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Hospitals Prohibit Vaginal Births After C-Sections

Armen Hareyan's picture

NPR's "All Things Considered" on Monday reported on hospitals that are barring women who have had previous caesarean sections to have planned vaginal births. Citing rising c-section rates and studies that found vaginal births after c-sections were a safe option for some women, the American College of Obstetricians and Gynecologists and NIH in the early 1990s issued guidelines that permitted VBACs in some cases. Initially, more hospitals began performing VBACs after the guidelines were issued, according to Bruce Flamm, a clinical professor of obstetrics and gynecology at the University of California-Irvine (Morales, "All Things Considered, NPR, 8/20).

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ACOG in 1999 revised its guidelines to say that only hospitals with a surgical team immediately available should allow VBACs (Kaiser Daily Women's Health Policy Report, 11/16/05). Some hospitals in recent years have stopped performing routine VBACs because of a lack of staff or other resources, NPR reports. Hospitals also have increased restrictions on VBACs as more information has become available about potential negative outcomes for infants in cases in which women experienced uterine ruptures, Flamm said. Uterine ruptures occur in about 1% of VBACs, according to NPR.

Steve Lewis, chief medical officer at Flagstaff Medical Center in Arizona, which does not perform VBACs, said, "We interpreted the [ACOG] guidelines strictly. And what that meant to us -- because patient's safety is the foremost concern -- was a dedicated anesthesiologist and a dedicated obstetrician to that mom. ... We can't have two moms in labor." Lewis said hospital officials enacted the policy because they would be unable to dedicate enough staff members to each woman in labor ("All Things Considered, NPR, 8/20). Audio of the segment is available online.

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives. The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.