Vaginal Birth after Cesarean Delivery

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.