April 16, 2014 — Despite the American College of Obstetricians and Gynecologists' 2010 guidelines stating that vaginal births after cesarean sections are generally safe, many hospitals still do not offer them because of fears of complications, the New York Times reports.
According to the Times, hospitals argue that VBACs are associated with a slightly higher risk of uterine rupture and that they cannot afford to keep staff members on hand in case complications arise.
Access to VBACs is especially sparse in rural communities with few providers, meaning that women in those areas who wish to avoid a repeat c-section must travel far distances to give birth. The Times highlights the situation in Casper, Wyo., where some women have begun a public campaign to change the local hospital's policy against VBACs.
However, Carol Solie, chief medical officer at the hospital, Wyoming Medical Center, said the facility is not adequately staffed to have physicians and anesthesiologists on call whenever a woman who desires a VBAC goes into labor, which is what the ACOG guidelines recommend. Solie added that women seeking VBACs could still deliver vaginally at the hospital if they sign a consent form accepting responsibility for acting against their physicians' advice and stating that they were told of the "inappropriate risk" associated with doing so.
Meanwhile, ACOG notes that the risk of uterine rupture during VBAC is low, about 0.5% to 0.9%. In addition, the guidelines state that VBAC is a safe procedure for women to avoid the pain and infection risk associated with having a c-section.
ACOG President Jeanne Conry said the guidelines were intended "to bring about changes" regarding providers' VBAC policies, but she acknowledged a lack of progress (Frosch, New York Times, 4/14).