"With my first pregnancy, I read all the books and wanted to experience a natural birth process, but then I didn't have a choice," says East Greenwich, Rhode Island, mom Sonia Millsom, whose first child, Anita, 5, was in a breech position and had to be delivered by c-section. "But with my second pregnancy, I did have a choice, and I wanted to try a vaginal birth."
Many moms who have an unplanned c-section share Millsom's disappointment over not experiencing a vaginal birth, and when they become pregnant again, this feeling often drives some of them to attempt what is known as a VBAC (vaginal birth after cesarean). It wasn't common in the United States prior to 1980. However, when studies showed that the rate of emergency c-section wasn't any higher for those giving birth by VBAC than it was for those having second vaginal births, the popularity of VBAC rose quickly, hitting an all-time high in 1991.
Unfortunately, this drastic increase in the number of VBACs led to less effective screening to determine which women were truly eligible for vaginal birth; serious complications, such as uterine rupture (a tearing of the incision from the previous cesarean), began to occur more often. According to Roger Freeman, MD, director of obstetrics and gynecology at Long Beach Memorial Medical Center, in California, this documented rise in the rate of rupture over the last decade has made doctors more hesitant about VBACs. In 2002, for example, the number of VBACs dropped from 55 percent to nearly 13 percent of all births. Today's attitude toward VBAC seems to be cautiously optimistic. So while fewer VBACs are being performed, they are much safer, and doctors are now evaluating patients more carefully.