249727 A matter of reproductive justice: Access to vaginal birth after cessarean for women in the United States

Monday, October 31, 2011: 8:42 AM

Lisa Pratt, BS, JD , David A. Clarke School of Law, University of the District of Columbia, Springfield, VA
Sarah Gareau, DrPH, MEd, MCHES , School of Health, Exercise, and Sport Sciences, College of Health Sciences, Lenoir-Rhyne University, Hickory, NC
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.

Learning Areas:
Advocacy for health and health education
Assessment of individual and community needs for health education
Diversity and culture
Ethics, professional and legal requirements
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
1. Compare the difference between policies that limit VBAC and laws and regulations which limit VBAC. 2. Evaluate a state-by-state VBAC access report card. 3. Discuss the impact restrictive policies and laws have on on women seeking a VBAC in their local area.

Keywords: Women's Health, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified because I have been involved with VBAC advocacy for 12 years and have researched the legal aspects of VBAC for the last three years including while I was earning my J.D.
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.