What to do if You're Denied a VBAC

The controversy over vaginal birth after cesarean (VBAC) rages on. Doctors and lawyer battle over what the risk of a trial of labor (TOL) is over an elective repeat cesarean (ERCS). Meanwhile, VBAC has been shown to be safe for most women who have had a previous cesarean birth, with a few exceptions.

The women who have decided that they wish to have a trial of labor are the ones having problems. Rather than climb back up on the OR table, they have decided to have a vaginal birth after cesarean. Now they face the VBAC police. These women must first find a doctor who is willing to do a VBAC. Once past that hurtle, they must ensure that the hospital or birth center that they use allows planned VBACs. Many times women must fight to get the birth they want.

Here are some tips to help you if you are denied a vaginal birth after cesarean:

• Know your medical history.
  Get copies of your original surgical reports. Find out what type of incision is made on your uterus, which may be different than the scar on your abdomen. Find out what type of closure was done, double or single layer repair. Find out the reasons given for your original cesarean. These will be key points in your search for a vaginal birth.

• Get educated.
  Know what the risks are of an elective repeat cesarean (ERCS) as well as a vaginal birth after cesarean (VBAC). Know what the signs are of uterine rupture and what you can do to avoid it.

• Get support.
  There are other women and men out there working on VBAC rights. Find support from these people and learn what they've done to further their cause.

• Talk to your doctor or midwife.
  What is their policy on VBAC. If they do not allow it, find out why. Do they feel that you have a medical reason why VBAC is not a good idea? Are they simply against VBACs? Or perhaps they have an insurance policy that says they should not do VBACs?

  If your doctor or midwife cannot do the VBAC because of legal or insurance reasons, you have to make a big decision. Do you stay with this practice and have an elective repeat cesarean? Or do you switch doctors or midwives to find a VBAC friendly practice?

• Hospital policy.
  Find out what the policy is of your hospital. If they have a no VBAC rule, what happens if you come in and refuse surgery? Are there exceptions made to the policy? If yes, how can you get one? If no, are there other hospitals around where you could give birth?

• What do you do if there isn't a hospital around?
  Women have done a variety of things given this situation. Some have actually picked up and moved (temporarily) to a location where they were allowed to have a VBAC, even if this meant staying in a hotel. Other women chose to have alternative births, such as a home birth. These are not options for everyone. Talk to others how have made decisions like this and talk to your health care providers about your specific situation.

• Public notice.
  Write letters to the editor of local papers. Offer to give speeches about this topic at local schools and universities. Be a guest on local TV news programs about the state of health care in your area. The more women know about their options, the more options become available.

• International Cesarean Awareness Network (ICAN)
  ICAN can provide you with morale and physical support. Find out how you can start a local chapter in your area to talk about cesarean and VBAC issues.