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Clinical outcomes in VBAC attempts: what to say to patients?

      The role of vaginal birth after cesarean delivery (VBAC) in modern obstetrics remains a major controversy. The most recent figures from the National Center for Health Statistics indicate a VBAC rate of 10% in 2004. The reason for the fall in VBAC had to do with concerns over safety and, perhaps, professional liability concerns. The question remains whether this fall in VBAC rate is in the best interests in the health of women. As has been shown in a number of studies, a VBAC attempt is associated with uterine rupture (roughly 0.5%-1.0%) and hypoxic ischemic encephalopathy (roughly 12/15,000). Concerns over these short-term maternal and neonatal risks must be considered in the context of longer term risks, such as the increase in abnormal placentation (eg, previa and accreta) with increasing number of previous cesarean deliveries.
      See related article, page 30.
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