Why This OB/GYN Passionately Supports VBAC Access (And You Should Too) with Dr. Chris Stroud

Upcoming VBAC Facts® Events

Jen Kamel: Hey there. Before we get started, I wanted to make sure that you knew that next Thursday, April 24th, 2025, I will be in Wenatchee, Washington to present "The VBAC Imperative: How to Improve VBAC Access and Outcomes While Decreasing Litigation Risk" at the Washington Association for Responsible Midwifery's Annual Conference.

If you want to offer VBAC in your practice and mitigate the legal risk, this powerful session is filled with strategies that you can immediately implement. In this three hour training, approved for nursing CEs, you will learn how to: One. Layer for specific strategies to deliver respectful healthcare and reduce your legal risk.

Two. Engage in effective yet protective informed consent conversations. Three. Confidently and calmly support those planning VBACs while protecting yourself. And four, learn why some parents sue while others don't. And it's not just about the severity of the outcome.

I am just one speaker at this conference, so go to warmmidwives.com to register. Which reminds me, next Monday, April 21st, I will be doing a live Q&A in conjunction with the International Cesarean Awareness Network. Go to ican-online.org to learn more and I'll include all these links in the show notes.

Join Our Email List to Learn More About VBAC

Jen Kamel: But if this is the first you're hearing about these events, then that tells me you're not on my email list. And that is the very best way for you to not only learn about VBAC, but to stay in the loop about upcoming VBAC Facts® events.

So how do you get on the email list? Go to vbacfacts.com/report and download my free uterine rupture report, which debunks the most persistent uterine rupture myths I've come across in the 18 years of doing this work. So go to vbacfacts.com/report to join my email list so that way you hear about these speaking engagements throughout the US and even internationally.

How To Book Jen to Speak at Your Next Event

Jen Kamel: Speaking to live audiences is one of my very favorite things and I am so excited to meet the incredible midwives of Washington State as well as physicians, nurses, doulas, and other VBAC supporters who will be in attendance.

Now, if you're interested in booking me for an in-person event, whether that is a session at your conference or a full or half day VBAC Facts® training, you can go to vbacfacts.com/speaking to learn more about the various topics I discussed, which is really, anything VBAC, but also you and I can jump on a call and discuss what specifically your audience is interested in and we can craft a program designed for your audience. So again, go to vbacfacts.com/speaking to learn more.

What We Will Talk About Today

Jen Kamel: With that, I give you my interview with Dr. Chris Stroud OB/GYN where he talks about why offering VBAC is so important to him, including his reasoning for supporting community midwives who attend home and birth center VBACs. We also discussed the concept of "acceptable complications," which may provide some insight as to why many OBs in the United States recommend repeat cesareans for everyone regardless of their medical history, their current clinical scenario, or how good of a VBAC candidate they are. He also shares his vulnerable and authentic reflections on being sued after a uterine rupture related fetal demise and why he continues to attend VBACs. Key topics covered include his practice's secret sauce, how working with community midwives has made him a better obstetrician, what he calls the four pillars of VBAC success, and a special message for physicians who don't attend VBAC and hospital administrators who maintain VBAC bans. Let's get started.

Dr. Chris Stroud: If you ask me the question, "Could a catastrophe happen with VBAC?" I have to say, "Absolutely, yes it could."

And then I point out that's where I think most of my colleagues fall short. They stop right there. They don't ask the other side of that coin, which is the question, "Could a catastrophe happen with a repeat c-section?" Well then I had to say yes. Well then the patient usually says, "well wait a minute." And exactly, that's the right response. So the reality is catastrophe could happen on either side of that decision.

Jen Kamel: Hello. Hello. Welcome to The VBAC Facts® Podcast. I'm Jen Kamel, VBAC Facts® founder. And since 2007, our focus has been to provide accurate and objective information on vaginal birth after cesarean and repeat cesarean to parents, professionals, policy makers and the court so all decisions can be informed, ethical, and just.

And today, I am so excited to have with us Dr. Chris Stroud from Fort Wayne, Indiana. Welcome Dr. Stroud.

Dr. Chris Stroud: Oh, thank you very much. It's good to be here.

Jen Kamel: I am so excited to have you here. I'd love to read your bio so people get a sense of who you are.

Dr. Chris Stroud: I think there are a few things in life more painful than hearing someone read your own bio.

Jen Kamel: Okay. Well brace yourself 'cause it's coming. Okay. Okay. Dr. Stroud is an obstetrician gynecologist, and a certified medical consultant in Creighton Model FertilityCare System/NaPro Technology. With more than 30 years experience, Dr. Stroud's practice centers on infertility, recurrent pregnancy loss, natural birth, and minimally evasive robotic surgery.

In September of 2014, Dr. Stroud left employment with a large hospital health system to establish the Fertility and Midwifery Care Center in Fort Wayne, Indiana. Then in the spring of 2019, Dr. Stroud and his wife Marianne, opened the Holy Family Birth Center, also in Fort Wayne, the community's first freestanding birth center. Dr. Stroud and Marianne have five children and six grandchildren. Dr. Stroud travels and speaks extensively on a variety of topics related to fertility care, authentically pro-life medical practice, and the challenges of contemporary independent medical practice.

He hosted the award-winning nationally syndicated podcast, "Doctor Doctor," which was retired in 2023 after 600 episodes. Now he hosts two podcasts, "All Things Women's Health" and "After the Homily with Father Daniel Schiedt." Welcome Dr. Stroud. And he said I can call him Chris. So we're just going to call him Chris.

Dr. Chris Stroud: Thank you. It's great to be here. Anybody that knows anything about me knows that I'm a huge VBAC Facts® fan, so, this is an honor for me to get to participate. Thank you.

Jen Kamel: Well, I love that we are interviewing each other on our respective podcast and then sharing both interviews with our audience. And it was funny because this morning I was walking with my son, he's 17, and I'm like, I want you to hear what this doctor said about my work. And I just played the intro and like the look on his face and the look on my face. And I was like, I know, right?

So, you know, I mean it's a little mutual admiration. We are both very passionate about VBAC and ensuring people have access to VBAC.

And so I would love to start at the beginning because I think where people went to medical school and what they learned about VBAC in medical school often has such a profound impact on how they view VBAC throughout their career. And I'm wondering, was that your experience?

Dr. Chris Stroud: Yeah. You know, actually no, it wasn't. The interesting thing is, even if it was a big deal, I don't remember. So that probably says something, but I don't think VBAC as a topic came up until residency in obstetrics and gynecology. I don't believe I ever encountered it really in women's health rotations at medical school.

Jen Kamel: And would you be willing to share what years did you go to medical school? I'm thinking about it in terms of my little VBAC rate chart that I always have in my brain.

Dr. Chris Stroud: Yeah. Generally speaking, most of your viewers probably weren't even alive then. But yeah, I went to medical school at the University of Florida, 1987 to 1991.

Jen Kamel: Okay.

When VBACs Were Required

Dr. Chris Stroud: Residency at the University of Virginia in 1991 to 1995. To put it in context, as you referenced, when I started residency, VBAC was a big deal in that the insurance company pendulum had swung way to one side. We weren't allowed to perform a repeat C-section until you had a trial of labor. That's hard to imagine sitting here today in 2025. But that pendulum had probably gone too far the other way because we would try to induce people for a few hours just to show good effort and then do the repeat c-section they wanted.

Jen Kamel: Hmm.

Dr. Chris Stroud: So that pendulum, as you know, has moved around a lot through the years.

Jen Kamel: Well, and you know, I share that how medical insurance companies were requiring VBAC in some areas of the country. I share that in my trainings and people are shocked. They just cannot comprehend, now that we are in this entirely different climate, they can't comprehend a world where everyone had the opportunity to VBAC, and in fact, they did not have the choice to choose a repeat cesarean.

So, you know, this is the value of understanding our history and where we came from and how we got from there to here, which, you know, we're not going to talk about today, but if people want to learn more, that's part of what I teach in "The Truth About VBAC­™ for Families," as well as "The Truth About VBAC™ for Professionals" 'cause understanding our history helps us understand how we got here and then how also we can do better.

Dr. Chris Stroud: Well, so much of medical education, particularly at the residency level is, struggle for the right words, it's a verbal tradition in the sense that the personal experiences of this mentor that you're looking up to, that controls your life literally, they're going to have such an impact on you.

