Attempts to develop a means of accurately predicting VBAC have failed. The strongest studies, in which scoring models were validated by applying them to a new population, found that half of women with unfavorable factors still birth vaginally. We would argue that attempts to predict VBAC are doomed because they assume the problem is centered in the woman rather than her care providers, but regardless of circumstances, most women will birth vaginally if their care providers believe in their ability to do so and treat them accordingly. We think efforts to restrict VBAC to optimal cases should be abandoned in favor of giving women accurate information about their likelihood of vaginal birth, encouraging all women who want to plan VBAC to do so with rare exceptions such as women who have had symptomatic scar problems in a prior birth, and instituting policies and practices that maximize every woman’s chance of safe vaginal birth. As one obstetrician said of VBAC, “Obstetricians should remember that to allow a patient to labour is not a treatment, it is a virtually unavoidable consequence of pregnancy”

Passage from chapter  6, The Case Against Elective Repeat Cesarean
image credit: Vicki Beauchamp, The Memory Box, Chicago, IL