Preserving the VBAC alternative:
8 pearls

Most women opting for a trial of labor have good outcomes, and those at risk for adverse results are becoming better defined—yet VBAC’s future is uncertain. The authors sum up the guidance we can glean from key studies.

Dr. Shipp is assistant professor of obstetrics, gynecology and reproductive biology, Harvard Medical School, and associate Ob/Gyn, Brigham and Women’s Hospital, Boston, Mass. Dr. Repke is professor and chair, department of obstetrics and gynecology, Penn State College of Medicine–Milton S. Hershey Medical Center, Hershey, Pa. He also serves on the OBG Management Board of Editors.

Is vaginal birth after cesarean an endangered procedure? Most women who attempt a trial of labor after cesarean have good outcomes, and those at high risk for adverse events, who should be excluded, are becoming increasingly better defined. Yet many physicians eschew this option altogether because of serious concerns about the safety of trial of labor after cesarean.¹

If VBAC is to play a role in obstetrical management in the 21st century, we will need to improve our ability to distinguish these 2 populations: