Reasonable or Ridiculous? Some Reasons You Can't Have a VBAC

The following is a collection of alleged reasons given to real women by their prenatal care providers explaining why they can't or shouldn't have a VBAC. Many of these mothers have gone on to vaginally birth one or more babies, and many of those babies were larger than their cesarean baby. That fact alone exposes many of these "reasons" as gross exaggerations, even outright lies. Or perhaps it merely exposes the ineptness of most medical professionals in the face of a labor and birth that doesn't proceed according to "plan". At the least, these statements reveal the lengths some care providers will go to in order to steer the mother towards the choice with which they as the attendant are more comfortable. You be the judge.

You will probably rupture. I just had a mom die from one right in front of me.

You have no fluid. The baby could lie on his cord and die. You don't have a choice.

You had two cesareans.

You shouldn't VBAC because you're so fat, we'd never be able to tell if you ruptured and the baby went into your abdominal cavity.

Your baby is breech.

If you go overdue your baby might get too big.

Because you have uterine prolapse, a repeat cesarean is a good idea (despite the fact that this mom has never birthed vaginally and has uterine prolapse anyway).

You have Idiopathic Thrombocytopena Purpura and don't make platelets during pregnancy.

Allowing VBAC makes our medical malpractice insurance too high.

Your uterus is too old and weak from previous births to handle labor.

You can't VBAC because of the vertical incision on your abdomen (even though the scar on her uterus is low-horizontal).

You can't deal with a dead baby.

Because it's your first, I won't attend a breech vaginal birth because you do not have a proven pelvis.

Because you're overweight, you might experience tissue dystocia (otherwise known as "fat vagina").

You're too short to birth vaginally (at 5'4", this mom went on to birth two more babies, both over ten pounds).

You have a huge bone sticking up in your birth canal (no obstetrician ever felt this bone, and this mom has gone on to vaginally birth three more children after three cesareans).

You're on our cesarean schedule?! Your labor must be stopped immediately.

Your second OB found that your first scar healed thinly. It's intuitively obvious, even though no studies have ever found it true, that a thin scar would be at greater than normal risk of uterine rupture. (The OB had actually noted that the LUS was thin, not the scar, which is a normal occurrence).

You have a history of anxiety disorder. In the worst-case scenario, you wouldn't be able to stay calm in order to reduce blood loss and oxygen deprivation to your baby if your scar ruptured.

You've never had a baby through there, so how do you know you could ever have birthed vaginally at all?

You've already been pregnant so many times, maybe your uterus won't work any more the way it would have if your first baby had been born vaginally (the last two statements were made within minutes of each other by the same obstetrician.)

If your husband is this baby's father, its head may not fit through your pelvis ("If" your husband is the baby's father? Not very respectful, in fact rather insulting!).

You've already had three cesareans. If you'd only had one or two that would be one thing, but the UR rate after three cesareans is something close to 50% (the actual rupture rate after three cesareans is slightly higher than after one low transverse cesarean).

There's no way we can monitor your baby's heartrate by auscultation during labor - the hospital no longer owns any of those big, old-fashioned fetoscopes. Repeat cesarean is the modern-technology way to get a baby out safely with no UR after three cesareans. (She had a Doppler in her pocket at the time she said this.)

Women who have had three cesareans and are looking for VBAC tend to have problems with authority. I cannot take someone like that as a patient because when I tell them to come in to be induced, they do disobedient things like not showing up.

Now that you're 35 weeks pregnant, it's too late to plan a VBAC with us. We haven't had time to get to know you well enough.

Hey, you already had a cesarean. You know what to expect.

VBACs are overrated.

It'll take too much time - planning a surgery will be so much easier.

Advanced maternal age (35 years old).

It's been too long since your last VBAC (ten years).

Your scar won't be strong enough since you haven't been pregnant in so long (the obstetrician actually advised this mom that she shouldn't plan on further pregnancies).

Your uterus is too "old", it will probably rupture.

You were previously diagnosed with "CPD" (cephalo-pelvic disproportion) and this baby might be bigger.

Your water may be low, baby may be malpositioned, placenta may degrade (and more - all of these predictions made at 21 weeks pregnant), you are predisposed to these problems due to previous cesareans, you should schedule a repeat cesarean because you're likely to have at least one problem, even if we can't catch it before labor.

Malpractice suits.

It is hard work.

You can't have a trial of labor/VBAC in this hospital without continuous fetal monitoring.

You could die. Your baby could die.

You shouldn't VBAC because during your first labor you had a tear on your cervix and a big baby.

"We don't allow VBAC" (said as the mother arrived at the hospital complete and pushing; the baby was visible at +2 station - almost crowning; the mother was gassed and sectioned).

With the exception of malpractice liability, none of the above "reasons" are borne out through medical research. On the contrary, in fact many of them are refuted by the evidence.

The old standby - "big baby" - has been disproved by many women, a large portion of those at home, who've birthed babies larger than their cesarean baby. Other common excuses for not offering women VBAC, such as low fluid, high fluid, high blood pressure, postdates, small pelvis, high blood sugar (or "GD" - gestational diabetes, a controversial diagnosis), are dubious at best.

Even in the event of a true pathological condition, which does happen on rare occasion, the decision about how to deliver belongs in the hands of the mother. It is a health care professional's obligation to provide medical consumers with accurate information about all options, including the risks of each one, and to then support the client in his or her decisions. What we find happening more and more often in the volatile climate surrounding cesarean and VBAC is that health care professionals are yielding to the temptation to use their status and the public's perception of them as "authority figures" to steer the client toward a choice that makes the most sense for themselves as the provider, both financially and in terms of liability.

A high level of education and medical expertise notwithstanding, it is never ethical for a care provider of any kind to use strong-arm techniques to get their way. The dirty little secret of the obstetrical world is that it's commonplace to use horrifying scare tactics to frighten protective pregnant women into making a convenient decision for the provider. Women truly believe they are making these choices for the safety of their babies, and care providers play on that vulnerability.

Most women do not have the advantage of being current on medical research pertaining to birth and VBAC. If they did, they would be able to call the bluff of care providers who try to terrorize them with visions of exploding uteruses and brain damaged/dead babies. It's an unfortunate fact of modern medical consumerism that we as patients/clients need to be as informed as possible about every aspect of our care. Gone are the days of implicit trust in healthcare professionals. The prevalence of high-dollar lawsuits for medical mistakes has led to an adversarial relationship between doctors and patients. The healthcare consumer may be unaware that it's even there, but we can rest assured that our healthcare providers know exactly which practices can land them in court, and which can't.

This would be less of a problem if there wasn't such a disconnect between what's best for healthy pregnant women and their babies, and what's best for birth attendants' malpractice insurance rates. As it stands now, there is a large discrepancy between healthy choices for normal pregnant women, and the best interests of obstetricians and other prenatal and delivery care providers. Until that changes, women need to be on their guard. You need to be willing to look further than what you're told in the exam room. You need to ask a lot of questions and double-check the answers. And if you aren't satisfied, you need to stop saying "My doctor's making me" and start saying "I'm finding a care provider who will treat me with respect". When we let obstetrical care providers know that we aren't mindless robots who cannot think for ourselves or make our own decisions, which ultimately translates into voting with our wallets, that's when we will regain autonomy and cease to be lambs led to the slaughter.