Updated: Jun 7, 2019
Does your hospital allow women to TOLAC (Trial of Labor After Cesarean)? This is something that unfortunately isn’t always the case in some hospitals. Women all over the world are being forced to choose a repeat cesarean because the hospitals in their area do not allow VBAC. Women often choose to drive or even fly across the state to find a hospital that will allow them to TOLAC, or they are choosing out of hospital locations to deliver such as a birth center or home because the local hospitals won't "accept" their choice to VBAC. But for those who do not have that option are often having Cesarean sections because they simply don't have a supportive resource. This is frustrating to many. Today we want to talk about VBAC bans. What is it, why is it happening, and what can we do about it?
What is a VBAC Ban?
A VBAC ban is when a location creates a policy where a woman with a previous Cesarean or multiple Cesareans will not be supported for a TOLAC. The location usually does not have providers who will support TOLAC and often times do not feel they have the proper staff on hand 24 hours 7 days a week. Now with this being said, even with a VBAC ban in place, it does not mean in any way that the birthing mother must have a repeat C-section. As patients in the medical care world, we all have the right to refuse treatment that is being offered. A hospital cannot refuse a mother in labor but, as you can imagine, this can make things very difficult for a mother wanting to experience a VBAC. What seems to be the main concern for hospitals that are choosing to ban TOLAC/VBAC is fear. Fear of complications during labor and birth including uterine rupture, a tear in the uterus. Uterine rupture is one of the most common worries when its comes to women wanting to TOLAC despite the fact that the actual chance of it happening is quite low. Up to 80% of women who attempt a VBAC will be successful and VBAC is generally associated with fewer complications than a repeat Cesarean. In VBAC specifically, the uterine rupture occurs when the uterus separates at the scar. However, uterine rupture can even occur in women without a prior Cesarean, albeit not as likely (0.07%) or 1 in 1,146 pregnancies (Nahum, 2018).
ACOG Statement on VBAC Bans
“Despite a 23 percent increase in VBACs from 1985 to 1996, that number has since plummeted as the cesarean delivery rate has continued to trend upward,” said Mark Turrentine, MD, chair of ACOG’s Committee on Practice Bulletins-Obstetrics. “This is the opposite of what we want to see happening, and it’s because there is still a great deal of misunderstanding regarding the safety of TOLAC and VBAC and a reticence to consider this a viable option due to medical liability concerns."
ACOG recommends that TOLAC is a great option for women and can happen in any hospital location that is a level 1 facility or higher. I quickly thought to myself, "Well, how do you know which hospitals are level 1?" Let me tell you how to quickly find out. If the hospital is equipped to deliver any baby, care for any mother, and provide assistance in ANY emergency (basically if it has an operating room), it will fit into the Level 1 facility requirement. So pretty much any hospital that delivers babies is a Level 1 or higher.
What can we do about VBAC Bans?
So the biggest question, is what do we do about it? We can drive miles away to another location, or birth in an out of hospital location but really, how do we help these VBAC bans in hospitals go away? Here are some suggestions to help make a change in your area!
Contact your local ICAN group see what they have information wise on your local hospitals and their policies
Write letters to the hospital and the board of directors. Let them know that you birthed somewhere else because of their current policies surrounding VBAC.
Write letters to your states medical board.
If you’re birthing at one of these hospitals that have a VBAC ban, ask for the policy and sign a waiver to allow you to birth there.
Give your provider the ACOG bulletin explaining that its reasonable for a mother to have a TOLAC.
File a complaint through Medicaid ( NOTE: women do not have to be on Medicaid to file a complaint).
According to Midwifery Today, all hospitals that receive federal funding (approximately 80% of them do) must adhere to the Center for Medicare and Medicaid Service’s (CMS) Conditions of Participation (CoP), which require hospitals to honor patient rights as defined by the Patient Self-Determination Act, the Consumer Bill of Rights and Responsibilities, the Emergency Medical Treatment and Active Labor Act (EMTALA) and the large body of case law upholding the right to refuse treatment, to be fully informed of the risks, benefits, and alternatives of any proposed treatment and to participate in all treatment decisions.Hospitals that fail to adhere to the CoP are subject to heavy fines and risk losing their right to qualify for Medicare and Medicaid funding. In addition, the CoP requires that hospitals institute an internal grievance process and give patients the information they need to know about how to file a complaint and where to appeal in the case of an unfavorable ruling.
Together it may take time, it may take some good effort but, if we join together as a tribe of women we hope that one day VBAC ban policies in hospitals world wide will end. It is important to know that, per ACOG, if a hospital states such policies that woman may not have a TOLAC that the hospital cannot force her to have a repeat cesarean section. Remember this is your baby and your body. Follow your heart. You know what is best and NO ONE can make you do something that you don’t want to do.
Check out Episode 14 of our podcast to hear the VBAC story of Tishra who had a VBAC in a rural area with a hospital VBAC ban!
Are you over the VBAC myths and want solid data to back up the facts? Grab your FREE VBAC MythBusters guide here.