Int. J. Gynecol. Obstet., 1991, 34: 211-215 International Federation of Gynecology and Obstetrics 211 Vaginal birth after cesarean section in rural Tanzania J. van Roosmalen Department of Obstetrics and Gynaecology, Leiden State University Hospital, P.O. Box 9600, 2300 RC LAden (The Netherlands) (Received November 2nd, 1989) (Revised and accepted December 20th, 1989) Abstract Eighty-seven of 134 women with a history of previous cesarean section in two rural hospitals in Tanzania had a vaginal delivery after a trial of labor. The incidence of scar-rupture was high; in 9 of 134 cases (6.7%). Maternal death, however, dia’ not occur. It is concluded that a trial of labor is justified, and that the risk of scar- rupture should be balanced with the risk of repeat operations. Keywords: Cesarean section; Previous cesarean section; Trial of labor; Uterine scar rupture; Tanzania. Introduction Cesarean section has become the most fre- quently performed major operation in the United States, and an elective repeat-operation is the most common indication for cesarean sec- tion [4]. This largely results from adhering to Craigin’s dictum: “Once a cesarean section, always a cesarean section” [3]. Although reports have been published which advocate this policy to be abandoned [4,13], only 8% of all women with a history of a previous cesarean section in America were allowed a trial of labor in 1984 [18]. This is in sharp contrast with 0020-7292/91/$03.50 0 1991 International Federation of Gynecology and Obstetrics Published and Printed in Ireland reports from Western Europe. In two recent studies in The Netherlands, for instance, three out of four women with a previous operation were allowed a trial of labor [9,17]. An important factor which contributed to the rise of cesarean births, is the relative safety of the operation for the mother, although mater- nal morbidity after cesarean section is much higher than after vaginal delivery. Maternal mortality after cesarean section in the United States is reported to be as low as 0.02-0.07% VI- Maternal mortality after cesarean section in African countries, especially in rural hospitals where most cesareans are performed by generalist doctors or even by medical aux- iliaries, is high with a range of 0.6-5.0% in a recent review [16]. Maternal mortality studies from Africa often do not refer specifically to this point [6,11]. In this article, data are presented on the out- come of labor in women with a history of a previous cesarean section. The issue whether a trial of labor is justified in the circumstances of rural hospitals in African countries, will be addressed. Materials and methods All 134 women with a history of a previous cesarean section, who delivered in two rural Clinical and Clinical Research