For obstetrics, malpractice liability is believed to have partly contributed to the increase in Cesarean deliveries and decrease in VBACs
. We view a shift from vaginal to Cesarean birth as possible evidence of defensive medicine, but with hospital discharge data, it is difficult to observe concurrent changes in maternal/infant outcomes.
Based on studies of a trial of labor after cesarean, conducted after the 1960s, the rate of VBACs
rupture rate may seem quite low but it's damn high if you're the one." And later in the same article: "I think VBAC
The increase reflects an 8% hike in primary cesareans and a 13% decrease in vaginal birth after cesarean (VBAC
) since 2002, according to preliminary birth data for 2004, which were released by the National Center for Health Statistics.
,talk to experts and to women who have had one (see the Where To Get Help panel below).
The C-section rate dropped until the mid to late1990s, when doctors began studying data of a relatively small number of catastrophic deliveries involving women attempting VBACs
. The tide changed after a massive lawsuit at USC Medical Center in Los Angeles, where there had been maternal and baby deaths, and children who suffered neurological damage, Frigoletto said.
The relative safety of vaginal birth after cesarean (VBAC
) has been documented in several large-scale studies in the past 15 years, and was affirmed in 2010 through a National Institutes of Health consensus development conference and a practice bulletin from the American College of Obstetricians and Gynecologists.
in both time periods had higher death rates than repeat cesareans," Ms.
A key strategy to reduce the repeat cesarean birth rate is to promote vaginal birth after cesarean (VBAC
) as an alternative to ERCD.
Most hospitals have a financial incentive to encourage C-sections, while most HMOs have financial incentives to encourage VBACs
. It is perhaps surprising, therefore, to see the relative similarity in how medical directors from each camp view and respond to this issue.
"We had actually stopped laboring VBACs
," says Ohnoutka.
experienced a sharp decline as rates fell again in 2004--they dropped 13 percent from 2003 to a 2004 VBAC
rate of only 9.2 percent.