Vaginal birth after cesarean. Physicians' perceptions and practice.

OBJECTIVE

To determine physician's perceptions about vaginal birth after cesarean section and compare them to the physicians' actual practice experience.

STUDY DESIGN

Physicians responded to a questionnaire on their perceptions of vaginal birth after cesarean section. Between July 1, 1991, and June 30, 1992, all attempts at vaginal birth after cesarean section were reviewed. All cesarean deliveries were also reviewed to determine which repeat cesarean sections could have been avoided.

RESULTS

One hundred twenty-four patients attempted vaginal birth after cesarean section, and 95 (76.6%) were successful. Physician perceptions revealed a success rate of 73.6%. Those patients whose labor was induced in their attempt at vaginal birth after cesarean section were less successful (41.9%) than those who did not require induction (88.2%) (P < .001). Upon review, 47% of patients who underwent elective repeat cesarean section did not have a contraindication to a trial of labor.

CONCLUSION

Physicians had an accurate perception of the success of vaginal birth after cesarean section in their practices. Vaginal birth after cesarean section success rates were consistent with those reported in the literature. Despite a high attempt rate (72.5%) among those eligible for vaginal birth after cesarean section, almost half the patients undergoing a repeat elective cesarean section did not have a contraindication to a trial of labor.