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Women's Health

Second Births Too Often Cesarean

Women With 'Bikini Line' Scars Can Have Vaginal Deliveries
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WebMD Health News

Nov. 7, 2002 -- The number of second cesarean births is up, despite efforts nationwide to reduce them. Public health officials want more women to have vaginal births after a cesarean delivery, which carry less risk for the mother, says the CDC in its Morbidity and Mortality Weekly Report.

In fact, two years ago the Surgeon General set a goal to reduce second cesarean births substantially by 2010, especially among women at low risk and women who have already had one cesarean birth.

To assess the progress of California in meeting the national objectives, CDC officials analyzed birth certificate data. Among their findings regarding vaginal births after cesarean (called VBAC by doctors):

  • From 1996 to 2000, the VBAC rate dropped from 23% to 15% among women who had previous cesarean births.
  • The highest VBAC rates were among women between ages 20 and 29, and the lowest rates were among women age 40 and over.
  • VBAC rates declined most -- 49% -- among women 19 years old and over.
  • College graduates had the highest VBAC rates, and women with less than a high school education had the lowest rates.
  • More women in HMOs had the highest VBAC rates; women with MediCal/Medicaid had the lowest rates.

California's declines reflect what's happening across the country, says an accompanying editorial.

"The decrease in VBAC might reflect medical and legal pressures, provider preferences, changed standards of obstetric practice, concerns about convenience, fear of prolonged or failed labor, and maternal preferences," the report says.

Before the 1980s, cesarean births were commonplace for women who had already had one cesarean birth. However, in 1980 the NIH concluded that a vaginal delivery was safe for a woman if she had a "bikini line" scar -- as opposed to a vertical scar from the top to the bottom of the abdomen.

Other studies have shown that women who have cesarean births have a greater risk of infections, hemorrhages, problems with subsequent pregnancies, and potentially less bonding with the infant.

In 1999, the American College of Obstetricians and Gynecologists issued guidelines specifying that the majority of women with bikini incisions -- who had no other risk factors -- could have vaginal births.

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