title: Vaginal birth after Cesarean rates are declining rapidly in the rural state of Maine.
abstract: OBJECTIVE
  The American College of Obstetricians and Gynecologists (ACOG) revised its practice bulletin on vaginal birth after Cesarean (VBAC) in October 1998 and July 1999 to require the presence of a surgeon, anesthesiologist and operating personnel throughout the trial of labor for patients with prior Cesarean. This study measures the change in VBAC rates from 1998 to 2001 and examines possible reasons for this change.
  
  
  METHODS
  We examined birth certificate and hospital data in the State of Maine from 1998 to 2001. Hospital-specific rates for primary Cesareans, total Cesareans, repeat Cesareans and vaginal deliveries after previous Cesarean were obtained. Additionally, we surveyed current obstetric-care providers in Maine regarding reasons for change in VBAC rates at their institutions.
  
  
  RESULTS
  VBAC rates declined by over 50% from 30.1 to 13.1%. The total Cesarean rate climbed from 19.4 to 24.0%. The most commonly reported reason for decrease in VBAC varied depending on whether a practitioner's hospital met ACOG guidelines.
  
  
  CONCLUSIONS
  A marked decline in VBAC occurred after the change in ACOG vaginal birth after Cesarean policy. Multiple factors have contributed to this decline, including patients refusing VBAC after counseling and inability of institutions to meet ACOG guidelines.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME 04102, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Pinette
authors.forename: J
authors.initials: J
authors.lastname: Kahn
authors.forename: K L
authors.initials: KL
authors.lastname: Gross
authors.forename: J R
authors.initials: JR
authors.lastname: Wax
authors.forename: J
authors.initials: J
authors.lastname: Blackstone
authors.forename: A
authors.initials: A
authors.lastname: Cartin
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D008281:Maine; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data* / Q000639:trends