title: Trends and patterns of vaginal birth after cesarean availability in the United States.
abstract: A review of the literature and analysis of the National Inpatient Sample Database was performed to describe the trends in vaginal birth after cesarean availability in the United States and the factors associated with changing use. Vaginal birth after cesarean increased after the first National Institutes of Health Consensus Conference on Cesarean Childbirth in 1981. It increased from 3% to a maximum rate of 28.3% in 1996. Despite studies reporting stable success rates of approximately 70% and low complication rates (<1%), concerns about patient safety and physician liability have led to more restrictive policies and a decrease in vaginal birth after cesarean use. The current rate is approximately 8.5%, and decreased rates have been noted for all age and ethnic groups. There is decreased use of vaginal birth after cesarean as the result of concerns about patient safety and physician liability, which has resulted in decreased availability.
authors.affiliation: Department Obstetrics & Gynecology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA. gregory@cshs.org
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: Lisa
authors.initials: L
authors.lastname: Korst
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D015975:Consensus Development Conferences, NIH as Topic; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016365:Liability, Legal; D009316:National Institutes of Health (U.S.); D057240:Patient Preference; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends*