I help to provide a low risk obstetric service in a remote area. I work in private practice and provide my services to the local hospital on a fee for service basis.

Imagine a 36-year-old woman who has had four babies by vaginal delivery in another location without any complications.  Her last was an elective section for a breech presentation in a teaching hospital. It was a routine delivery.

Now she comes and asks me where she could have her next baby. If she wants a repeat section would be prepared to do it at our local hospital.

Significant obstetric risks for her include;

• 1:4 to 1:10 risk of placenta accreta if she has placenta previa
• 3:100 risk of placenta accreta if there is even if there no placenta previa
• 3:100 that the next baby also being breech at term

In choosing the mode of delivery the NIH Consensus Development…