The anesthesiologist's role during attempted VBAC.

American College of Obstetricians and Gynecologists' guidelines on vaginal birth after cesarean had both intended and unintended consequences for anesthesiologists. Epidural analgesia continues to play an important role in patient acceptance of a trial of labor after prior cesarean delivery. It does not impact the success rate of vaginal birth after cesarean and may be a diagnostic tool when uterine rupture occurs. Preanesthesia evaluation and counseling should occur early in the patient's care. Intrapartum management includes appropriate oral intake and close communication between anesthesiologist and obstetrician. If uterine rupture or postpartum hemorrhage occur, appropriate algorithms should be followed.