So depending on when a mentor was training during that pendulum swing, they may have this whole vocabulary and library of horrible VBAC stories. Because some things that were done were wrong, but they bring those stories to another generation who passes those stories on to another generation, and the data never has a chance because of this kind of oral history teaching.

Jen Kamel: Exactly. And you know, humans are fundamentally emotional creatures. And so at the end of the day, it doesn't matter what the data says on one hand because if someone has an overwhelmingly positive or negative experience, that is what they're going to lead with.

And also the power of the data enables us to contextualize those really bad or really good experiences, and especially when you're providing healthcare to be able to provide it in a more neutral way that favors the evidence and autonomy.

Dr. Chris Stroud: Yeah, I couldn't agree more.

Jen Kamel: Yeah, we agree about a lot of stuff. So you didn't learn anything about VBAC in medical school and then during residency, it was the culture where everyone was laboring and really no one had the option to choose a cesarean.

Dr. Chris Stroud: Correct. Yeah. And then during my four years of residency, I feel like that pendulum started to swing back a little bit in the other direction.

Jen Kamel: Yeah.

Dr. Chris Stroud: But I don't feel like I learned anything dramatic in terms of an opinion in residency. We just did what we did. There was VBAC, it was a thing. It wasn't always presented as a thing. I remember as a chief resident, if there was a VBAC in labor, I had to be in the building. Other than that, I didn't have to stay in the building unless needed. That's about the only thing that I remember about VBAC as a resident.

Jen Kamel: Well, and you know, it's interesting 'cause you say you didn't learn a lot of things, but what I'm hearing is that VBAC was just normalized for you.

Dr. Chris Stroud: Yeah, that's interesting. You're right. I mean, the fact that I don't remember a lot probably means that it was presented in a way that was, you know, more vanilla, more neutral.

Jen Kamel: Yeah. And so this was just the norm. To be able to present VBAC without a lot of the drama and the hyperbole that it is accompanied with today. I feel like it gave you a foundation of "this is the norm, this is the default."

Dr. Chris Stroud: Potentially. I see what you mean. I think you're probably right.

Jen Kamel: So let's talk about when you opened your first practice. I'm assuming VBAC was something that you offered and that was just because that was the norm.

Dr. Chris Stroud: And that's a really good point. So my first job after residency was in a small town in southern Wisconsin, Beloit, Wisconsin. And I don't believe then VBACs were offered by that hospital.

Jen Kamel: Oh, interesting.

Dr. Chris Stroud: So it really wasn't on my radar. I wasn't there very long. Then moved to a small town in southwest Georgia, a father son practice, and VBAC was really the norm. Not something we ever really even talked much about. We had VBACs, we had non VBACs, and we had VBACs. And if a patient wanted to repeat C-section or if she wanted to VBAC, it was just another question that you needed to ask. But to your earlier point, it wasn't presented as a dramatic thing that needed a lot of thought and a lot of consideration.

His VBAC Philosophy

Jen Kamel: Yeah. Has your philosophy about VBAC evolved over time?

Dr. Chris Stroud: You know, I know that it has, I just don't know that I can really articulate how.

Jen Kamel: Yeah.

Dr. Chris Stroud: I've been doing this now 30 plus years, so it's hard to remember when things change from one maybe to the other. In the last 15 years of practice, my partners and I have been very proactive in promoting the availability, I would say, of VBAC.

And that's not to say we're trying to convince every woman who's had our prior cesarean section to have a VBAC. I would say we spend a lot of energy trying to convince people to just make decisions based on good information.

VBAC is not for everybody, and if it doesn't interest you, you shouldn't do it. But you should make that decision with good information and not a lot of mythology, both about VBAC or maybe the mythology about the perceived safety of a repeat C-section.

And so if something has evolved over the years, it's been probably my sense of balance in that my job is to help you understand the complex issues. You decide what you want to do based on your feelings and your values. But my job is to make sure that you're not deciding to do one thing because you're convinced that it's safer than the other, when in reality that may not be the case.

Why His Believes Offering VBAC is Important

Jen Kamel: Yes. Yes. And so why, I mean, just let's get down to the bottom line, why do you think it is important to offer VBAC and do you view this as a public health issue?

Dr. Chris Stroud: Yeah, I think I probably have two things draw me to VBAC, I suppose. One of them is, I just don't like things to be wrong, so I struggle, and you might have a dose of this as well. I struggle to hear someone say, "well, I'm worried about the safety, so I'll have a repeat C-section." I just, I have a hard time letting that just kinda hang out there.

So I feel compelled to say, "great to have a repeat c-section, but I'm just a little troubled with that last thing that you just said." And so that's just my, maybe cantankerous, personality about data. I just want to make sure that I didn't let that go. Because if I say nothing, then she takes that as an endorsement that that was the right position. Right. So that's a part of me.

The other part of me is VBAC is just cool. I mean, births are all beautiful, right? In their own ways. There is something about a successful VBAC, and I define success by an attempt, not by whether the baby emerges from the vagina.

Jen Kamel: Yeah.

Dr. Chris Stroud: But there's something about way that a woman describes her experience with a successful VBAC attempt that is just, it's just exciting.

There's that look, there's this feeling of overcoming odds, of winning, of maybe she feels like something was robbed from her before. And now she's beaten that demon back and achieved this thing that she felt like defined her. You just don't get that very often, and it's exciting. It's, it's just fun to see that.

How He Counsels Patients on VBAC vs Repeat Cesarean

Jen Kamel: Yeah. Yeah. I love the comment that you made about, you can't just let that statement hang in the air. So could you give us like a little nutshell of when you counsel people on VBAC versus repeat cesarean, what are the major points that you make?

Dr. Chris Stroud: Yeah, I try to make it like it is, which I think is relatively straightforward and I say something along the lines of, "If you ask me the question, could a catastrophe happen with VBAC? I have to say, absolutely yes it could."

And then I point out that's where I think most of my colleagues fall short. They stop right there. They don't ask the other side of that coin, which is the question, "Could a catastrophe happen with a repeat c-section?" Well then I had to say yes. Well then the patient usually says, "Well, wait a minute." And exactly, that's the right response. So the reality is catastrophe could happen on either side of that decision.

The reality is when people like you start pulling back the layers and layers and layers of the data, two big things I believe come to mind or become evident. One is the risk of catastrophe in either case is very, very low. And the risk of catastrophe is not only very low, it's probably approaching equal. So now that's a whole different story. And then I like to say, "Look, you're pregnant. You are driving down the interstate at a hundred miles an hour and the road forks, you've got to go repeat C-section or VBAC, you only have two choices. If the risks are equal relatively, then you just decide which set you're most comfortable with. But you've got to make a decision because you're already on this road. And by the way, there is not a safer decision. They're both right from a safety perspective." And if nothing else, my goal there is just to lower the patient's anxiety and say, "Oh, well then we can make a decision based on just preferences, not on fear." If I get that done, I think I've won.

Jen Kamel: Yeah. Yeah, absolutely. You know, I love to cite the National Institutes of Health after their 2010 VBAC conference, and listeners who's been with me for a while, they probably know this by heart, and good, I'm glad. They talked about how the risk of, like you said, a very bad outcome can happen with a VBAC and an [elective] repeat cesarean. The risks are low.

And at that time we had emerging evidence of those increasing risks that can come with multiple prior cesareans. Especially for someone who wants more children, VBAC is a compelling option. And even if someone doesn't want more children, VBAC is still a compelling option 'cause like you said, the risks of a truly catastrophic outcome are present for both, but unlikely with both. And you have two different buckets of risks and benefits to choose from.

The Concept of "Acceptable Complications"

Dr. Chris Stroud: And there's this weird thing that we obstetricians do. And I'll say that collectively, that's probably not exactly fair, about surgery risk. And if you think about it, it's hard to get into our mindset, but you know, there's this phrase that I detest "acceptable risk."

Jen Kamel: Yes.

Dr. Chris Stroud: You know, or "acceptable complications." So if we go and do a repeat C-section and something bad happens, maybe a blood clot or maybe an amniotic fluid embolism or maybe a severe infection in the culture, that's sort of not my fault. You know, I think I'm a brilliant surgeon and those things just happen, but I didn't do anything wrong. So I don't feel bad about that. I don't feel judged. I don't feel like I did something wrong.

