Abstract
Background:Cesarean deliveries have been on the rise in recent decades, and as a result the question of how to manage subsequent deliveries becomes ever more important. Historically, repeat cesareans were thought to be the only option. However multiple studies have shown that successful vaginal birth after cesarean (VBAC) has the lowest rate of maternal morbidity and mortality compared to elective repeat cesarean delivery (ERCD). The controversy lies in the risk associated with unsuccessful VBAC, which is associated with an increased risk of uterine rupture and maternal mortality. Objective:To compare the risks and benefits of VBAC and ERCD, examine the characteristics of VBAC candidates to predict trial of labor after cesarean (TOLAC) success, and comment on current recommendations for delivery management after prior cesarean section. Conclusion:Careful consideration on an individual basis is required to predict if VBAC will likely be successful. Multiple medical and nonmedical factors influence the outcome of TOLAC. However, current evidence suggests that successful VBAC should not be considered an exception to the rule, but with prudent physicians’ guidance is a viable option for many women with prior cesarean delivery.
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