Vaginal birth after cesarean section: the demise of routine repeat abdominal delivery.

In light of the abundant very favorable data and considerable published patient experience regarding vaginal birth after cesarean for selected gravidas, the authors are moved to repeat with emphasis the question asked by Dr. Danforth in his recent treatise on cesarean delivery: "The question now is not whether the dictum of automatic repeat cesarean section is still valid, but rather why we continued to adhere to it for more than 60 years, as though it had been carved in stone." From recently published American data, it is obvious that more providers and more patients must be convinced of the safety, efficacy, and cost effectiveness of a selective program of trial of labor and vaginal delivery following previous cesarean birth if we are to effect a significant reduction in this nation's cesarean birth rate. The policy of "once a cesarean section, always a cesarean section" should be applied correctly only to its intended group of patients with previous uterine fundal or upper-segment incisions. As the advisability of insisting on a trial of labor for all parturients who have no contraindications becomes a signal part of the fabric of obstetric practice in the United States and the remainder of the world, we shall witness the demise of routine repeat abdominal delivery.