Vaginal Birth After Cesarean on the Decline

Forced C-sections may be the future of your child's entrance into the world.

Mom Matters

Vaginal Birth After Cesarean on the Decline

Are forced C-sections the future of your child’s entrance into the world?

-Stephanie Elliot

a young mother and her newborn childTen years ago, I had my second child and my first vaginal delivery, or what is known as a VBAC,* a vaginal birth after cesarean. It was all I had hoped for with my second baby, as my first delivery was an unexpected and frightening emergency C-section.

Today, had I been pregnant with my second child, I might not have been able to go the VBAC route, and personally, I would have been disappointed if I hadn’t been given the opportunity to try. In a world convoluted with malpractice suits and wrongdoings, and lawyers ‘he-saiding’ and ‘she-saiding,’ the VBAC is fast becoming a thing of the past.

So is it safe to assume that women are being forced or ‘coerced’ into thinking a repeat C-section is better for them and for their babies? Somebody must be telling them this. reported that “more than nine out of 10 births following a C-section are now surgical deliveries.” A 2005 study by Childbirth Connection, a 91-year-old maternal-care advocacy group, indicated that 57 percent of women who had a C-section were interested in the option to have a VBAC but were swayed from doing so.

Is this a case of OBs looking out for themselves, or are they concerned about the well-being of their patients? As reported, much of the hesitation on the parts of the OBs to conduct VBACs is the scare of a malpractice suit and the costs involved in the procedure. In 1999, the American College of Obstetricians and Gynecology mandated that in order to prepare for a VBAC, a hospital must have surgeons and anesthesiologists “immediately available” rather than “readily available.” This puts additional costs on the hospitals and on the doctors. I wonder if today’s doctors are looking at birthing babies as a business — why spend hours waiting for a woman to deliver her baby vaginally if a doctor can convince her to schedule a nice, quick, hour-long surgery, thereby eliminating extra staff and the possibility of an emergency situation?

If my OB had indicated that a VBAC was not an option, I would have found another doctor, one who would listen to me. One who would be concerned with the way I had hoped my labor and delivery would go, although, as I knew from the birth of my first child, nothing is guaranteed. I didn’t want a doctor who would be apprehensive to let me have my baby the way babies are supposed to come out of a woman’s body just because he would fear something might go wrong and I would sue him.

The International Cesarean Awareness Network Fact Sheet states:

“Deliberately performing unnecessary surgery in the belief it avoids lawsuits is indefensible. That many obstetricians seem oblivious to the profound violation of ethical principles is shocking.”

It can’t be stated any clearer than that. I don’t know what doctors promise to do when they become doctors, whether they take an oath or learn the code of ethics, but I thought making sure their patients are cared for in the best possible manner would be at the top of their list. And forcing or convincing someone to choose an option she might not necessarily be comfortable with is definitely unethical in my book.

As with anything, there are risks of VBACs, the main concern being uterine rupture, but if a woman goes into labor spontaneously, that risk is less than one percent. With my third birth (and my second VBAC), I was 11 days overdue, and while I begged to be induced, my OB would not permit it because induction could cause stress on the uterus, which could cause a rupture. So, I waited it out in hopes of another successful VBAC at the advice of my doctor.

Of course, there are absolutely times when a VBAC is not an option:

Your first labor was long and difficult, and you experienced slow cervical dilation.

You have a small pelvis (and although I am not in the medical field, nor have I ever played a doctor on television, I personally disagree with this).

You have genital herpes.

There is fetal distress.

You are pregnant with twins.

You have diabetes or high blood pressure.

There are far more risks involved in having a cesarean than a VBAC, some of which may include: blood loss, hemorrhaging, hysterectomy, bladder/bowel injury, incisional endometriosis, heart/lung complications, blood clots, anesthesia and surgical complications, reduction of possible breastfeeding establishment, compromise of psychological well-being and emotional trauma, among others. The International Cesarean Awareness Network indicates that even premature and at-risk babies born by cesarean fare worse than those born vaginally.

If you’re in a predicament with your pregnancy and are not sure which route to take, it’s absolutely worth having a talk with your OB. The main point is that you have a doctor you trust and who knows your history and your birth philosophy, and that you are both in agreement with how you want to deliver your baby.

