Vaginal birth after cesarean section in a small hospital.

Most studies on vaginal birth after cesarean section come from medical centers or university hospitals. However, the minority of births in the United States occur in these hospitals. When compared with larger institutions, many small hospitals have longer operating start-up times, less adequate blood banking facilities, and decreased obstetrical anesthesia support. Over a 30-month period in a small hospital, a trial of labor was successful in 76% of patients with prior cesarean section. Despite the limitations of support in a small hospital, vaginal birth can be offered to selected patients with prior cesarean section delivery. In our experience, vaginal birth after cesarean delivery requires significantly more physician hours in the hospital than does repeat cesarean section. The problem of a pregnancy with a prior cesarean section is an ever-increasing one and, in our practice, approximately 25% of multiparous patients have had a prior cesarean delivery.