This is a question that I’ve heard a lot.
Here is the three second answer: VBACs got a bad rap in the 1990s before we understood the increased risk of rupture during an induced VBAC labor, especially with Cytotec. Even if your OB is supportive, s/he may be under pressure from hospital administrators, or other OBs in their practice, who feel differently. Finally, your OB might have experienced a recent lawsuit, uterine rupture, or other bad outcome that influences the way they counsel you.
In the 90s, babies and moms were unnecessarily injured and died when VBAC labors were induced with Cytotec resulting in a high rate of uterine rupture. Lawsuits were lost and loads of money was paid out. Rather than taking a step back and permitting VBACs to begin spontaneously and progress normally, which has a far lower rate of rupture than induced or augmented VBACs, doctors took two steps back and declared VBAC dangerous. ACOG now says that Cytotec should not be used to induced VBACs. (For a complete history of VBAC and cesareans, read A History of VBACs and Cesareans in the USA by The Well Rounded Mama as well as the recent article in Time. For more information on the dangers of inducing labors with Cytotec (misoprostol), read Cytotec Induction and Off-Label Use by Marsden Wagner, MD, MS.)
Often OBs are under pressure from hospital administrators. For a complete understanding on the inside workings of hospital VBAC bans and how hospitals impact how an OB counsels a woman seeking VBAC, read Interview with Dr. Fischbein – An Inside Look at Hospitals & VBAC Bans.
Finally, as was discussed at the 2010 National Institutes of Health VBAC Conference, a recent uterine rupture or lawsuit could result in an abrupt change in an OB’s VBAC policy. Chet Edward Wells, M.D., a Professor from the Department of Obstetrics and Gynecology at University of Texas Southwestern Medical Center at Dallas, presented, “Vaginal Birth After Cesarean Section: Views From the Private Practitioner.” It was fascinating. You can watch his presentation here and read the abstract here.
As you can see, none of these factors have anything to do with whether you are a good candidate for VBAC or not. I wish practitioners would be more honest about their situation and refer women out to care providers who do attend VBAC. It does not benefit anyone to exaggerate or minimize the risks of VBAC.
To view the differing rate of uterine rupture for spontaneous, augmented, and induced labors, read Estimates of Risks of Uterine Rupture and Comprehensive chart on uterine rupture measuring multiple variables.
Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center at Dallas