Vaginal birth after cesarean section. Acceptance and outcome at a rural hospital.

A retrospective review of all pregnant women with a history of cesarean section was conducted at an isolated military hospital. During the two-year period 1988-1989, 62 patients were initially considered eligible for attempting vaginal birth after cesarean section (VBAC). Seventy-nine percent (49/62) of the patients initially requested a trial of labor, and 14 of them ultimately did not meet American College of Obstetricians and Gynecologists criteria. Three patients reversed their decision late in pregnancy. Eighty-eight percent (28/32) of those undergoing a trial of labor delivered vaginally. The three patients with more than one prior cesarean section all delivered vaginally. The four failures occurred in patients who had a history of well-documented cephalopelvic disproportion. Perinatal morbidity consisted of intrauterine fetal demise prior to the onset of labor at 40 weeks' gestation. Maternal morbidity included postcesarean endometritis (n = 1) and vaginal sidewall laceration (n = 1). These results indicate that in a rural hospital VBAC was well accepted by patients and was safe; however, further study is required.