Birth beyond the borders: Vaginal births after cesareans (VBAC)

The cesarean section (c-section) rate has risen dramatically in the US and is now over 30%. These rates far exceed the World Health Association recommendation that optimum birth outcomes occur when rates are below 10%. One factor in the rising rate is the reduction of vaginal births after cesareans (VBAC). Over 300 hospitals have instituted policies to ban VBAC, leading women who want hospital births to believe their only option is a repeat c-section. Women wanting to deliver vaginally may be dropped by their care provider. While it is illegal to refuse to admit or treat a woman in active labor, many women are unaware of their rights.

VBACs are safer than elective repeat cesarean; about 75% of women attempting will have a successful vaginal birth. The risk of serious complications rises when labor is induced or augmented by artificial means, which is commonplace in hospital settings. A small but growing number of women wishing to avoid interventions are having VBACs at home. The safety of home-based VBACs has been questioned, but there is little evidence-based policy that has been enacted; in South Carolina, Licensed Midwives have been counseled against attending VBACs, curtailing home birth options for some women.

We describe stories of VBAC home births with “illegal” attendants, unassisted births, and the births of SC residents taking place beyond the state borders. These experiences underline the issue of reproductive choices for women. Women should not have to cross literal and figurative borders to experience the birth of their choosing.