When I got pregnant with my second child, I did my homework. I knew I was capable of dilating and pushing because of my first labor. But I am also fully aware from personal experience that sometimes things can go wrong and that a vaginal birth may not always be the best or safest delivery option.

But to be told that a woman is not even going to be allowed to TRY to deliver her child through her vagina because of a slight risk (which to me, is the doctor saying, “We’re scared something can go wrong and we don’t want to be sued”) or because of an inconvenience to hospital protocol or because they need to get additional staff on board … well, that’s just wrong. Not only is it wrong, but it’s also unethical – and women should stand up for their rights to birth the way nature intended.

Stephanie Elliot is a contributing editor at Betty, and she also answers your parenting questions at Just Another Manic Mommy. Visit her at or

*For more information on Vaginal Birth after Cesarean, or if you’ve been denied a VBAC, visit

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0 thoughts on “Vaginal Birth After Cesarean on the Decline

  1. THANK YOU so very much Steph for this article– this needs much more press than it’s getting. What I see as a contributing factor to the problem is that it seems that many 1st time C-sections aren’t emergency necessities– early inductions (for ‘convenience’ or other non-medically necessary reasons) are more common now (at least from what I hear from parent groups) than when I was pregnant the first time 9 years ago. And of course, the use of pitocin in conjunction with pain medications like epidurals frequently have the inadvertent side effect of actually slowing labor down. Which can lead to the hospital declaring that a patient has simply labored ‘too long’ and must go in for surgery. I can’t help but think that if the majority of pregnancies were cared for by midwives and women opted for as minimal medical invasiveness as possible, exploring options other than epidurals for pain management, there would be a significant decrease in the amount of C-sections in our country. Which SHOULD be a goal that the medical community strives for. Just my humble opinion.

  2. What an awesome article! As a doula I strive to make sure women know they can make informed choices against their OB’s or hospital’s recommendations. You are absolutely right about the minimal invasiveness during labor leading to better outcomes. It is sad that although midwives are cheaper to employ and to use most insurance companies won’t cover them. Midwives tend to be better at caring for a normal healthy pregnant woman than a skilled surgeon. If women were treated like whole beings and their emotional state during labor was just as important as their physical state I think outcomes would improve significantly.

    And on a side note, did you know that the US has the second highest infant/mother mortality rate in all developed countries despite the fact that we spend the most per mother on testing and interventions? Something’s gotta give!

  3. Originalmama- AMEN! When I had my first child, the insurance we had covered midwifery services 100%– I didn’t fork over one cent for the entire prenatal/labor/delivery care that I got for all those months. With my second child almost 6 years later, our insurance covered most of it– I had a few copays, but only a year and a half later with my third child (and third insurance, as well), the coverage was only 90%– we had copays and had to pay 10% of all the fees. Things definitely changed in the insurance world during that time, and most unfortunately, my dear wonderful birth center was forced to close during the short time between my 2nd and 3rd children’s births. Thankfully, we had two other birth centers still open (in the entire state!) that we could choose from, so we opted for the one closest, and the entire staff of midwives was as wonderful as my previous center. It all seems so logical and natural to opt for midwifery care– health wise, cost wise, support wise– yet if insurances make it more difficult for financially-struggling families to make that choice, what sense is there??

  4. with my first i had a c-section, no one really gave me a choice witht the second. it was just assumed that’s what i was having again. after a very traumatic first birth i was into having the least amount of risk ,but it would have been nice if someone had asked what I wanted with my second..

  5. needcoffee–I’m just curious — why did you not feel like you could tell them what you wanted for your second birth? We women should be the ones in charge!

  6. Why in all the articals i read are the doctors/hospitals painted as the enemy of the VBAC? If the hospital isn’t equipt to handle a rupture immediately the outcome is very grave for both mother and baby. So much woman on woman pressure is put on moms-to-be to have natural deliveries, which is really unfair especially when you’ve already experienced a difficult labor and unexpected c-section. I’ve tried to VBAC unsuccessfuly and the disappointment I felt after my first c-section was nothing compare to the overwhelming relief i felt when they moved me to the operating room for my second c-section when it became too risky to continue. There’s something about the controled environment of the operating room that lends comfort even if the first time it scared the crap out of you.

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