Reducing repeat cesareans


George Macones, MD, the Mitchell and Elaine Yanow Professor and head of Obstetrics and Gynecology at Washington University School of Medicine, conducted one of two large observational studies in the United States in the past decade that have looked at the efficacy and safety of allowing a women to try to give birth vaginally after a prior cesarean section (C-section).

The study reviewed the records of approximately 25,000 women and found that the rates of the previous uterine incision breaking open were less than 1 percent.

“The rates are quite low and are comparable to, if not lower than, the complication rates of most other obstetrical procedures we perform on a daily basis,” Macones says. “It’s important to share this data with patients.”

This year, he served on an expert panel convened by the National Institutes of Health that affirmed that allowing women to try to give birth vaginally after a prior C-section is a reasonable option. The panel also recommended that current VBAC guidelines be reconsidered and more research conducted.

The American College of Obstetrics and Gynecology also recently released new guidelines meant to make it easier for women to find hospitals and doctors that will allow vaginal birth after C-section. These guidelines expand the pool of women considered eligible for vaginal births.