In 1999 (and again in 2004), ACOG released guidelines [pdf] stating that “VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available.” This standard has been widely blamed for the lack of VBAC availability in many parts of the United States, as many hospitals discouraged or stopped doing VBACs, and in some cases malpractice insurance companies refused to cover claims resulting from the procedure.
As Rita Rubin explained in a 2005 USA Today story on the issue, “Many hospitals have interpreted that [the 'immediately available' standard] to mean they must have an anesthesiologist and operating room standing by whenever a patient attempts a VBAC, a luxury they say they can’t afford. If they can’t meet the guidelines, they argue, they’re opening themselves up to lawsuits should mother or baby be injured during a VBAC attempt.”
What level of risk is acceptable, and who decides? Currently, hospitals, insurance companies, and plaintiff attorneys decide or strongly influence whether VBAC is an option. Instead, the patient should be allowed to make that choice after she has been informed of the facts and has been counseled by her physician thoroughly.
“Despite the reality of disparate resources, we should ‘find a way’ for those who want the option of VBAC,” Scott continues. “Reducing the number of primary cesareans deals with the problem where it originates.”