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Home › Articles › VBAC › The Pros and Cons of VBAC

The Pros and Cons of VBAC

An Updated Look at Vaginal Birth After Cesarean

By Lisa A. Goldstein

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The problem is that those statistics included incidents where women were given Pitocin (an artificial form of oxytocin, which can make the uterus contract more strongly) and/or a cervical ripener such as Cytotec (a drug used off-label, or not for its intended purpose) that actually caused the death of some women in the 1990s from ruptures, Cassidy says.

"The truth is that if you leave women alone and don't interfere by using such drugs, the VBAC risk is much, much smaller than that fraction of a percent," Cassidy says.

Hospitals had already been moving away from VBACs when the revised guidelines and other studies came out, so because of the one-two punch, many facilities stopped offering the procedure because they didn't have – or didn't want – the burden of additional staff or liability. So this ruling really affected policy in small or rural hospitals, Cassidy says.

"The national VBAC rate, which peaked at 28 percent in the late '90s, has dropped to about 10 percent," Cassidy says. "And the prohibition is actually far more extensive than the numbers let on – obstetricians are discouraging women from attempting vaginal birth after they've had a C-section, not only out of lawsuit fears, but also because a second Cesarean is often easier and more efficient for most hospitals to perform."

One OB/GYN, Dr. Walter Evans at Presbyterian Hospital of Dallas, agrees with this. "The current reimbursement system pays a global rate for delivery no matter how long it takes," he says. "The fees we are paid now are about the same as the 1990s and our expenses are much higher. There is not much incentive to wait long hours for something bad to happen."


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