At the March 2009 meeting of the WV Chapter of the ACNM much concern was expressed by midwives all over WV regarding poor availability of vaginal birth after cesarean (VBAC).  It seems that many women who have a history of cesarean birth are not sufficiently informed that vaginal birth is often a better option than surgical birth, and in cases where women request a VBAC, many are unable to find a hospital or health care provider willing to offer it.  

West Virginia mothers are not alone.  In 2005, forty-five percent of women responding to the national Listening to Mothers II Survey would have preferred to give birth vaginally, but could not find a caregiver (45 percent) or hospital (23 percent) that “allowed” it.

Healthy People 2010 set an objective to “Reduce cesarean births among low-risk (full term, singleton, vertex presentation) women” by 2010.  The target national percentage is 15%.  According to PeriStats – March of Dimes, the overall cesarean rate in WV (ranking fifth in the nation) climbed to an all-time high of 35.2% in 2006.  The primary cesarean rates in WV also rose from 16.1% in 1996 to 24.7% in 2006.  During the same interval, 1996 to 2006, the WV VBAC rate plummeted from 23.9% to a dismal 4.9%. 

In light of the facts that over one third of pregnant WV women experience surgical birth, and the WV cesarean rate is more than double the HP 2010 goal, those present at our meeting voted to pursue a project, led by the ACNM Chapter, to study VBAC in WV. Our goals are to increase access to VBAC services, to encourage more women to birth vaginally, and simultaneously to decrease the overall cesarean rate for the women of WV.

The WV CNM VBAC Study Group has since held biweekly conference calls to further investigate VBAC issues within the state.  A survey was sent to Chapter members.  Respondents representing approximately 72% of WV midwifery practices answered these questions:  Are women in your community able to have a VBAC?   Yes (38%), No (62%) and If VBACs are not available in your community, what are the reasons?  Liability issues (46%), staffing issues (38%), hospital policy (31%), limited or no physician coverage (31%), anesthesia coverage (31%), lack of information about VBAC (23%), consumer preference for repeat cesarean (7%).  Other comments (2): “Physicians not committed to pursuing this” and “Our hospital will close the L&D unit on 7/31/09”

*  Current areas of research and review:  NNEPQIN (Northern New England Perinatal Quality Improvement Network), ACNM’s REDUCE Campaign (Research and Education to Reduce Unnecessary Cesareans), ACOG Practice Bulletins, ICAN, March of Dimes, the Milbank Report.

*  Resource gathering (on-going):  Hospital administrators, hospital risk managers, insurance representatives (liability and commercial health insurance), community leaders, pregnant women and their families, physicians.

For more information about the WV-ACNM VBAC Study group, please contact Chapter Chair, Lyn Haley.