Limited Access to Vaginal Birth After C-Section in U.S. Counties

Recent research from the University of Massachusetts Amherst reveals that only about 16% of U.S. counties offered pregnant individuals the option to attempt vaginal birth after a previous cesarean section (VBAC) between 2016 and 2021. This limited access underscores significant geographic disparities across the country. The study analyzed birth certificate data nationwide, finding that counties with higher availability of obstetric services, particularly in the Northeast and Western regions, had better access. Conversely, large portions of the South and Midwest regions had extremely limited options.

Despite guidelines from the American College of Obstetricians and Gynecologists (ACOG) endorsing VBAC as a reasonable choice for most women with a prior cesarean, access remains low. Factors contributing to this include hospitals lacking specialized staff, inadequate immediate access to surgical intervention, and ongoing concerns about clinical liability. Interestingly, when considering only counties with hospitals that provide obstetric services, access increased to 30%, but still less than a third of these counties offered VBAC options.

The research also noted that while national VBAC rates increased from 12.4% in 2016 to 14.2% in 2021, the proportion of counties where VBAC is available did not grow correspondingly. This suggests that VBAC gains are occurring mainly in areas where it was already an option, rather than expanding to new regions.

Furthermore, the challenges are compounded by historical shifts in clinical guidelines and provider comfort levels, largely influenced by concerns over liability in cases of adverse outcomes. Ensuring broader access to VBAC could lead to benefits such as shorter recovery times, fewer infections, and reduced risks in future pregnancies.

This study highlights the urgent need for policy and institutional changes to improve access to vaginal birth after cesarean, ultimately supporting better maternal health outcomes across the United States.