Vaginal birth after cesarean birth--California, 1996-2000.

In 2000, of all births in the United States, 23% were cesarean, approximately 37% of which were repeat cesarean births (i.e., births to women who had a previous cesarean birth). Approximately 60% of cesarean births might be by elective repeat cesarean delivery (ERCD). Because cesarean birth is associated with higher maternal morbidity than routine vaginal birth, two of the national health objectives for 2010 are to reduce the cesarean birth rate among women at low risk to 15% of women who are giving birth for the first time (objective no. 16-9a) and to 63% of women with previous cesarean births (objective no. 16-9b). A key strategy to reduce the repeat cesarean birth rate is to promote vaginal birth after cesarean (VBAC) as an alternative to ERCD. Achieving the national health objective for 2010 will require increasing the VBAC rate to 37%. During 1989-1999, VBAC rates in the United States increased from 19% in 1989 to 28% in 1996 and then decreased to 23% in 1999. This report summarizes an analysis of California's VBAC rates during 1996-2000, which indicates that the VBAC rate in California decreased by 35%, from 23% in 1996 to 15% in 2000. Strategies to improve VBAC rates might include educating women about the risks for complications and benefits of VBAC, ensuring careful selection of VBAC candidates, developing guidelines for management of labor, and educating health-care providers about reducing VBAC risks.