The Commission for the Accreditation of Birth Centers

Policy Regarding Vaginal Birth after
Cesarean Section in Birth Centers

This past November's issue of the Journal of Obstetrics and Gynecology published the results of the multicenter multiyear research sponsored by the National Association of Childbearing Centers (NACC). This research was designed to assess the safety of vaginal birth after c/section in a birth center setting. The original hope and hypothesis was that this research would support the safety of VBAC in a birth center setting. The results did not support the original hypothesis. The results showed that the rate of adverse serious neonatal outcomes were greater in women attempting VBAC than in the low risk women originally studied for the research on safety of birth in a birth center.

During the ten years of the NACC research on VBACs the CABC allowed birth centers to be accredited and do VBAC under the research Standard 9. With the publication of NACC's research the CABC had to reassess it's position on VBAC. This spring the commissioners met and reviewed not only the NACC research but also other research related to VBAC and the position of other major organizations such as ACOG, MANA, and ACNM related to VBAC. After much discussion it became clear that VBAC carries more risk than that experienced by the low risk women studied in the National Birth Center Study. There does not seem to be any continuing support for the hypothesis that a VBAC labor is as low risk as a labor without a prior uterine incision. The basic premise of birth centers is that they are the place for the care of low risk mothers and neonates. VBAC does not fall into that premise at this point in time.