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Births by caesarian section are at an all-time high in the U.S. One reason -women who've had one C-section are often forced to give birth that way in subsequent deliveries. In the 1990s, a study showed that wasn't always medically necessary. But vaginal births after caesarian - known by doctors as VBAC - are not allowed at many hospitals.
Arizona Public Radio's Laurel Morales reports.
LAUREL MORALES: Audrey Creed(ph) is a full-time mom. On a recent, sunny afternoon, she breastfeeds her youngest while her two older boys play. All three of her children were born via C-section, not by choice, Creed says.
Ms. AUDREY CREED: I was just intensely disappointed.
MORALES: Creed had a last-minute C-section with her first child because he went into distress. When she became pregnant with her second, she assumed she would be able to have a vaginal delivery. She was shocked to learn that Flagstaff Medical Center didn't allow vaginal births after caesarians, so she had to have a C-section.
Ms. CREED: What I really wanted was to be able to provide presence for the birth of my children.
MORALES: For most of the 20th century, the rule of thought was once a C-section, always a C-section. But in the early '90s, emerging studies showed VBAC to be a safe option. So the National Institutes of Health and the American College of Obstetricians and Gynecologists embraced V-BAC as a way to decrease the caesarian delivery rate that had reached 25 percent.
OB-GYN Bruce Flamm is a clinical professor at the University of California, Irvine. He's researched VBACs extensively. He points out, while a C-section is major abdominal surgery, a VBAC also carries a risk.
Dr. BRUCE FLAMM (Obstetrician-Gynecologist, Clinical Professor, University of California, Irvine): The uterus will tear or rupture. And that happens in about one percent of the cases.
MORALES: Initially, VBACs were only done at university hospitals, where in-house staff was available at all times. But with the new studies endorsing VBACs as an acceptable option, Flamm says hospitals big and small started to allow VBACs across the country.
Dr. FLAMM: As more people started doing VBACs, they found that the uterine rupture rate was still about one percent. But in that one percent, they started to see some very bad outcomes, particularly for the baby. Some hospitals were not equipped to do a caesarian section very, very quickly. And that's why some hospitals said, well, we probably can't do VBACs any longer.
MORALES: Flagstaff Medical Center was one such hospital. Steve Lewis is the chief medical officer.
Dr. STEVE LEWIS (Chief Medical Officer, Flagstaff Medical Center): This is the labor and delivery room. It's designed so that mom can labor here, can deliver the baby here.
MORALES: Lewis says the hospital adopted its policy in 2005 after careful review of ACOG's guidelines, which call for the immediate availability of a surgical team.
Dr. LOUISE: We interpreted the guidelines strictly. And what that meant to us -because patient safety is the foremost concern - was a dedicated anesthesiologist and a dedicated obstetrician to that mom. And that's a big deal. That means they're not doing something else. We can't have two moms in labor. And they're dedicated to the mom who is laboring after a C-section.
MORALES: Lewis says that could mean they wait a whole day or longer while the woman labors. And Lewis says they didn't have the staff to do that for every VBAC so the policy was written. No routine VBACS.
For Audrey Creed, though, it's hard to understand. Hospitals are there for emergencies, she says, after all.
Ms. CREED: I understand that that's what the hospital's there for, to handle emergencies. And so in that respect, the policy never made sense to me.
MORALES: In his studies of VBAC, OB-GYN Bruce Flamm says, for the women, it all boils down to choice.
Dr. FLAMM: There were some women that strongly wanted caesarian in our studies and others that strongly did not want caesarian.
MORALES: For now, whether women get that choice depends on the policy of the hospital where they deliver.
For NPR News, I'm Laurel Morales in Flagstaff.
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