Even the American College of Obstetricians and Gynecologists has acknowledged that the operation is overused. Though there is no consensus on what the rate should be, government health agencies and the World Health Organization have suggested 15 percent as a goal in low-risk women.

“VBAC” has become a battle cry, with fierce advocates on both sides—women who insist that they should not be forced into surgery versus doctors and hospitals who insist on repeat Caesareans, citing the risks of labor and concerns about liability and insurance.

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Originally, the mantra was “once a Caesarean, always a Caesarean” because of fears that the scar on the uterus would rupture during labor, which can be life-threatening for both the woman and the child. But after an expert panel in 1980 declared it safe for many women, vaginal birth after Caesarean had a heyday: in 1996, the rate reached 28.3 percent in women with previous Caesareans.

Then, there were some ruptures, deaths and lawsuits. The obstetricians’ group issued stricter guidelines, and the rate sank. It is now below 10 percent, and some experts think the pendulum has swung too far the other way.

In Tuba City last year, 32 percent of women with prior Caesareans had vaginal births. Its overall Caesarean rate has been low — 13.5 percent, less than half the national rate of 31.8 percent in 2007 (the latest year with figures available). This is despite the fact that more women here have diabetes and high blood pressure, which usually result in higher Caesarean rates.

The hospital serves mostly Native Americans — Navajos, Hopis and San Juan Southern Paiutes. Four other hospitals in New Mexico and Arizona, run by the Indian Health Service, also offer vaginal birth after Caesarean to some women (it is not safe for all) and have relatively low Caesarean rates without harming mothers or children, whose health in the first month after birth matches nationwide statistics. Doctors say there is no scientific evidence that Native American women are more able than others to have vaginal births.