But for whatever reason, if there's a uterine rupture during a VBAC labor, I feel absolutely responsible and I'm at fault, and I did it wrong. Well, I don't like that feeling. I don't want it. So I'll go with these risks with a repeat C-section that I'm much more comfortable with culturally. It's a tough thing to understand, I think, for non-surgeons, but it's a very tough mindset to try to change.

Jen Kamel: Well, and how I summarize that concept is the notion of just greater control with the repeat C-section versus the lack of control with a planned VBAC. And yet, in both circumstances, in the absence of negligence, the physician is not responsible for any of those outcomes because those are all known risks.

Ideally the patient is making an informed decision, so they know that there are these small risks here. There's these small risks here, but those small risks mean they happen to someone. And no matter how small the number is, it is going to happen to someone, will it be you? Very unlikely. But it might be and that uncertainty, that's a challenge with healthcare 'cause I think so many of us want to know what time is dinner, what time do I wake up, what do I need to do to achieve this goal? And things tend to be pretty discreet and clear. And yet when it comes to healthcare, things are not as discreet and clear because we aren't in control of so much.

Dr. Chris Stroud: Yeah, it's medicine not carpentry.

Jen Kamel: Exactly, exactly. Yeah. So I would love to note, do parents travel to you to planned VBACs?

Dr. Chris Stroud: Oh my goodness. It's an embarrassing answer. I mean, we see patients, we're in northern Indiana, I see patients from two hours away in Indianapolis, three hours away in Louisville, Kentucky, Toledo, Detroit, Cincinnati. People travel insane distances for a shot at a VBAC.

Jen Kamel: Yeah. And I get goosebumps hearing you say that because what that tells me is that there is nowhere between where they're coming and you that they feel like they have a shot.

Dr. Chris Stroud: Right? It's sad, but it's a reality and I don't think we're unique in that sense in our geography. I think

Jen Kamel: Yeah. Yum.

Dr. Chris Stroud: there's people all over the country that find themselves in that same position.

Jen Kamel: Absolutely. You know, whenever I talk to a physician like yourself who is unabashedly supportive of VBAC, they have that story of the people who have traveled hours or even flown across large bodies of water, flown across oceans to see them because they know that provider is someone that they can trust. And someone who is, when they say you need a C-section, they can believe them and not always wonder, "was that really necessary?"

Dr. Chris Stroud: Yeah. Yeah. You remind me of one of the things I probably say often to patients when we're talking about this is, I'll say something along the lines of, "Look, if we get to the end of this and you felt like you had a good team, that helps you make transparent decisions, that respected your decisions and your options, and this baby doesn't come out of your vagina. You're going to walk through that C-section feeling victorious."

Jen Kamel: Yes.

Dr. Chris Stroud: It's really not the outcome, it's the attempting, but it's got to be authentic.

Jen Kamel: Yes.

Dr. Chris Stroud: And there's got to be so much trust. And transparency, but people will drive and travel to get that feeling.

Jen Kamel: You know, I love how you position, how the success is in the intention to labor, is in the action of laboring. I do the same thing because I think a lot of people, parents and clinicians alike, get very fixated on the outcome. And where the baby comes out. And that is what defines success versus failure.

And I think it's hard for parents for a set of reasons, and it's hard for clinicians for another set of reasons. And to be able to put that emphasis on our intention rather than the outcome, which we cannot 100% control that. I think it just completely frames the topic in an entirely new way, which focuses on agency.

Avoiding VBAC Bait & Switch

Dr. Chris Stroud: Yeah. Yeah, I like that. I agree completely. I'm reminded of an kind of an unpleasant topic that's probably worth bringing up.

Jen Kamel: Do it.

Dr. Chris Stroud: I call it the VBAC bait and switch.

Jen Kamel: Oh, yes.

Dr. Chris Stroud: And I know you've seen this, but because so much is put on the attempt.

Jen Kamel: Yes.

Dr. Chris Stroud: Physicians will often say, "Oh, yes, yes, VBAC, you'll be great. You'll be great. Not a problem." And, viewers I know have heard this, and you're cruising through the pregnancy and everything just seems wonderful. And then there's this perception of, "Well, your baby might be big, your glucose intolerance is a problem," or "You need to be induced and we don't induce VBACs" or something. And suddenly the rug has been pulled out from under you.

Jen Kamel: Yeah.

Dr. Chris Stroud: And in reality, the intention of an authentic trial was probably never there. And that is a huge problem that has got to be spotted early on and corrected.

Jen Kamel: Yeah. How would you advise people to spot that early?

Dr. Chris Stroud: Oh.

Jen Kamel: You set yourself up.

Dr. Chris Stroud: I know, I did, didn't I? I think there's a couple of things. One is depending on where you live in the country, the model of care is critical. You might think, "Well, I really like this provider." Oh, "this obstetrician" may be in this case, great, but that obstetrician is not going to be on call every day and they're going to get sick and they're going to have sick children and they're going to go to Florida.

What happens if that provider's gone? Someone has to cover for them. What are those people like and do they share their VBAC values? I don't think most people actually think their way through that. That often results in the, "Well, I'm on call Friday, let's just induce you. I'm going to be out of town next week." And that leads to failed VBAC and to increased C-section rates.

So one of the critical things is you need to pick a model of care that you like. Is there one person, is there five people? How do they cover for each other? Do they share philosophies? That's critical.

Then when you're talking to one person about VBAC, I like a couple of simple questions. Why do you do VBACs? Other people don't? Why do you? And you should get a good answer there that you feel comfortable with. My favorite question: tell me about your last VBAC. If they start stuttering and staring at the ceiling, it's probably time to leave. I can tell you about my last one.

What you're really looking for there, I think, is a sense of passion. If I can't remember the last VBAC, that means they're not a big deal to me, and I really don't take this seriously. So I think those are things. Choose the right model of care and understand it, pursue the individual and the group, if it's a group. Why do you do this? How do you feel about it?

Does He Worry About VBAC Safety?

Jen Kamel: Those are excellent tips. So some might say, since you attend planned VBAC, you must not be worried about safety. What do you say in that response?

Dr. Chris Stroud: You know, that would be like saying since you drive on I 75, you must not care about safety. We do, as humans, complicated relative risk ratio analyses at our subconscious level

Jen Kamel: Yes.

Dr. Chris Stroud: every minute of every day. The best one I can think of is driving in a car. You have an appointment, you've decided, whether you've actually thought it through or not, the risk of me getting killed in the car on the way to that appointment is justified by what I feel like I'll get out of that appointment. But you're doing this complicated evaluation even though you don't realize you're doing that. The same is true with VBAC. I care very much about safety. That's why I want to make sure people choose what they understand to be their best option, and they don't use bad information to choose it.

Thirty plus years of doing this, I've had a healthy young 26-year-old woman die from complications of a routine C-section, not even a repeat c-section, a routine C-section. She died, left a husband and a child behind. I'll never ever forget that feeling. Now, on the other side of the fence, had a uterine rupture where the baby died and I had to do a hysterectomy. And that woman and her husband were absolutely devastated. So I know both sides of the fence. And as we said earlier, they're unavoidable.

Jen Kamel: Yeah.

Dr. Chris Stroud: So I care very much about safety as I think any good provider does. But I don't want to make wrong decisions based on fear of safety problems.

When He Induces Planned VBACs

Jen Kamel: So are there any differences between how you attend a VBAC and a non VBAC labor?

Dr. Chris Stroud: You know, I guess yes and no is an easy answer. The best VBAC labor is the labor that begins spontaneously and proceeds spontaneously, the baby emerges and doves are released and it's wonderful, right? I mean, that's a great VBAC.

But there are times when a VBAC patient needs to be induced. Maybe she develops preeclampsia or gestational hypertension or something else. As you know, the data is very supportive, that's very appropriate.

So when we're inducing a VBAC, I think in our group, we take a very hard look at induction anyway and try extremely hard never to do what we call elective inductions, just because I'm tired of being pregnant and my in-laws are in town. There needs to be a medical reason to accept the risk of induction. The same is true with VBAC. I think that discussion in that equation is probably even more important with VBAC.

