by: James Brann, MD

Are you hoping to experience a vaginal birth after having had a cesarean delivery? You may find your hopes are squelched by modern practitioners.

Hospitals around the country are now banning vaginal birth after cesarean delivery and insisting women undergo repeat cesarean delivery. Hospitals say they cannot comply with the guidelines issued in 1999 by the American College of Obstetricians and Gynecologists. The guidelines call for a doctor to be available "immediately" throughout active labor when a woman is attempting a vaginal birth after cesarean delivery, in order to perform an emergency cesarean section if needed. Previous guidelines had called for a physician to be "readily" available. In order for a hospital to comply with the new recommended guidelines, a whole operating crew, an anesthesiologist and obstetrician would have to be in the hospital around the clock. Only major medical centers, with in house physicians, will be able to continue to offer vaginal birth after cesarean delivery. Smaller hospitals may now have to abandon the practice.

Why the controversy? Women attempting vaginal birth after cesarean delivery are at a greater risk for uterine rupture than what was once believed. Uterine rupture can be life threatening for both the mother and her baby. Some patients with uterine rupture may require a hysterectomy and some infants may die. The controversy that arises with the risks associated with vaginal birth after cesarean delivery is that many women are willing to take the risk, but their freedom of choice over who controls childbirth is being steamrolled by physicians and hospitals. Women are not being allowed to have a choice in their mode of delivery. Doctors say their position is based on concern for the patient's safety.

Doctors now have a new worry that women trying to avoid repeat cesarean delivery may give birth at home or in birthing centers that are not equipped to perform emergency cesarean surgeries if necessary. Also of concern is the possibility that laboring patients may wait to the last moment to go to the hospital to avoid repeat cesarean section.

The controversy surrounding vaginal birth after cesarean delivery is not only a health care issue, it is becoming a women's civil rights issue. A woman should have the right to choose her mode of delivery. Currently the right of a woman to be involved in her birth plan is being crushed under the weight of new laws and strict healthcare limitations that should be a cause for concern for all women across the nation.

If you are considering a vaginal birth after cesarean, be certain to discuss your options completely with your healthcare provider. http://www.womenshealthcaretopics.com/pregnancy_week_36.htm.