Vaginal birth after cesarean delivery: views from the private practitioner

This survey was conducted to assess physician opinion regarding vaginal birth after cesarean delivery (VBAC) and to examine how physician and hospital characteristics influence the private obstetrical provider's decision to offer or not to offer trial of labor after cesarean delivery. A confidential postal survey of private practicing obstetricians in the Dallas-Ft. Worth Region (n = 774) of North Texas. Of 774 obstetrician-gynecologists, 458 completed and returned the survey for a response rate of 59%. The survey revealed that 52% of respondents offer VBAC to their patients and indicated that the most common reasons for declining use or discontinuation of VBAC were maternal-fetal safety concerns associated with uterine rupture followed by medico-legal liability concerns. Factors associated with physicians not providing VBAC for their patients were physicians in obstetrical practice <10 years, a physician's previous involvement in the care of women with uterine rupture complicated by maternal or neonatal complications, and a physician's previous involvement in cesarean delivery-related medical malpractice litigation.