But beyond that, in a simplistic way, a VBAC labor shouldn't look or feel any different than a regular labor does. In the community where I practice, we've made arrangements, or I guess I would say agreements, with the hospital that we will ask laboring VBAC patients to have a saline lock IV. It doesn't have to be hooked up to anything. We ask them to have continuous fetal monitoring. It makes the hospital happy. And so we think that's a compromise that we try to live with. Beyond those two things, you really shouldn't be able to look at a patient laboring and know that it's a VBAC labor.

What "Immediately Available" Means to Him

Jen Kamel: So in terms of your quote, "immediate availability," does that differ with VBAC versus a non VBAC labor per hospital policy or your own policies?

Dr. Chris Stroud: It does and I'm sure that varies greatly across the nation. It's probably very localized. Here in northeastern Indiana, the hospital where I predominantly practice has a on-campus rule. If you have a VBAC in labor, the primary physician capable of performing an emergency C-section has to be on the campus of the hospital.

Our hospital, as very commonly now we're seeing across the country, also has an in-house laborist, who never leaves, plus in-house anesthesia, which is just another layer of safety that makes us all feel better I think about doing VBACs, but that's different all across the country.

That's not to suggest for a minute that you have to have that in order to safely do VBACs. ACOG has been very clear in that you can do VBACs in small community hospitals. It just requires an informed consent and an understanding of what you're doing. It's very nice if you can deliver at a place that has these extra layers of safety for a whole host of reasons.

Why Aren't All Hospitals Attending VBAC?

Jen Kamel: Yeah, absolutely agreed. And thank you for inserting that part about what ACOG says because even though they've been clear since 2017, their VBAC guidelines, which explicitly state level one hospitals, as defined as those that offer basic care and OB, should be offering VBAC.

So they're very clear, and yet it's been now eight years, since we're recording this in 2025, that that's come out and I still, still, just this last week, I've had two different clinicians approach me and say, "But we can't offer VBAC because we don't have 24 7 anesthesia." So I'm not sure where that disconnect is.

I rhetorically ask, and maybe you have some insight, how is it possible that ACOG can publish these guidelines in 2017? And even before that, they were talking about how immediately available, like you said, is ideal but not a requirement and should not be used to force people, or coerce people, or tell people, their only option is a repeat C-section.

So how is it ACOG can be using this language for so many years and people still think 24 7 anesthesia or physician presence is required. Do you have any insight on that?

Dr. Chris Stroud: I think I do. I think this is a medical cultural phenomenon. A mentor of mine in medical school used to say "dogma dies a delinquent death."

There are great examples throughout medicine where it was known for a generation that by wearing gloves to examine patients would prevent infection. And yet for that to be known, then to show up in the textbooks, then to be common practice, took generations to occur.

Medicine moves and changes exceptionally slowly, unless it's out of fear and then it has the ability to change overnight, which is another phenomenon, but it is all part of the same phenomenon: it's cultural.

You know, I'm not making this up, last night I was in an argument with a physician here about a policy matter relating to VBAC in two prior cesarean section patients. I pointed out that, "ACOG, that you've just been quoting to me on many, many things, points out that that's very appropriate." And all I got was an audible sigh and an eye roll. So, in other words, I like the data when it's supporting my position, but I don't like the data when it doesn't support my position. That is a medical cultural phenomenon that we're not going to change that, I don't think, if we just call it out for what it is and help people recognize it when it's occurring, maybe, maybe that's as good as it's going to get. But you have to appreciate that when you're fighting these kind of battles.

On Not Giving Up

Jen Kamel: Yeah. Yeah. And that's why I think it is so important for us to be consistent, applying the pressure, sharing the facts, and not giving up, because it is so easy to step into this work and say, "Well, nothing's changed. Oh, well." It's like we can't have that attitude. We have that attitude and who is then at the table?

It reminds me of the Healthy People 2020 goal, which was a national goal set up by the US Federal Government. They wanted the VBAC rate to be 28% nationally by 2020. And one of the things I noticed is when Healthy People 2030 came out, I immediately looked up where VBAC was. There was no mention of VBAC.

And so that makes me think whoever was there to champion VBAC on the 2020 guidelines, they weren't there for 2030. They weren't there at the table to say, "this is important," or they were there and they were ignored. Nevertheless, even if we're ignored, we still need to speak out. And so I think of that and that's why the work that you do, and the work that I do, and the work of other people who are in this same space, is so important because we are all addressing this issue from different angles and perspectives and reaching different audiences. And that is going to make change.

And it has, I mean, we can see that from 2008, even until now, our VBAC rate has increased from about, I think it was six or 8%, then to about 14% now. That's a considerable increase. And so I can't help but feel that that is a result of education, people asking for what they want, clinicians learning the facts, and us collectively moving towards a kind of healthcare that centers evidence and autonomy because that's what all healthcare should do.

Voting with Your Feet

Dr. Chris Stroud: Yeah. I like that. I love the way you reach out to providers and sort of consumers alike. My personal feeling is the change comes from patients, not from providers, and that patients vote with their feet.

Jen Kamel: Yeah.

Dr. Chris Stroud: And I think most families probably don't appreciate the economic impact they have the potential to have by walking out and saying, "If that's how you feel about this thing, that's so important to me, I respect your right to have that opinion, but I'm also going to exercise my rights and I'm not going to pay you for services. I'm leaving." And if enough patients do that, physicians start paying attention.

It happens a lot that physicians will call me and say, "How is it you do so many VBACs and people are driving to see you?" Well, I'll help you if you'd like to learn that. It's not difficult. But patients have such power.

Jen Kamel: Yeah.

Dr. Chris Stroud: I think what you do educates them to be ready for that sort of exercising of that power, but don't underestimate patients how much you can do to change things like this.

Administrative, Hospital, & Legal Challenges

Jen Kamel: Yeah, absolutely. So I'm curious to hear what are the biggest challenges you've encountered as a physician who attends VBAC, and how have you even overcome those challenges?

Dr. Chris Stroud: Yeah, I mean, the challenges, I think, there's always an administrative hospital legal challenge waiting to happen. I mean, that's just there. And frankly, I understand the hospital's position. I was a hospital administrator in a former life. I get their position, you know, life would just be easier for them if there were no VBACs. Right or wrong, it would be easier. And I get that, but I think they also get that's not a reality, that's acceptable. But there's always that challenge. Ready to happen.

Another intrusive policy that makes VBAC either impossible, or more difficult, we've negotiated on the saline lock, we've negotiated on the continuous monitoring. If some of my anesthesia colleagues had their way, the patients wouldn't eat for the last five weeks of pregnancy or something, you know, so their stomach would be, you know, I'm being facetious, but challenges are always there. I think sometimes the greatest challenge that we face as a pro VBAC group like you mentioned earlier, why aren't you concerned with safety?

When I'm trying to talk to a family and say, you know, "You're not a good VBAC candidate. This is not a good thing for you. We should be thinking differently." Then suddenly I'm the villain. And I want to say, you know, "I'm the VBAC guy. I'm not the enemy. I'm sitting on your bed at three in the morning and I'm saying, if you were my daughter, I would say 'it's over.' Let's go do a family centered C-section.'"

But sometimes that's a huge challenge and it probably has less to do with me and more to do with the wounded patient that she received from the previous experience. But that can be very challenging. And if there's younger, less experienced physicians participating, they can think, "Oh, I don't want any part of this. This is what I was afraid of. I don't want any part of this."

Jen Kamel: So I have two thoughts. When you talk about hospital administrators being concerned. One, so they would be happier if no one had any VBACs, but do they connect that at all to the primary cesarean rate that's occurring at their facility and in their larger community?

Dr. Chris Stroud: No, I don't think so. No disrespect to my administrative colleagues, but I don't think that makes it onto the spreadsheet. That's not the issue.

Jen Kamel: Yeah, well, and absolutely no disrespect because as we've talked about, we are all humans first, and the way that we process information and the way that we perceive risk comes through our human eyes. So, you know, that is how we process information, but recognizing that that's how we process information and realizing that when we say we wouldn't want any VBACs here, not considering what that means for the practice happening right now in terms of primary cesareans that are occurring for big baby or arrest of descent, which when it doesn't even meet ACOG's clinical guidelines half the time, and a variety of other things like vaginal breech delivery when there's an opportunity there for clinicians to be trained in vaginal breech delivery and yet that opportunity is not engaged.

