The rate of Caesarian sections in the United States has risen to 25 percent, the major reasons being medico-legal and convenience considerations (VBAC, 2003, 84-85). However, there is a wealth of data to suggest that they are more costly, and certainly not innocuous. Vaginal Birth After Caesarean (VBAC) is becoming increasingly popular, and the medical profession has tried somewhat to discourage it because of the risk of uterine rupture. While postpartum fever seemed to correlate with uterine rupture at VBAC in a recent study, there was no relationship between single or double layer closure, the use of antibiotics, or white blood cell count. The most critical factor seems to be the strength of the surgical scar. Some studies have suggested that wall thickness is a good indicator of the potential for uterine rupture. A French study of 642 patients undergoing VBAC showed a rupture rate of 2.5 percent. If the wall thickness was greater than 4 mm, there were no uterine defects, and using a cutoff of 3.5 mm, the negative predictive value was 99.3 percent.
VBAC is not new: the earliest such case on record dates back to 1500 when a farmer performed a Caesarean on his wife, who went on to have several more children by vaginal birth (Rinehart, 2001, 16). In Europe, VBAC was the norm throughout the last century, but in the United States it was almost unheard of until the late 1950s. The rate increased slowly until the 1980s, when a number of large studies showed it to be a relatively safe procedure. In the early 1990s, VBACs were being recommended to more and more women, and managed care operations were encouraging doctors to do them. Interest backed off a little when some complications arose, mainly from uterine rupture.
The success of VBAC depends on the obstetrical history of the woman and the reason for the C-section (Rinehart, 2001, 17). The published success rates for hospitals usually range from 60 percent to 80 p...