Cesarean: changing the trends.

A rising cesarean birth rate, both nationally and at our institution, led us to attempt to reverse the trend. Vaginal birth after cesarean (VBAC) was introduced as an alternative to repeat cesarean in 1982. The impact of VBAC on the cesarean rate for our institution was assessed from 1982-1988. Over the period studied, the rate of repeat cesarean rose from 5.0% in 1982 to 6.9% in 1985, then steadily fell to 5.3% in 1988. During this same period, the primary cesarean rate rose from 7.5% in 1982 to 11.9% in 1986, then declined to 10.6% in 1988. Changes in the rate for all cesareans paralleled those for primary procedures: 12.5% in 1982, 17.6% in 1986, and 15.9% in 1988. In patients with a history of previous cesarean, the relative risk of repeat cesarean dropped from 10.2 (95% confidence interval 8.8-11.8) in 1982 to 5.2 (95% confidence interval 4.5-6.0) in 1988. In the face of a rising rate of primary cesarean births, the introduction of VBAC has helped to stabilize the overall cesarean rate at our institution.