One source of the variation in VBAC rates is the decision by many health care providers and hospitals to discontinue offering their patients the opportunity to attempt a trial of labor after cesarean delivery (TOLAC). 2– 4 One identified cause for the increasing total cesarean delivery rate is the declining rate of vaginal birth after cesarean delivery (VBAC), a procedure that also has great variation between hospitals. 1 Recent reports of large variations in cesarean delivery rates across hospitals have led to suggestions that there may be nonmedical factors associated with higher or lower cesarean delivery rates. The overall rate of cesarean delivery has been increasing in the United States and accounted for 32.8% of all births in 2011.
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