Dr. Chris Stroud: So there are a whole host of things that we could do to ensure that as few VBACs as possible happen in a community, but we have to do the work on the front end to make sure that those primary cesareans don't occur.

I love that idea. The best way to deal with the VBAC is to not deal with the VBAC.

Jen Kamel: Exactly.

Dr. Chris Stroud: Avoid your first C-section and then this is a moot point. We can move on to something else.

Don't Leave Those with Primary Cesareans in the Dust

Jen Kamel: Well, exactly, and I think it's really important whenever we talk about reducing the cesarean rate to focus on those primary cesareans, but let's not leave all those people who've already had a C-section in the dust, because when we focus only on primary C-sections, we're forgetting the millions of people who have had C-sections and want more children.

Dr. Chris Stroud: Just going to say, you know, there are some babies on some days that will just not fit out of some pelvises. It was just bad luck. The baby got twisted up in funny, goofy

Jen Kamel: Yeah.

Dr. Chris Stroud: position and just for whatever reason, that baby got stuck. And so that C-section is perfectly appropriate and you should do it. She's going to have to deal with VBAC later.

Jen Kamel: Yeah.

Dr. Chris Stroud: But then to not allow her to do a VBAC, I can't tell you how many times I've seen a patient that had a horrible labor ended up in C-section, and you think, "No baby will ever come out of that pelvis." And then the next pregnancy rolls around and the baby falls out in the parking lot right before she even got a chance to get in.

Jen Kamel: Yeah.

Dr. Chris Stroud: Because it's goofy, it's labor. We're not in charge. Babies do weird things. But if she'd been denied a chance at VBAC

Jen Kamel: Yeah.

Dr. Chris Stroud: that would've been criminal to do that.

Jen Kamel: Absolutely. Well, and the other thought I have about that hospital administrator who says "we don't want to have any VBACs here," what is their connection between the rates of things like accreta and placenta previa and cesarean hysterectomy, which absolutely increases as you have the rising number of prior cesareans, ICU admissions, blood transfusions, hemorrhage. Is there a connection between all these other outcomes that are associated with prior cesareans and mandating repeat cesareans?

Dr. Chris Stroud: Absolutely no question. I mean, just anecdotally, I think I went maybe 20 years in my career and never saw an accreta. And suddenly I would say probably in the last four to five years I've seen probably one a year.

Jen Kamel: Yeah.

Dr. Chris Stroud: I don't think that's a coincidence. But just as a very practical point, I mean, accreta can be a life-threatening complication. And all too often it's never mentioned as a potential long-term complication of that first C-section.

Questions for Non-VBAC Providers

Jen Kamel: Yeah, absolutely. So I would ask you, how would you counsel your counterparts, other OBs, who are currently struggling with offering VBAC? And I mean, we can think of the major reasons that are in their head. So how would you counter those reasons?

Dr. Chris Stroud: Yeah. Not too long ago, I had a new physician join our practice who had spent most of their career as an anti VBACer.

Jen Kamel: Interesting.

Dr. Chris Stroud: If you're going to join us, you got to change your position. So this person said, "Well, I'm willing to. Have you ever had a complication?"

And I said, "Yes. I've had VBAC complications. One big one."

And he said, "And you're still doing 'em?"

I said, "Yes." And then I quickly went to, "And I've had complications from repeat c-sections. Have you?"

And the physician said, "Oh, well, yeah."

And then I was able to connect that you're going to have them on both sides. Then I tried to say, "We do not make our best decisions out of fear, from a fear-based position nothing goes right. We're not good at making good decisions when they come from a place of fear. So let's try to look more objectively at the data and try to get rid of the fear as we decide these things."

And then, you know, I like to talk to newer non VBAC physicians about sort of the ideal VBAC candidate. And I'll try to find that patient to get involved with this new VBAC physician's care. I like to joke and say, "It would be a seven foot tall woman who's had 11 babies and her 12th baby, she had a C-section for breech, and now she's pregnant again." Right? That's a VBAC dream for someone who's new to this. It's also not a reality.

Jen Kamel: Yeah.

Dr. Chris Stroud: But if we can find a good experience for someone, they're going to get that this is not mystical, it's not magical.

Jen Kamel: Yeah.

Dr. Chris Stroud: But look at the data. Try to understand when you're making a decision out of fear, call that out for what it is, and try to work through that. And then to look very hard at both sides of the complication fence, the repeat C-section complications and the VBAC complications.

Jen Kamel: Yeah. Absolutely. So what are the biggest misperceptions you've seen from colleagues, whether that's nurses, administrators, OBs, about VBAC?

Dr. Chris Stroud: Oh, what, that's a list, isn't it?

Jen Kamel: It is a list. Pick your favorites. It's like picking your favorite kid.

Dr. Chris Stroud: Yeah, you know, that two prior C-sections is inappropriate. That's unsafe. Really? I can't prove that. Maybe you can, I can't prove that. I think that's one that we commonly encounter.

VBACs can't be induced, you know, that's a common sort of obstacle. A gestational diabetic, who is a VBAC, that's out of the question. Even though she's maybe well managed and better off than her non gestational diabetic counterpart.

Jen Kamel: Yeah.

Dr. Chris Stroud: You know, those are some of the, I think, common misconceptions about VBAC. But, you know, some kind of goofy things. I mean, when I was in a hospital where we weren't allowed to have a VBAC patient in a certain room because that room was too far from the operating room.

Jen Kamel: Wow.

Dr. Chris Stroud: So I had to get a tape measure and show that that was the same distance as the other rooms. But that's a great example of just fear based decision making.

It's the Lawsuit

Dr. Chris Stroud: And then if we're talking just about obstetricians, it's the lawsuit. "I'm going to get sued," you know? And that's a tough one to answer, isn't it? I mean, the only way I've ever been able to answer that is I copy a mentor that I just love. His name is Dr. Patrick Duff at the University of Florida. He's still around, so he might hear this one day. But he used to say, "If you do the wrong thing, you may be sued. You do the right thing, you may be sued. So why don't you just do the right thing and not worry about it?"

Which is easy to say and hard to do because lawsuits are fearful, terrible things, but that does happen to be the reality. If you choose to be an obstetrician gynecologist, you are going to be involved in legal matters. And you can't de-risk yourself out of that by avoiding and avoiding other things. So why not just do the right thing and do your best and document your best, have good relationships with your patients

Jen Kamel: Yes.

Dr. Chris Stroud: and actually participate in informed consent and you're going to be just fine.

Jen Kamel: Yeah, I think physicians really underestimate the power of nurturing a trustful relationship with their patients that is collaborative and not authoritarian. Because we know from the research, when we look at physicians and OBs who are sued, we can see the quality of that relationship impacts whether that lawsuit is filed or not.

Dr. Chris Stroud: Yeah, yeah. It's so true. Too far many, too many, physicians, the informed consent discussion is, "Here's what I think you should do. Do you agree?"

Jen Kamel: Yes.

Dr. Chris Stroud: That's hardly informed and it's hardly consent. You can't give your consent if you don't understand what you're consenting to.

Jen Kamel: Absolutely.

Dr. Chris Stroud: If I make you understand, and that's my job to make you understand, not to make you agree with me, to make you understand, then you can make an informed decision.

Jen Kamel: Yeah.

Dr. Chris Stroud: Without that, there's no such thing as informed consent.

His Practice's Secret Sauce

Jen Kamel: Yeah, absolutely. So do your non-supportive colleagues take call for your VBAC clients?

Dr. Chris Stroud: No, we don't share call in my practice model. We don't share call with other groups and we don't cover other groups. We spoke earlier in the podcast about the model of care. I just think that's so critical that you understand as a patient, you may really like that provider sitting in front of you, but they're not going to be there all the time. And you've got to understand how that call arrangement works. It's just a reality of life.

Jen Kamel: Yeah. Tell me about building your practice as you bring on other VBAC clinicians, whether they are OBs or midwives. Do they have to attend VBAC as a condition of employment?

Dr. Chris Stroud: Yes. Yeah, I mean that, that's a philosophical non-starter. And we have several philosophical non-starters, but that's just on the list. I would argue you shouldn't join a group that you don't agree with and

Jen Kamel: Yeah.

Dr. Chris Stroud: whether you're talking about VBAC or whether you're talking about vaginal breech or really any other important defining topics, you have no business being in a group and sharing the care of people

Jen Kamel: Yeah.

