A Discussion of the Barriers to VBAC

Dr. Mark Landon

The majority of women who have a cesarean in one pregnancy go on to have cesareans in subsequent pregnancies. Sometimes it's because that's what they want (which is perfectly fine), but often it's because they are not given any choice in the matter. That's not fine.

Sadly, many hospitals or caregivers will not "allow" Vaginal Births After Cesarean (VBACs). Some say they allow it, but in the end the caregiver ends up scaring or pressuring the mother out of VBAC, or put so many restrictions on it that it's practically a miracle if the mother gets one.

There are risks to VBAC that are real and must be considered, but there are also real risks to repeat cesareans, especially multiple repeat cesareans. The rise in the incidence of placenta previa and placenta accreta, both life-threatening conditions, is tied to the rise in cesareans, especially repeat cesareans. Yet women are often not being adequately counseled about the risks of cesareans.

The "trial of labor" (TOL) rate for VBACs in the United States now is much lower than in Europe, and much lower than it used to be here in the U.S. The U.S. medical community, by and large, turned its back on VBAC in the early 2000s. While the rules around VBAC were loosened a bit a few years ago in order to help make it more available to women, this hasn't really happened. Many providers and hospitals still do not allow women to choose VBAC, even though about 70% of women who try for a VBAC will have one.

The following article is an excellent overall summary on the barriers to VBAC in the U.S. from one of the leading experts on VBAC, Dr. Mark Landon. If you haven't had a chance to read it yet, definitely check it out.

http://www.obgynnews.com/specialty-focus/obstetrics/single-article-page/barriers-to-vbac-remain-in-spite-of-evidence/1ed7ba28390ddf7e619f6e6d4018bdfa.html