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C-sections also boost the odds of certain problems with later pregnancies, including abnormalities in the placenta that can lead to severe bleeding during labor.

According to Macones, a number a factors have likely driven the rise in the U.S. C-section rate. Some women request the procedure, for instance, so as to choose when they give birth or to avoid long labor.

And obstetricians may be quicker to do them now than in years past. Worry over being sued should something go wrong during natural labor and delivery is one factor, according to Macones.

But he said there are potential ways to bring the C-section rate to a more appropriate level.

"I think the most important is to try to avoid first cesareans, and do them only when indicated," Macones said. One way to do that, he added, is to limit labor inductions to only cases where they are necessary.

Midwives, from time immemorial, have been the principal guides for women in childbirth. But their expertise and their role has been compromised in many industrialised countries. With the demise of traditional midwifery, we have the rise of medicalised birth. As we've lost our guides to childbirth, we have lost sight of the meaning of birth.

The Ecologist meets pioneering midwife Ina May Gaskin, who has helped thousands of women tap into their inner mammal. ‘If chimpanzees can do it, so can we,' she says. The practical consequences of fear in childbirth are proven: instead of oxytocin, the love hormone that open up the body, we have adrenaline, which shuts down our natural processes. This leads to, for many, a cascade of interventions. Having the right hormones makes a huge difference in the kind of birth you have. This is what doctors don't tell you.

Whatever their motivation, all are among a striking trend: Home births  increased 20 percent from 2004 to 2008, accounting for 28,357 of 4.2 million  U.S. births, according to a study from the Centers for Disease Control and  Prevention released in May.

While it is much easier to perform a C section than successfully deliver a  breech baby vaginally, says Prof. Glezerman, many women can benefit medically by  the return to traditional techniques. "We are trying to unite obstetricians and  midwives in the field to revive vaginal delivery for breech presentations," he  notes. Prof. Glezerman's initiative provides scientific evidence to those  physicians and midwives looking to return to more traditional birth methods for  breech.

Back to the future

Prof. Glezerman says that retraining the obstetrics community in these  traditional methods is an urgent task, because the medical field now has two  generations of medical residents with hardly any training in vaginal birth for  breech deliveries. "The skill has disappeared," he explains. "Residents are no  longer taught these techniques, and senior physicians are doing it less and  less. We need to go back to the future and relearn what has been forgotten."

At the Rabin Medical Center in Israel, Prof. Glezerman runs workshops for the  newest generation of gynaecologists and obstetricians on techniques for vaginal  delivery for breech babies. His courses include techniques of breech delivery,  changing presentation from breech to head and management of different breech  presentations. With these workshops, Prof. Glezerman hopes to reintroduce  critical delivery skills into the field, and raise awareness that breech  presentation of babies does not always necessitate C-section deliveries.

Of course, says Prof. Glezerman, physicians still need to be able to  recognize dangerous risks when they arise. In those cases, vaginal delivery is  not a viable option ― but doctors must judge each situation individually.

Vaginal Birth After Cesarean is a Safe and Reasonable Option for Most Women

Redondo Beach, CA, July 21, 2010 – The American College of Obstetricians and Gynecologists (ACOG) released updated Practice Guidelines for vaginal birth after cesarean (VBAC) today. ACOG states that VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins and unknown uterine scars.  ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor.

“ACOG’s updated recommendations for VBAC are much more in line with the published medical research and echo what ICAN has stated for years .” says Desirre Andrews, President of ICAN.  “The benefits of VBAC cannot be overstated and if ACOG is truly ‘serving as a strong advocate for quality health care for women’ then this is a long overdue action on their part.”

Women’s health advocates praised the new guidelines, because they expand the pool of women considered eligible for normal births, but expressed doubts about whether the recommendations go far enough to change a decade of entrenched behavior by doctors, hospitals and insurers.

 The new guidelines, from the American College of Obstetricians and Gynecologists, replace its earlier ones — which were exactly what led many hospitals to ban vaginal birth after Caesarean in the first place. But the college says it never intended to limit women’s access to normal birth, and it acknowledges that its policies may have helped fuel the trend toward too many Caesareans.

 “It will be better for women in the long run if we can lower the C-section rate,” said Dr. Richard N. Waldman, president of the obstetricians’ group. The guidelines are being published on Thursday in the August issue of Obstetrics & Gynecology.

 About 1.4 million women had Caesareans in 2007, the latest year with figures available.

 The new guidelines go beyond the earlier ones, however, and state that vaginal birth after Caesarean is also reasonable for most women carrying twins and those who had two prior Caesareans.

 Even if a hospital does not offer trials of labor after Caesarean, the college says, “such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.”

WASHINGTON — Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines — a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals. 

Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.

Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.