A Natural Birth: the VBAC debate

I have delivered babies for 13 years as a family doctor.  I enjoyed my Ob Gyn rotation so much I thought I was going to be an obstetrician for the first 6 months of clinical rotations.  If  family medicine did not include obstetrics, I probably would have chosen internal medicine.

In the latest edition of her blog, Dr. Jaime Bowman clearly describes the unintended consequences of the vaginal birth after Cesarean section (VBAC) rules postulated by the American College of Obstetricians and Gynecologists (ACOG).  She has put into words what has been on my mind for years.  My big city hospital does not allow VBAC’s even though we have 24 hour C section capability.  Most VBAC’s at our facility occur because the fetus’s head is crowning and there is no time for a section.  Yet not one of these women has had a uterine rupture.  ACOG’s efforts to eliminate a rare complication have driven C section rates up nation-wide.

She also addresses the negative impact of elective inductions.  Texas Medicaid now requires us to divide all deliveries into 3 categories:

  1. after 39 weeks,
  2. before 39 weeks medically necessary
  3. before 39 weeks not medically necessary.

The next step is probably nonpayment for deliveries before 39 weeks which cannot be medically justified.


From Womb to Tomb – …a small town mommy, md with big ideas and an even bigger voice….

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