Dr. Chris Stroud: if you don't have some philosophical alignment. A unique thing about our group, we're a combined physician nurse midwife group and every patient belongs to every provider. We don't differentiate. You're a midwife patient. You're a physician patient. You're my patient. You're someone else's patient. You're a patient of our practice. We want you to know us all, to meet us all so that you could, in theory, close your eyes at an appointment and not know who you're talking to because we're the same.

Jen Kamel: Yeah.

Dr. Chris Stroud: Then we practice sameness. We try very hard to be the same. Then I think our secret sauce is, if any young providers are listening, we have a meeting every single week on Tuesday mornings at 7:00 AM and we talk about every patient we saw the week before that has anything even remotely interesting.

VBAC always gets on the list so that everybody feels like they understand the care plan, they're invested. If a patient has a unique set of circumstances that are important to her and her spouse, let's call those out for what they are so we all understand them. I think that promotes a cohesiveness. That drives trust because the patient feels

Jen Kamel: Yes.

Dr. Chris Stroud: they feel like they're part of a team. Many brains make good decisions. It's hard to do. It takes some investment of time, but the outcome I think is tremendous.

Jen Kamel: Well, and I think from the patient perspective, knowing that no matter who shows up, whether it's for a prenatal appointment or for delivery, you know what their philosophy is, you are already on the same page and you're not sitting there hoping Dr. So-And-So doesn't get called in. Or your favorite doctor, the only doctor in the practice who will "allow" you to labor, is now gone, and now you're stuck with someone who you know it's going to be a battle. That is incredibly stressful.

Dr. Chris Stroud: I would say that's probably more common than the opposite.

Jen Kamel: Yes.

Dr. Chris Stroud: You may live in a community where that's your only option and you're going to have to try to make the best of that. But it is not an ideal situation. Not at all.

Jen Kamel: Yeah, absolutely not.

On Collaborating with Community Midwives

Jen Kamel: So I also know that you collaborate with community midwives who attend out of hospital birth. I would love for you to share a little bit why you do that, because there are so many physicians who are so nervous about collaborating with community midwives, meaning licensed midwives, certified professional midwives. Sometimes they're called lay midwives, but that that terminology really doesn't encompass the extent. Yeah. It depends on where you live, and it depends on your level of understanding of their training and knowledge and experience. But that's a whole other conversation. We're talking about non-nurse midwives who practice in the community and who may even attend VBAC at home or birth centers. Why do you collaborate with these midwives? Why do you think that's important?

Dr. Chris Stroud: You know, my answer would be probably pretty similar to why do I do VBACs. I mean, on the one hand, just because it's the right thing to do. I mean, there's a data based reason to do that, that's good practice. I'm an obstetrician. I'm a surgeon. I have certain skills that I learned through medical school and residency and I can contribute to the care of those patients.

Jen Kamel: Yeah.

Dr. Chris Stroud: And those providers, those midwives, need my level of care in order for them to be safe. If I refuse to participate, I'm harming their patients, potentially. I'm not doing the right thing there, I would argue I'm probably doing the wrong thing. But then the other part of it is, just like VBACs, it's just very cool. If a patient gets to have the home birth she wanted because I was willing to receive a transfer from her provider, how do I lose in that? I walk away feeling good about that. And I get cards from patients with pictures of babies that will say, "You made my home birth possible." And I'll think, "Gosh. I didn't even know that. I wasn't even thinking about that."

Jen Kamel: Yeah.

Dr. Chris Stroud: But I think we have a responsibility, as obstetricians, that we need to be available to help. We don't get to pick, you know, a cancer doctor doesn't pick who gets cancer. I don't pick who has a complication that needs my help. So we support certified nurse midwives and non nurse midwives throughout our community.

What He Has Learned From Home Birth Midwives

Dr. Chris Stroud: And it's a terrific experience. We've got a great relationship. And so a lot of the myths that you'll hear obstetricians say about so-called outlying or community midwives, I've never experienced that because we have a great relationship. It's collaborative. We share ideas, we share our protocols with them. And I'll tell you, to be perfectly honest, I'm a better obstetrician because of the time I've spent with a home birth midwife in our community who easily taught me more about how to deliver babies than I ever learned in residency. So there's a lot to be said for that collaborative relationship. It goes both ways.

Jen Kamel: Can you tell me a little bit more about what you've learned from this community midwife? Because I think that is really valuable for clinicians to hear.

Dr. Chris Stroud: Yes. Well, you and I both know who she is and she'll probably watch this. Now I'm going to be embarrassed, but, um,

Jen Kamel: That's okay. It's time to let her beam.

Dr. Chris Stroud: Right. Her name's Rhoda Baughman of Agape Home Birth. There you go, Rhoda. I just did that. How about that? Yeah, I met her early on in my tenure here, which I was not a new obstetrician by any means. And I would accept her transfers to the hospital, and then she would come into the hospital and really assume the role of doula. She didn't have hospital privileges, so she couldn't actually touch the patient in a clinical way

Jen Kamel: Mm.

Dr. Chris Stroud: but she would stay there and be supportive. One of my strongest memories is, I was putting on a glove to examine the patient and Rhoda said, "Well, it appears as though you're about to examine the patient." And just looked at me. That was her gentle way of saying, "You haven't told her that you're going to examine her, or that you would like to examine her, is that okay?"

Jen Kamel: Yeah.

Dr. Chris Stroud: And, you know, I had no malice. I just completely didn't see that as something that ought to be done. So in one moment there, she taught me about

Jen Kamel: Hmm.

Dr. Chris Stroud: really informed consent in a way of saying, "I would like to examine you. I think it's got value. Is that okay?"

Jen Kamel: Yeah.

Dr. Chris Stroud: Well the patient is going to say yes, but it was important that I ask. And you know, that was a critical thing that she taught me. But she probably also taught me a lot about patience.

Jen Kamel: Hmm.

Dr. Chris Stroud: Not the plural of patient, but to wait. And I love the phrase "failure to progress is more times than not, failure to wait."

Jen Kamel: Yeah.

Dr. Chris Stroud: And if the baby is safe and the mom is safe, there is no rush and there is no clock. I can't tell you how many c-sections are averted by just being patient.

Jen Kamel: Yeah.

Dr. Chris Stroud: Maybe get an epidural and sleep a few hours and then start pushing again, just by being patient and waiting. And so Rhoda taught me a great deal about, about a lot of things, but those are the two big ones that come to mind.

Then, you know, as a medical student, think when I did my third year rotation in obstetrics, I think 90% of the births I did were with nurse midwives. Interestingly that was just random. It was a Jacksonville Hospital in Jacksonville, Florida with babies coming out of the woodwork. And the midwives taught me how to manage a birth and what to do and I probably just carried that with me in a subconscious way.

Longest Second Stage

Jen Kamel: Yeah. Yeah. You know, as an aside, I just interviewed someone else about their birth story and they had a c-section while pushing twice. So two prior cesareans for the exact same reason. And I'm just curious, what's the longest someone has pushed, or been complete, before you called "failure to progress" or they delivered vaginally? Do you recall?

Dr. Chris Stroud: That's a great trivia question almost, isn't it? Um, I don't know because we often do therapeutic rest.

Jen Kamel: Mm-hmm.

Dr. Chris Stroud: Where we'll say, "Just stop now." You can't do that without an epidural. I mean, you know, you can't not push if you're in a natural [unmedicated]

Jen Kamel: Yeah.

Dr. Chris Stroud: labor. But, the woman who has an epidural or maybe for the woman who's pushing, and getting nowhere, we'll often consider maybe an epidural. In our birth center population, we'll sometimes transfer to the hospital, get an epidural, sleep a few hours, wake up, maybe turn the epidural off, and the baby comes out. Like it was like nothing ever happened. I mean, her uterus and she were both exhausted.

Jen Kamel: Yeah.

Dr. Chris Stroud: So, so I don't know. Even ACOG will say though, for a first time mom with an epidural, five hours, four hours, this is not beyond the pale at all, as long as the baby's healthy and the mom is healthy. So, I don't know the answer. The clock is a tricky thing, but a long time, a very long time.

Jen Kamel: Yeah.

Dr. Chris Stroud: I like to tell patients, "I can last longer than you can." So it would be more common for a patient to say, "I'm done already let's do a

Jen Kamel: yeah.

