The making of a medical tradition: vaginal birth after cesarean.

By 1982, both the National Institutes of Health (NIH) and the American College of Obstetricians and Gynecologists had recommended that hospitals adopt policies favoring vaginal birth after cesarean (VBAC). Yet VBAC has since made only small inroads against repeat cesarean section and is primarily popular among progressive obstetricians and middle-class women wanting to experience natural childbirth and to avoid surgery. This study was undertaken to learn why, in hospitals permitting and ostensibly encouraging VBAC, some obstetrical patients choose 'trial of labor' for vaginal delivery, and others choose elective repeat cesarean section. Interviews with 100 women showed that the choice of a delivery method was largely influenced by the respondents' interactions with physicians, their reconstructions of the meanings of the previous cesarean section, and their personal ideologies about reproduction and motherhood. Ethnic minority women exhibited a greater preference for elective repeat cesarean than did white women. Caution is nevertheless urged in overinterpreting the significance of patient ethnicity for the continued popularity of elective repeat cesarean surgery.