Reproductive Health

Birthing Options Grow Scarce after C-Sections

Tuesday, November 15, 2011

In her doula work Hana Askren finds that women who want a vaginal birth after a Caesarean often cannot find a doctor or hospital to provide this kind of care.

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Lone Doctor Overbooked

She decided to look further afield and found one obstetrician who claimed to have high success with VBACs. However, he has so many patients that now, in her sixth month, she still has only met the nurses and doesn't know much about his practice standards or how he calculates his high success rate. In addition, she has to drive for about an hour to reach the clinic. "That worries me a little bit," she says; nevertheless, he appears to be her only choice for a hospital-based VBAC attempt. Martinez is due in February.

More than half of American women looking for a VBAC could not find a doctor or midwife offering that service, according to a 2006 report by the Childbirth Connection, a New York non-profit focused on maternity care.

Lead author Eugene Declercq, professor of maternal and child health at Boston University School of Public Health, says the situation may have worsened since then.

VBAC rates have plummeted to less than 10 percent in 2008 from 28 percent in 1996, while Caesarean section rates have steadily risen to 32 percent from around 20 percent in the same time period.

Caesarean sections are the most commonly performed surgical procedure in U.S. hospitals, according to a 2006 study of childbirth statistics sponsored by the Agency for Healthcare Research and Quality.

As fewer doctors offer VBAC, Declercq worries that repeat Caesareans are becoming "all they [mothers] can envision."

Ellie Miller, who works as a doula in New York, decided to have a home birth VBAC; she had a Caesarean with her first baby after a prolonged pushing stage. She opted to stay at home because after having given birth in a hospital, she knew staying home would give her more choices about how to labor. As a doula, she sees her clients' labor process managed by doctors who "only want to do what they know."

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Hana Askren became a doula after growing up with her father's stories about delivering babies in a birth center. A Los Angeles native, she now lives in New York, where she works as an editor on a financial publication and also coaches high school girls' wrestling with Beat the Streets Wrestling.

For more information:

Listening to Mothers, Survey 2006:
http://www.childbirthconnection.org/article.asp?ck=10396

NIH, Vaginal Birth After Caesarean:
http://consensus.nih.gov/2010/vbac.htm

U.S. Govt: Vaginal Birth After Caesarean:
http://www.ahrq.gov/clinic/tp/vbacuptp.htm

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