211509 Vaginal birth after cesarean (VBAC) bans

Monday, November 9, 2009: 11:42 AM

Lisa Pratt, BS, JD candidate , David A. Clarke School of Law, University of the District of Columbia, Springfield, VA
The cesarean section (c-section) rate in the U.S. has reached pandemic levels. At over 30%, it far exceeds the World Heath Organization's recommendation of 10% for optimal birth outcomes. One in three pregnant women will have a c-section and her birth options afterward are increasing limited. Despite the evidence supporting the safety of vaginal birth after a cesarean (VBAC), a recent survey found that over 800 hospitals now have formal VBAC bans in place and hundreds more do not have any doctors willing to support VBAC deliveries, resulting in de facto bans. This trend, coupled with the restrictive licensing of home birth midwives, is forcing women to choose between an unnecessary surgery, an illegal care provider or an unattended homebirth.

Legally, pregnant women can refuse treatment; however, women are often unaware of their rights and fearful of retaliation for not complying with the doctor's orders. Pregnant women are being dropped from care for insisting on a trial of labor. Women who choose to go outside of the hospital system are finding their options equally limited as state laws either forbid home birth midwives from practicing or prohibit them from attending VBAC deliveries. I will describe stories of the struggles women have gone through to avoid unwanted surgery.

Refusing to allow pregnant women to make an autonomous decision regarding her care reduces safety, compromises outcomes, and treats pregnant and birthing women as second class citizens.

Learning Objectives:
1. Discuss the magnitude of VBAC bans and restrictive licensing for home birth midwives; 2. Describe the impact of VBAC bans and restrictive licensing for home birth midwives on pregnant women; 3. Identify the options women have when VBAC deliveries are forbidden.

Keywords: Maternal Care, Maternal Well-Being

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am JD candidate and birthing rights advocate.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.