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VBAC Policy Memo

posted Jul 27, 2011, 4:52 PM by Lisa Baracker   [ updated Jan 11, 2012, 10:53 AM ]
I present to you one of my MPH writing assignments for Health Policy & Management Class which I completed in the Summer of 2011.

To: Senator Ed Hernandez, O.D., Chair, Senate Committee on Health
Subject: VBAC Support at Every California Hospital
From: Lisa Baracker, Doula and Birth Advocate, Whatadoula
Date: 23 June 2011

Problem Statement           
California is the most progressive state in terms of healthcare. California’s teaching hospitals and research facilities represent some of the worlds best advances in medicine, its constituents have passed laws allowing access to medical marijuana, and yet California women are still subject to hospital policies that impede their right to birth the way they choose. This is especially true after they have had a previous caesarean section. What’s more shocking is that there are still hospitals in California that are refusing to allow women to attempt Vaginal Birth After Caesarean (VBAC) despite the preponderance of evidence that it is safe for both moms and babies.

Proposed Solution
There is no reason for a limitation on VBAC's at any hospital where women give birth, especially given that "current evidence shows that the majority of women can have safe vaginal births after prior cesareans.” "[1],[2]  Legislation needs to be enacted that requires hospitals who offer birth services to women to also offer VBAC to those women who meet the criteria set forth by the American College of Obstetrics and Gynecologists (ACOG) and widely accepted by the Association of Certified Nurse Midwives (ACNM) and the Midwives Alliance of North America (MANA).  These criteria are very straight forward and simple to assess and now they need to be put into action at an administrative level. "The preponderance of evidence suggests that most patients who have had a low-transverse uterine incision from a previous cesarean delivery and who have no contraindications for vaginal birth are candidates for a trial of labor."[3],[4]

The Criteria for a VBAC:

  • Women who have had one previous cesarean with a low-transverse incision.
  •  Women with a clinically adequate pelvis.
  •  Women with no other uterine scars or previous uterine rupture.
  •  A physician capable of monitoring labor and performing an emergency cesarean should be immediately available throughout active labor.
  •  Anesthesia and personnel for emergency cesarean delivery should be available.

Major Obstacles/Implementation Challenges
Currently, all Hospitals in California that have Labor & Delivery Units are capable of performing scheduled cesareans, emergency cesareans for vaginal deliveries with complications, and are required to have anesthesiologists on call 24 hours a day for emergency surgery.  It is therefore unacceptable that any California Hospital refuse a woman the right to a VBAC to women who meet the aforementioned criteria. The only thing standing in the way of VBAC rights are doctors who refuse to comply with the recommendations of ACOG. Midwifes who offer VBAC services are offering a safe and ethical service to their patients by allowing them a trial of labor after cesarean, yet still hospitals and doctors are limiting this service and clearly this has affected one if not many patients in an adverse, if not wholly improper manner.  Birth is a major life event that significantly impacts a mother's physical and emotional well-being. A cesarean can be a life-saving procedure for a mother and/or her baby, but overall, birth by cesarean puts healthy pregnant women at risk for medical complications.

References, Footnotes, and Exhibits



[3] Adapted from Vaginal Birth After Previous Cesarean Delivery. ACOG Practice Bulletin, Number 54. The American College of Obstetricians and Gynecologists, 409 12th Street SW, P.O. Box 96920, Washington, DC 20090-6920.

[4] Clinical Management Guidelines for Obstetrician-Gynecologists, July 2004.