
Am Fam Physician. 1999;60(4):1245-1248
One or two previous low-transverse cesarean deliveries.
Clinically adequate pelvis.
No other uterine scars or previous rupture.
Physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean delivery.
Availability of anesthesia and personnel for emergency cesarean delivery.
Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should receive counseling about VBAC and be offered a trial of labor.
Epidural anesthesia may be used for VBAC.
A previous uterine incision extending into the fundus is a contraindication to VBAC.
Women with two previous low-transverse cesarean deliveries and no contraindications who wish to attempt
VBAC may be allowed a trial of labor. They should be advised that the risk of uterine rupture increases as the number of cesarean deliveries increases.
Use of oxytocin or prostaglandin gel for VBAC requires close patient monitoring.
Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.
Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.
After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician.