A matter of reproductive justice: Access to vaginal birth after cessarean for women in the United States

Background: The 2010 NIH Consensus Conference on Vaginal Birth After Cesarean (VBAC) reaffirmed the relative safety of VBAC and recommended women's preference for delivery after a prior cesarean be honored. The International Cesarean Action Network has documented that one-half of hospitals in the U.S. prohibit VBAC; however, there is limited research on birth center and home birth VBAC restrictions. Objective: The purpose of this research was the development of a comprehensive VBAC access state-by-state report card. Methods: A legal review of over 150 state laws and regulations, including those prohibiting or restricting VBAC access in the hospital, birth center, or home, was conducted for the report card. An overall percentage access score for each state was calculated by averaging the individual access grades for in hospital, birth center and home birth with a licensed provider: A (≤ 10%); B (11-20%); C (21-30%); D (31-40%); F (≥41%). Results: Of the fifty states and D.C. surveyed, none received an A, one received a B, 9 received a C, 28 received a D, and 13 received an F. VBAC access was therefore limited in at least 80% of the states (n= 41). Conclusion: This report card reveals that U.S. women desiring a VBAC have few options on how or where to deliver with more than fifty percent of hospitals prohibiting VBAC and most states limiting or prohibiting birth center and home birth VBAC. Not only are these restrictions a violation of women's reproductive rights, but they also limit access to evidence-based maternity care.