Dr. Chris Stroud: c-section."

On Being Sued After a Uterine Rupture

Jen Kamel: Yeah, so I'd love to talk about uterine rupture. You know, a topic that we talk about quite a bit. So some hospitals ban VBAC or greatly narrow their VBAC policy as a result of experiencing a uterine rupture, especially if it resulted in a fetal demise or a lawsuit. You've already talked about, you've experienced a fetal demise from uterine rupture. How did your hospital respond to that uterine rupture in your practice? And did you have to continue lobbying to attend VBAC?

Dr. Chris Stroud: Yeah, that's a, oh boy, that's a good question. How did they respond? Not well. Not well at all. And in fact, it resulted in litigation and as is often the case with professional liability litigation, I was named, the hospital is named, everybody is named. And, sadly sometimes all of the parties in the lawsuit sort of turn on each other and start shooting. That certainly happened, that I was somehow at fault. And so I had to fight not only against the person suing me, but I had to fight a co-person in the case who was also being sued. And that happened to be the hospital. It wasn't personal. I get it. But that, that was pretty demoralizing. But they didn't respond with banning VBACs. And there, I think honestly, it goes back to the economic credibility.

Jen Kamel: mm.

Dr. Chris Stroud: There are too many women coming here to have VBACs to suddenly say, "Nope, we're not going to do that anymore." But I think too, there was some trust and respect between probably our group and the hospital that said, "These are not reckless people that aren't concerned with safety. This is a bad outcome. This is why we have a process for this. Let's try to learn from it." There were some mistakes made

Jen Kamel: Yes.

Dr. Chris Stroud: that I think that we all learned from, but fortunately they didn't react in that sort of knee jerk way that you describe. I've certainly seen that happen. Unfortunately, that happened to me with breech vaginal birth. That's probably another

Jen Kamel: Hmm.

Dr. Chris Stroud: podcast we could do.

Jen Kamel: Oh, absolutely. I would love to do that.

Dr. Chris Stroud: Yeah, breech vaginal birth. We lost that at both of the hospitals

Jen Kamel: Mm

Dr. Chris Stroud: in my community at about the same time.

Jen Kamel: mm

Dr. Chris Stroud: Except for the after coming twin, and twins, we can still do those, which is great. But sad that we lost the opportunity for a breech vaginal birth. But that didn't happen with VBAC fortunately.

Processing Trauma After a Uterine Rupture & Fetal Demise

Jen Kamel: So when you experience that uterine rupture, did you consider that a traumatic experience for you personally? How did you process that trauma so it wasn't brought with you in future clients?

Dr. Chris Stroud: I don't know that I did. I probably have brought them. It's been about maybe seven years since that case and I probably did bring that with me a little bit. I don't know that I couldn't, it was very traumatic.

I've spent some time talking with physician groups about what it is like to be involved in litigation. It's, it's hard. It strikes at the essence of who you think you are. Whether that's right or wrong, it still does that.

I knew the patient very well and felt like we had a very good relationship. So that was tough. Her baby died. I mean, that was awful. It was tough. Her marriage ended up struggling as a result of that. I mean, it's just an awful, awful thing. There's just no good, no nice way that you can describe that. So it was very traumatic.

I think what helped me was in the course of going through litigation like that, one of the many things that you do is you dive into layer after layer after layer of every moment of care that happened. If you made a mistake as a physician along the way, it becomes very clear that you made a mistake. Well, you're never going to do that again. You're going to learn from that. But if you realize, "I didn't make any mistakes," this was a bad outcome that was unavoidable

Jen Kamel: yeah.

Dr. Chris Stroud: maybe the catastrophe could have been handled differently, but it wasn't handled incorrectly. If you're fortunate enough to have that epiphany, I think that's very saving and very, very helpful for the physician.

But you could learn that you did something wrong. That's part of being a physician, at least it should be, is to say, "I could have done better there. I didn't do the best thing that I could have done there." If that deserves an apology, then one should be made. And you should learn from that and try to teach others from that and move on.

And when I say move on, I'm not suggesting a callous disregard for the outcome. But I'm saying, "Don't quit. Don't stop doing VBACs. Don't run the other direction. Learn from it. Be better and take that forward with you and try to help other people be better as a result." I do think I've done that as a result of that bad outcome, but it's very hard and it certainly left its mark on me.

Jen Kamel: Yeah, so one of the reasons why physicians don't attend VBAC,

Dr. Chris Stroud: I hate to interrupt you, but I

Jen Kamel: nope.

Dr. Chris Stroud: and I, it's probably obvious, but I feel compelled to say, not for an instant am I not reminded that it left its mark on the mother

Jen Kamel: Yes.

Dr. Chris Stroud: who lost her baby and lost her, lost her uterus and the ability to have more children. When I'm saying it left its mark on me, I don't want to engender pity for me, but I'm answering truthfully. But we have to remember how horrible it was for her. It is horrible all around.

Jen Kamel: Yeah. Yeah.

Dr. Chris Stroud: Yeah.

Jen Kamel: Thank you for adding that. I did not get that feeling when you said that at all. But I think it just shows your integrity and your honesty and your vulnerability, which while you were sharing that, I just sat there and that's what I was thinking.

And to be able to model that sort of way of being for other clinicians, for other physicians, to be able to embrace all of the complexity of what being a human means, and integrate that with being an obstetrician. That's a really special thing, and I just want to acknowledge you for that because that's not something that I see often in life in general, and especially among physicians who I feel often feel like they need to have, um, I mean, of course you need to have this professional separation, this professional line, but it almost sometimes blurs the ability to even see the human on the other side of that line.

Dr. Chris Stroud: That's too bad.

On Advocating for His Patients

Jen Kamel: So, so many physicians struggle with the political nature of VBAC, and what I mean by that is navigating hospital policy that requires this or requires that. How do you navigate that and how would you advise your colleagues around the country in terms of best practices in, for negotiation, say.

Dr. Chris Stroud: Yeah. First and foremost, that's my job, right? I am the physician and my patient needs this, so it's my job to get it for her. And if my hospital doesn't like that, it's my job to advocate for my patient. I don't have a patient- hospital relationship or a physician- hospital relationship. I have a physician- patient relationship and I have a duty to her. And part of that duty may be, in this particular case, to advocate.

And that's not a new concept. That's been around since the beginning of the practice of medicine. So it's not an option. I have to do that. And one should feel that compulsion, I think. It's just necessary work that needs to be done. I think most physicians make that connection if maybe they were thinking about a public health issue or an infectious disease or a pandemic or something like that. But the principles are exactly the same. I'm advocating for my patient.

And then when it comes to VBAC, I think we're also advocating in a public health way for the population. So sometimes we will say to a patient, "I'm sorry, but I can't take you on as a VBAC patient. I just can't because I think, while I probably would, in the perfect world, this isn't a perfect world, and if I go down and lose VBAC, this entire community loses VBAC, and the risk is just too great. And I'm sorry, but I'm going to have to shift from being your advocate to being a community advocate, and that's uncomfortable.

Jen Kamel: Hmm. Yeah.

Dr. Chris Stroud: But for an important topic like VBAC we have to, but the advocacy with the hospital is just part of our job. And you can't give up. You just have to keep doing it and keep doing it because it's the right thing to do.

Advice: Reversing VBAC Bans

Jen Kamel: Yeah, yeah. So do you have any advice for physicians or other clinicians, healthcare providers who want to reverse a VBAC ban at their facility?

Dr. Chris Stroud: Yeah. I haven't had to fight that fight, thank goodness. But you know, maybe it's a little idealistic of me, but I still believe at my ripe old age that few things can't be accomplished sitting down and talking. And just start these conversations with administration in a calm and leveled way. Sometimes, not you, I don't mean this for a minute, but sometimes it's very common, I've seen it in some of my nursing colleagues where they'll come to a discussion about a topic and they'll have a stack of papers and, you know, they'll essentially want to say, "Doctor, I've looked through every one of these articles and it's conclusive that you're an idiot."

So, you know, okay, is not going to work. We're not going to get anywhere like that. But to try to have a conversation that says, you know, "I'm not a rebel, I'm not a cowboy. I'm not unconcerned with safety. I believe what I believe about VBAC because of the data and the research." Maybe we could start walking through some of that then just try to understand the other person. If I can understand why they're so opposed to VBAC and try to put myself in that position, I may be able to help them through whatever those obstacles are. But it's going to take patience. It's going to take perseverance. But mostly it's just going to take a willingness to be vulnerable, to explain things, to explain your position, and try to understand other people's positions.

