Vaginal Birth After Cesarean Trends: Which Way Is the Pendulum Swinging?

The cesarean delivery rate has plateaued at 32%; concurrently, after peaking in the mid-1990s, trial of labor after cesarean (TOLAC) rates have declined. Less than 25% of women with a prior cesarean delivery attempt a future TOLAC. This decreasing trend in TOLAC is caused by inadequate resource availability, malpractice concerns, and lack of knowledge in patients and providers regarding the perceived risks and benefits. This article outlines the factors influencing recent vaginal birth after cesarean trends in addition to reviewing the maternal and neonatal outcomes associated with TOLAC, specifically in high-risk populations.