL rate, in women with prior cesareans;
  • VBAC-TOL;
  • trial of labor, candidates;
  • TOL, contraindicated in high risk for uterine rupture;
  • risks of vaginal birth, after cesarean-trial of labor;
  • labor status and cervical examination;
  • management of vaginal birth;
  • risks associated with TOL

Summary

A recent review of contemporary caesarean delivery in the United States concluded that primary emphasis should be placed on reducing cesarean deliveries for dystocia and repeat operations as these two indications have contributed most to the rise in the overall caesarean rate. A modest decline in cesarean delivery occurred in the USA from 1988 to 1996, which fell to 21% and was largely the result of an increased trial of labor rate in women with prior cesareans. However, at present, only 8.5% of women with prior cesarean undergo trial of labor in the USA. Remarkably, nearly two-thirds of women with a prior cesarean are actually candidates for a trial of labor. Thus, the majority of repeat operations can be considered elective and are clearly influenced by physician discretion. Trial of labor rates are consistently lower in the USA when compared with European nations, suggesting significant underutilization of trial of labor in the USA. As 8–10% of the obstetric population has had previous cesarean delivery, more widespread use of trial of labor could substantially decrease the overall cesarean delivery rate.