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Richard L. Faiola, MD
Steck Medical Group Chehalis, Wash

JAMA. 1991;265(18):2338.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Dr Stafford's¹ allegations that the large variance in the percentage of women offered vaginal birth after cesarean section (C-section) is best accounted for by economic self-interest is seriously flawed. Dr Stafford has used statistics from 1986 and judged them by the standards of 1991.

What is more likely described by his data is the usual evolution of a novel or high-risk enterprise into the routine. It is natural that the physicians most willing to deviate from the "once a C-section, always a C-section" dictum will be those in large medical centers or teaching facilities. In 1986, most hospitals insisted that the physician be in constant attendance of a patient in labor anticipating vaginal birth after cesarean section (VBAC). That was simply not practical for most private practice physicians in most small proprietary or community hospitals. It was not until 1988, 2 years after this study, that . . . [Full Text PDF of this Article]

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