Four Pillars of VBAC Success

Jen Kamel: Yeah. You've talked before about the four pillars of success for parents planning VBACs. Can you tell us more what those four pillars are?

Dr. Chris Stroud: Yeah. The big four, I like to say aggressive education. That's An odd phrase, but aggressive education. First thing on that list, VBACfacts.com. I think every viewer should know what that means, right? But the reason I say that is at some point along your VBAC journey, the naysayers are going to start. It might be your relatives, it might be your coworkers, the nurses, maybe your provider, but the voices are going to start, and you need to be very well versed on the facts, not the emotion, but the facts. So when someone says, "oh, well you have gestational diabetes, VBAC is off." Actually, that's not true, and you need to know that because you've educated yourself on that. So aggressive education is a big one.

The next aggressive is I would say, aggressive fitness. And that probably is a bit of a misnomer in a way, but I like to say there, you know, just think about the difference between success and failure might be a millimeter in diameter. You can't change your bones. You can't change your muscles. You might be able to change the fat. So don't go gain a hundred pounds if you're trying to do everything possible for a VBAC.

At the same time, get into the best health you can be. Labor is an athletic event. It is asking more of your body than you'll ever ask. You wouldn't train for a marathon by gaining a hundred pounds. Don't train for labor by doing that. So be fit. Exercise, be at your best fitness, and manage your weight gain aggressively in a healthy way. But be aggressive about that.

Then the other thing I would toss into that, is in most cases, a chiropractic provider who loves pregnancy, and you say to them, "make me limber because millimeters make a difference". Say to them, "I want a VBAC, I want to be successful." And if you meet a chiropractic professional that is comfortable in that space, you'll know it immediately. They'll smile and say, have I got the program for you? Those are two big pillars.

The third one is, you and I touched on it, find the right group. You've got to

Jen Kamel: Hmm.

Dr. Chris Stroud: find a provider group that's going to support your desires for VBAC that are passionate about it, not casual.

Jen Kamel: Yeah.

Dr. Chris Stroud: And then the fourth of the four pillars, I would say avoid induction.

Jen Kamel: Hmm.

Dr. Chris Stroud: What I mean by that, non indicated induction, no elective inductions. And so if you need to be induced because you have preeclampsia or gestational hypertension or the baby's not growing or something like that, that's different. But because you're sick of being pregnant and your mother-in-law thinks something is wrong because you're 41 weeks, that is not a reason to be induced and that may very well cost you your VBAC.

Parents: Most Important Thing for Them to Consider

Jen Kamel: Yeah, yeah. What is the most important thing for parents considering VBAC to know?

Dr. Chris Stroud: Um, that's a good question. Or a hard question anyway. I would answer that by saying understand what motivates you.

Jen Kamel: Hmm.

Dr. Chris Stroud: And what I mean by that is, are you doing VBAC because you don't want a scar on your belly? I just made that up. But what I'm trying to say is don't choose VBAC or repeat C-section for a reason that isn't valid, that isn't factual, like choosing repeat C-section because it's the safest. So if you say to yourself, "I want to do VBAC because it's the safest," I don't know that I can prove that it is. So ask yourself, why do you think you want VBAC? And be clear about that and honest about that with yourself because that's going to shade all of your other decisions as you travel through the pregnancy journey.

A Message for Physicians Who Don't Attend VBAC

Jen Kamel: Yeah. How would you counsel physicians who don't attend VBAC?

Dr. Chris Stroud: Start, you know, start. I mean, I think I could almost make a bioethical moral argument that what you're doing is wrong. I mean, if you're telling a patient that a repeat c-section is safer, you are factually incorrect, and so that is unethical. You are, you are saying something that is not true. You and I, Jen, can prove that beyond the reasonable doubt with data. So if that's what you're doing, you are really in a bad place. So you need to change that.

If you don't do VBAC, because it just scares you, just be honest and say, "I don't do VBAC. It scares me." But then say to the patient, "But this guy over here does, and so you shouldn't see me. If VBAC is important to you, then go somewhere else."

You know, some surgeons don't do robotic hysterectomies, but don't try to tell the patient you shouldn't have one. Say, "I don't do them." Be honest. And then pass them on to someone who does, or at least have them have that discussion. So ask yourself why you're not doing VBAC and then be honest about it with yourself and with your patients. And if you're that first person, you really need to make a change.

Message to Hospital Administrators with VBAC Bans

Jen Kamel: Yeah. Yeah. What is your message to hospital administrators who uphold VBAC bans?

Dr. Chris Stroud: Stop, you know, the same thing that, that's wrong. That's bad healthcare. You're robbing someone not only of a choice, you're robbing them of a valid choice that the overwhelming data supports that is a valid, reasonable, sensical thing to do, right? And so that's wrong. I think that has a moral component to it, that, that is bad medicine. Stop doing that.

And then for all of the other reasons that you and I talked about, if they're really interested in what's best for their population, they need to think about that a lot harder now. And if they're avoiding or banning VBAC because their legal team and their board says, you can't do it, then okay, say that and be honest about it. And tell the community that you should be transparent about that. So the patients could choose another facility perhaps, if that's even an option in your community.

But especially if you're the only hospital provider in a community, and you take that ban, that has horrible implications for your community. And most hospitals would at least give lip service to, they're there for the community. Well, if that's the case, you need to fully understand the full public health ramifications of that decision.

Jen Kamel: Yes. Here, here.

Dr. Chris Stroud: Yeah.

Jen Kamel: Well, thank you so much for being with us today. Thank you for sharing your experience, your perspective, your wisdom, your humanity. I really appreciate it.

Dr. Chris Stroud: Well, thank you. It's been an honor and thank you for your work. I don't think I would be sitting here, I'm not exaggerating, if it weren't for VBAC Facts® because so many years I just read and read and read. And I still do. If I'm going to go give a talk, the first thing I do, I go to two places. I go to Evidence Based Birth® and I go to VBACfacts.com. Both amazing websites for all of you viewers. If you haven't spent time there, you need to be and you need to support, when I say you, I mean viewers, need to support Jen, your work, because you're the voice in the wilderness. Without your work, there's not a voice. So keep it up and you deserve all the support you could possibly get.

How to Work with Dr. Stroud

Jen Kamel: Thank you so much. How can people learn more about you, your work, hire you to be their provider?

Dr. Chris Stroud: We take care of people from long distances, but there's a limit to that from a practical standpoint.

Jen Kamel: Okay.

Dr. Chris Stroud: We also have a huge telemedicine practice, and I find, I do a lot of VBAC telemedicine consults where

Jen Kamel: Ah,

Dr. Chris Stroud: patients have been told something, they're just not sure about it. Maybe an obstetrician said, "You should never have a baby again. You had a uterine window." You and I could do a whole episode just on that.

Jen Kamel: Yes.

Dr. Chris Stroud: So we'll get their operative notes, and then we'll schedule an hour telemedicine consult, just to talk that through. That's certainly something that we can do.

Dr. Stroud, D-R-S-T-R-O-U d@myfmcc.com. Feel free to email me directly. That goes right to me. Our website is myfmcc.com. But we do a lot of telemedicine. We'd be happy to try to at least advise you and to help you know the right questions to ask your providers based on a review maybe of your medical records.

Jen Kamel: And are you able to offer telemedicine to people outside of Indiana? How does that work?

Dr. Chris Stroud: We do.

Jen Kamel: Okay.

Dr. Chris Stroud: Physicians should be licensed in the state of the patient where the patient lives, and so we have to abide by that. So we're not licensed in all 50 states,

Jen Kamel: Okay.

Dr. Chris Stroud: but a lot of them between all of our physicians, usually we can work something out.

Jen Kamel: Well, thank you so much again. Thank you for joining us, and until next time, I'm Jen Kamel, founder of VBAC Facts®. And don't forget what we're about. Since 2007, our focus has been to provide accurate and objective information on vaginal birth after cesarean and repeat cesarean to parents, professionals, policy makers, and the court so all decisions can be informed, ethical, and just. I'll see you again in two weeks. Until then, take care. Bye.