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Updated: Aug 5, 2026
14:56
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Once a cesarean, always a controversy
1Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Riverside, California, USA. bruce.flamm@kp.org
Obstetrics and Gynecology
|August 1, 1997
Summary
The approach to delivery after a cesarean section has shifted from "once a cesarean, always a cesarean" to favoring vaginal birth after cesarean. However, this practice is now being re-evaluated, making the management of prior cesarean delivery a controversial topic.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Historically, the standard practice in the United States was to perform repeat cesarean deliveries for all women with a prior cesarean.
- In the 1980s, there was a significant shift towards promoting vaginal birth after cesarean (VBAC).
Purpose of the Study:
- To examine the historical trends and current controversies surrounding delivery management for patients with a prior cesarean delivery.
Main Methods:
- Review of historical practices and recent trends in obstetric management.
- Analysis of the evolving clinical guidelines and patient care protocols.
Main Results:
- The pendulum has swung from routine repeat cesarean to increased VBAC rates.
- Recent trends indicate a questioning of the safety and efficacy of widespread VBAC.
Conclusions:
- The optimal management strategy for women with a prior cesarean delivery remains a subject of ongoing debate and clinical controversy at the end of the 20th century.
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