The Effect of the ACOG Guideline on Vaginal Births after Cesarean

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Abstract
In October 1988, the American College of Obstetricians and Gynecologists (ACOG) issued a physician practice guideline stating that a prior cesarean section is no longer a reason for performing a repeat C-section. Using a panel data set consisting of 55 Massachusetts hospitals over the years 1987 to 1991, this study examines if the ACOG guideline had any impact on the practice of vaginal births after cesarean (VBACs) at the typical hospital. The empirical results suggest that the ACOG guideline led to a permanent 5.6 percentage point increase in the VBAC rate, ceteris paribus. As a result, the study suggests that practice guidelines do sometimes work. The information dissemination role of the popular press may provide the reason why the AGOG guideline influenced the practice of VBACs.