Many hospitals refuse to perform  vaginal deliveries after the mother has had a prior c-section.  Guidelines issued by the American Congress of Obstetricians and Gynecologists in 2010 said that vaginal births after cesareans (V.B.A.C.s) are largely safe. Despite this, many hospitals and doctors still do not perform them for fear of complications. Hospitals note that V.B.A.C.s carry a slightly higher risk of uterine rupture, and some say they cannot afford to keep staff at the ready if something goes wrong. The risk of uterine rupture in  V.B.A.C.s is between 0.5% and 0.9%.

The problem is especially acute in rural areas, where women have to travel considerable distances for care. Many women who have had a prior cesarians want to avoid the pain and risk of infection from abdominal surgery, but they feel as if they are being robbed of their choice. Providers  claim that they do not have the resources to support the option, noting that they must have a team on call  in case there are complications and surgery is required.

The problem is not limited to rural areas.  A  2012 study  conducted by researchers at the University of California, San Francisco, and elsewhere found that nearly half of California hospitals that handle births still do not offer V.B.A.C.s.  The study found that over half of the doctors are refusing the procedure because of time requirements.   “Time is money for physicians, and they don’t want to have to spend their time hanging around waiting for women in labor,” said Mary Barger, an associate professor of nursing at the University of San Diego, and one of the study’s authors.

Read more at the NY Times.