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Medical News & Perspectives
May 5, 2010

Expert Panel Calls for Greater Access to Trial of Labor After Cesarean Delivery

JAMA. 2010;303(17):1683-1685. doi:10.1001/jama.2010.494

Professional societies should reconsider guidelines that currently limit access to a trial of labor for women who have had a previous cesarean delivery and who are at low risk of complications, recommended a panel of experts convened in March by the National Institutes of Health's (NIH’s) Office of Medical Applications and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The rate of vaginal birth after cesarean delivery (VBAC)—the result of a successful trial of labor—has declined precipitously since peaking in the mid-1990s, from nearly 30 VBACs per 100 live births to women with a previous cesarean delivery in 1996 to fewer than 10 per 100 live births by 2007, according to data from the National Center for Health Statistics. The panel analyzed a host of medical and nonmedical factors that may have contributed to the decline in VBAC and concluded that a trial of labor is a reasonable option for many women who have had previous cesarean delivery via a low transverse uterine incision and who do not have complicating risk factors. Yet the policies of many hospitals and clinicians effectively prevent many women from pursing this option.