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Over the course of the past 15 years, I have come across a lot of misinformation about VBAC.

All of the myths below have come straight from readers who have asked me, “Is this true?”

And every single time, the answer has been, “No.”

I thought it was time to pluck out the most pervasive VBAC myths and assemble them into one article… and downloadable handout.

These myths cover basic things like uterine rupture rates to difficult topics like death and logistical things like hospital policy.

In the end, all of these myths confuse birthing women and people about their options making it impossible for them to make a truly informed decision between vaginal birth after cesarean (VBAC) and elective repeat cesarean section.

What myths have you heard about VBAC? Let me know in the comments below.


Many people believe, “once a cesarean, always a cesarean.” This prevailing conventional wisdom is greatly influenced by persistent and pervasive myths about VBAC. It’s time for some clarity.

Myth: Once a cesarean, always a cesarean.

According to the National Institutes of Health (NIH), “VBAC is a reasonable and safe choice for the majority of people with a prior cesarean.” [1]

The American College of Obstetricians (ACOG) concurred when they said: “The preponderance of evidence suggests that most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about and offered TOLAC [trial of labor after cesarean].” [2]

Myth: Planned labor after one cesarean has a 60% uterine rupture risk.

The risk of uterine rupture during a labor after one low transverse (bikini) cut cesarean is about 0.5%–1% depending on factors. [1]

First time parents are also at risk for serious complications that can require delivery via emergency cesarean. [3,4,5]

Myth: Hospitals ban VBAC because it’s such a serious and unusual complication that they cannot manage it.

Hospitals with labor and delivery units have protocols in place to respond to obstetrical emergencies.

The guidelines used to manage the complications among first time and repeat cesarean mothers are also used to address uterine rupture in those planning VBACs.

Myth: To expedite an emergency cesarean, epidurals are required in planned VBAC. [OR] Those planning VBACs can’t have epidurals because they obscure the pain of uterine rupture.

Per ACOG, epidurals may be used during a planned VBAC [2] and evidence suggests that epidurals do not mask uterine rupture-related pain. [6]

However, only 26% of women who experience a uterine rupture report abdominal pain, so it is an inconsistent and unreliable symptom. [7]

Myth: There is a 25% chance that someone will die during a VBAC.

The risk of maternal mortality is very low whether a birthing person plans a VBAC (0.0038%) or an elective repeat cesarean (0.0134%). [1]

Limited evidence suggests that there is a 2.8%–6.2% risk of perinatal death (the baby died either during labor or within 28 days of being born) after a uterine rupture with many factors contributing to this range. [1]

Myth: There are no risks associated with cesareans other than surgery.

The most serious cesarean-related complications become more likely as an individual woman has more cesareans. [8]

Placenta accreta, when the placenta embeds too deep within the uterus, is one such condition. It carries its own risks including excessive bleeding, blood transfusion, hysterectomy, surgical injury, and maternal death. [9]

After two cesareans, the risk of accreta is 0.57%, [8] slightly higher than the risk of uterine rupture after one cesarean.

Myth: I can’t have a VBAC in my state because it’s illegal.

VBAC is legal throughout the United States and in some states, it’s legal for a midwife to attend a community VBAC where birth occurs at home or at a birth center.

Myth: My doctor will lose their medical license if I have a uterine rupture.

Farah Diaz-Tello, Senior Counsel & Legal Director at If/When/How: Lawyering for Reproductive Justice clarifies, “I have never heard of a situation in which a physician has lost their license for adhering to a woman’s wishes after providing them with full informed consent, and attending them in a manner that is consistent with the standard of care. Even physicians who have been found liable for medical malpractice do not automatically lose their license.”

Myth: Planned VBACs shouldn’t be induced.

When a complication requires the baby to be born sooner rather than later, but not necessarily in the next ten minutes, induction can make the difference between a VBAC and a repeat cesarean.

This is why ACOG maintains that medically indicated induction “remains an option” during a VBAC. [2]

Myth: Hospitals ban VBAC because they can’t meet ACOG’s “immediately available” requirement.

Some hospitals interpret AC0G’s “immediately available” recommendation to be a mandate that an anesthesiologist must be in the hospital 24/7. Some hospitals that cannot provide that level of coverage have banned VBAC.

However, “immediately available” does not have a standard definition and hospitals across the country implement the guideline in different ways. [12]

Myth: Hospitals that do not have 24/7 anesthesia coverage ban VBAC.

There are hospitals that offer VBAC without 24/7 anesthesia. The rural hospitals that serve the Navajo Nation in New Mexico are an example with a 38% VBAC rate. [10] Contrast that to the VBAC rate in the US: 14%. [11]

Myth: The evidence shows that 24/7 anesthesia coverage creates a safer environment for VBAC.

