KRISTA SEYMOUR
Observer-Dispatch

Following a campaign that lowered cesarean rates nationwide, the rates are going back up.

Part of the reason for that increase is that medical professionals have changed their opinions regarding vaginal birth after c-section, or VBAC.

"In the '90s, VBAC became quite popular," said Dr. Bruce Flamm of Kaiser Permanente Medical Center in Riverside, Calif. "Then in the last several years, the pendulum has swung away from VBAC, and far fewer are being performed. There's no question that VBACs were responsible for keeping the c-section rates from getting higher in the 1990s."

Flamm said that in 2002, the national c-section rate rose 7 percent when the American College of Obstetrics and Gynecology suddenly discouraged allowing vaginal births after c-sections.

VBACs can quickly become dangerous if the uterine scar from a previous c-section ruptures during labor, experts say. But doctors are also concerned about the effects of multiple c-sections.

Flamm, a member of ACOG, said the organization had first encouraged VBACs after successful studies were conducted in test hospitals. But the same conditions didn't exist at all hospitals nationwide.

"The studies were generally done in hospitals that had obstetricians and anesthesiologists in-house, 24 hours a day," Flamm said. "As the trend of VBAC spread, they were occurring in medical centers where at times there were no obstetricians or anesthesiologists. It's not that there were suddenly more uterine ruptures, but when they did happen, the outcome was worse."

Vaginal births after c-sections have not fallen completely out of favor.

Denise Barber, a midwife through St. Luke's Hospital, said the chance of a rupture is only about 1 in 200 when having VBAC.

"We really support VBAC, if the patient chooses to have it," Barber said.

Rita Popeo, the administrator for Women's and Children's and Medical Surgical Services at St. Luke's Hospital, said that most women at St. Luke's opt to have a repeat c-section instead of a VBAC.

In 2002, St. Luke's Hospital had a primary c-section rate of 15.8 percent, and a repeat rate of 12.7 percent.

Some physicians believe that a small chance of rupture is enough reason to avoid VBAC.

"Yes, the chance is small," said Dr. Mary Dalton, a physician who teaches at Columbia University. "But the consequences can be devastating. When rupturing occurs, a number of babies die, a significant number of babies end up with neurological handicaps and the maternal risk is also very significant."

Flamm believes c-section rates will reach an all-time high within the next few years because of fewer VBACs, malpractice concerns and a trend he calls "c-section on demand," when mothers schedule births conveniently into their appointment books.

"All things are pointing the rates in the same direction, and taking the trends in the same direction," he said. "That direction is up."