Another way to potentially lower the overall cesarean
delivery rate and certainly reduce the maternal mortality in
women considering large families is to adopt an approach to
VBAC which includes counseling regarding future pregnancies.
Certainly, the rise in VBAC in the late 1980s was
associated with a fall in the overall cesarean delivery rate
[16]. While such widespread use of VBAC is unlikely to
occur again, more selective use, identifying the best
candidates [32] and helping women consider the benefits in
future pregnancies may be beneficial. Moreover, a recent
paper demonstrated that for women with a prior chance of
VBAC success of 70% or greater, both maternal and neonatal
outcomes were at least as good if not better in women
undergoing a trial of labor versus those choosing an elective
repeat cesarean [32].