That a woman who has had a cesarean should have a say in whether to try a vaginal birth during her next delivery should hardly be a controversial notion.
But according to the National Institutes of Health, a third of U.S. hospitals and half of our doctors refuse to let such women attempt labor. It's due to a fear of lawsuits over uterine ruptures, the No. 1 risk when a woman is trying a vaginal birth after cesarean, or VBAC. The rupture risk is between 0.7 and 0.9 percent.
Extremely small as that risk may be, even tiny numbers represent real women and real babies who can suffer serious consequences in a delivery gone bad. It's understandable that hospitals, doctors and insurers are cautious in today's malpractice climate. But when up to 80 percent of women who are "allowed" to attempt VBAC succeed, it's not so easy to understand why all women aren't "allowed" to weigh the risks and to make their own choices regarding their own childbirth experiences.
A cesarean, after all, adds to a woman's risk of hemorrhage and infection, and lengthens postpartum recovery by several weeks. It also decreases a woman's chances of breastfeeding her baby.
The American College of Obstetricians and Gynecologists, which has said for years that VBAC is a safe and appropriate choice for many women, recently eased its guidelines to say that hospitals offering women trial labors after cesareans should have a surgical team "readily available" instead of "immediately available."
It's a small change, but one that might send the precipitously declining VBAC rates headed in the right direction again.
In 1996, nearly 28 percent of women with a prior cesarean were giving birth vaginally during their next deliveries. But after a rash of lawsuits over uterine ruptures, the ACOG in 1999 issued the "immediately available" standard. Hospitals started refusing to let women try VBAC because they couldn't afford to pay surgeons essentially to be on standby during labor and couldn't risk being sued if they went against the guidelines and something went wrong. Consequently, the VBAC rate had plummeted to 8.5 percent by 2006.
Today, nearly one in three of the more than 4 million births in this country every year are by cesarean, adding billions of dollars to our overburdened health care system. A cesarean generally adds two days to a childbirth hospital stay and from $2,000 to $5,000 to the bill.
Not forcing women to have repeat cesareans when they aren't medically necessary and are unwanted seems like an obvious way to cut that appalling rate.
Let these new guidelines be the impetus for giving women the information they need to weigh the risks and to be able to choose a trial labor or a repeat cesarean themselves.
