MMWR Morb Mortal Wkly Rep. 2002 Nov 8;51(44):996-8.
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.
2000年，在美国所有出生的婴儿中，23%是通过剖宫产出生的，其中约37%是再次剖宫产（即曾有过剖宫产史的女性所生的婴儿）。约60%的剖宫产可能是选择性再次剖宫产（ERCD）。由于剖宫产与比常规阴道分娩更高的孕产妇发病率相关，2010年的两项国家卫生目标是将低风险女性的剖宫产率降低至首次分娩女性的15%（目标16 - 9a）以及曾有过剖宫产史女性的63%（目标16 - 9b）。降低再次剖宫产率的一项关键策略是推广剖宫产后阴道分娩（VBAC）作为ERCD的替代方案。要实现2010年的国家卫生目标，需要将VBAC率提高至37%。在1989 - 1999年期间，美国的VBAC率从1989年的19%上升至1996年的28%，随后在1999年降至23%。本报告总结了对1996 - 2000年加利福尼亚州VBAC率的分析，该分析表明加利福尼亚州的VBAC率下降了35%，从1996年的23%降至2000年的15%。提高VBAC率的策略可能包括对女性进行关于VBAC并发症风险和益处的教育、确保仔细筛选VBAC候选者、制定产程管理指南以及对医疗保健提供者进行关于降低VBAC风险的教育。