AC0G confirms that the data is not available: “Although there is reason to think that more rapid availability of cesarean delivery may provide a small incremental benefit in safety, comparative data examining in detail the effect of alternate systems and response times are not available.” [2]

In the absence of empirical evidence, the “immediately available” recommendation is based on the lowest level of evidence which is “consensus opinion.” [2]

Hospitals without 24/7 anesthesia implement a variety of policies to make VBAC safer including fire drills and cesarean under local anesthesia. [10]

Myth: If your hospital doesn’t offer VBAC, you have to have a repeat cesarean.

As Howard Minkoff MD said at the 2010 NIH VBAC Conference, “Autonomy is an unrestricted negative right which means a woman, a person, anybody, has a right to refuse any surgery at any time.”[12]

ACOG affirms that, “Respect for patient autonomy also dictates that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.” [2]

There are real risks and benefits to VBAC and elective repeat cesarean section. Make the right decision for yourself: understand your options, discern truth from fiction, know your legal rights, and study the facts.

Want to learn more? Download my free checklist outlining the 5 secrets to planning a VBAC, my free report on the top 5 uterine rupture myths, or my handout which uses ACOG’s VBAC guidelines to debunk even more VBAC myths.

If you are a parent planning a VBAC and want to learn more, join me in “The Truth About VBAC™ for Families.” It’s the most comprehensive course available to parents on VBAC.

If you are a professional who wants to expand your knowledge of the VBAC evidence so you can better serve VBAC families, check out VBAC Facts® Professional Membership.

Jen
  Resources Cited
  1. Guise, J.M., et al. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US).
  2. American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 205. Vaginal birth after cesarean delivery. Obstetrics & Gynecology, 133(2), e110-e127.
  3. Deering, S. H. (2018). Abruptio Placentae. Medscape: http://emedicine.medscape.com/article/252810-overview#a0199
  4. Beall, M. H. (2018). Umbilical Cord Complications.  Medscape: http://emedicine.medscape.com/article/262470-overview#a30
  5. Allen, R. H. (2022). Shoulder Dystocia. Medscape: http://emedicine.medscape.com/article/1602970-overview#a03
  6. Johnson, C., & Oriolf N. (1990, Nov-Dec). The role of epidural anesthesia in trial of labor. Regional Anesthesia & Pain Medicine, 15(6), pp. 304-8.
  7. Nahum, G. G. (2018). Uterine Rupture in Pregnancy. Medscape: http://emedicine.medscape.com/article/275854-overview#aw2aab6b6
  8. Silver, R. M., Landon, M. B., Rouse, D. J., & Levene, K. J. (2006). Maternal Morbidity associated with multiple repeat cesarean deliveries. Obstetrics & Genecology, 107, 1226-32.
  9. American College of Obstetricians and Gynecologists. (2018). Placenta accreta spectrum number 7 (replaces committee opinion no. 529, July 2012). Obstetrics & Gynecology, e259-e275.
  10. Bimbach, D. J. (2010, Mar). Impact of anesthesiologists on the incidence of vaginal birth after cesarean in the United States: Role of anesthesia availability, productivity, guidelines, and patient safety. Vaginal birth after cesarean: New Insights. Bethesda: National Institutes of Health.
  11. Osterman, M., Hamilton, B., Martin, J., Driscoll, A., & Valenzuela, C. (2022). Births: Final data for 2020. National Vital Statistics Reports; vol 70 no 17. Hyattsville, MD: National Center for Health Statistics.
  12. National Institutes of Health Development Conference Panel. (2010). National Institutes of Health Consensus Development conference statement: Vaginal birth after cesarean: New Insights. March 8-10, 2010. Obstetrics & Gynecology, 115(6), 1279-1295.

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Jen Kamel

Jen Kamel is the CEO and Founder of VBAC Facts® whose mission is to increase access to vaginal birth after cesarean (VBAC). VBAC Facts® works to achieve this mission through their educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. As an internationally recognized consumer advocate, Jen speaks at conferences across the world, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. VBAC Facts® envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support so they can plan the birth of their choosing in the setting they desire.

Learn more >

Jen Kamel

Jen Kamel is the CEO and Founder of VBAC Facts® whose mission is to increase access to vaginal birth after cesarean (VBAC). VBAC Facts® works to achieve this mission through their educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. As an internationally recognized consumer advocate, Jen speaks at conferences across the world, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. VBAC Facts® envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support so they can plan the birth of their choosing in the setting they desire.

Learn more >

Free Handout Debunks...

There is a bit of myth and mystery surrounding what the American College of OB/GYNs (ACOG) says about VBAC, so let’s get to the facts, straight from the mouth of ACOG via their latest VBAC guidelines.

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