Clinical Practice Guideline Executive Summary: Labor After Cesarean/Planned Vaginal Birth After Cesarean

Cesarean deliveries are a common surgical procedure in the United States, accounting for 1 in 3 US births. The primary purpose of this guideline is to provide clinicians with evidence to guide planning for labor and vaginal birth after cesarean (LAC/VBAC). A multidisciplinary guideline development group representing family medicine, epidemiology, obstetrics, midwifery, and consumer advocacy used a high quality systematic review by the Agency for Healthcare Research and Quality (AHRQ) as the primary evidence source.

The evidence report was updated to include research published through September 2012 with an additional key question on facilities and resources needed for LAC/VBAC. The guideline development group developed recommendations using a modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

The panel recommended that an individualized assessment of risks and benefits be discussed with pregnant women with a history of 1 or more prior cesarean births who are deciding between a planned LAC/VBAC and a repeat cesarean birth.

A planned LAC/VBAC is an appropriate option for most women with a history of prior cesarean birth. Increased access to providers and facilities capable of managing LAC/VBAC are required to reduce the US cesarean rate and associated maternal morbidity while increasing choice for childbearing women and their families.

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