C-section Debates

Cesarean births are considered more costly, with an average price of nearly $20,000 compared to $11,400 for a vaginal birth. Many groups are focusing on reducing elective cesareans because of associated poor outcomes in the babies.

Lovelace Hospital also has a 34% rate of vaginal births after C-sections, which is accomplished by offeringing 24-hour in-house availability of obstetricians, anesthesiologists, and neonatalogists, Teicher says. "Our group philosophy is that patients have a right to a VBAC," he says.

A National Institutes of Health panel said in 2010 that there was a "troubling fact" that pregnant women have limited access to clinicians and facilities able and willing to offer a trial of labor after a previous C-section delivery because of so-called VBAC bans.

"Many, even those at low risk for complications in a trial of labor, are not offered this option," the NIH said in a statement. The panel urged that guidelines related to VBAC should be reviewed, noting malpractice concerns "and additional research undertaken to better understand the medical and nonmedical factors that influence decision-making for women with previous cesarean deliveries."

According to the American Pregnancy Association, most women who have undergone C-sections can be candidates for VBAC, and most can successfully give birth vaginally. There is a concern for the risk of uterine rupture during a vaginal birth after a C-section, which is estimated at 1 in 500 patients, according to the American College of Obstetricians and Gynecologists.

This article appears in the March 2012 issue of HealthLeaders magazine.