Missouri Hospital Restricts Midwife-Led VBACs
What happened
The Mercy hospital system in Missouri has changed its policy to exclude midwives from participating in high-risk vaginal birth after cesarean (VBAC) deliveries. The new rule restricts midwifery-led care for patients with prior cesareans deemed high-risk, forcing some to find new providers mid-pregnancy.
Why it matters
- The risk of uterine rupture during a trial of labor after cesarean (TOLAC) for a patient with one prior low transverse uterine incision is between 0.2% and 1.5%. This rare but serious complication is a central factor in hospital policy-making for VBACs. - Studies have shown that midwife-led care can increase the likelihood of a successful VBAC. One study found that when a hospital switched to a midwife-led model, the percentage of women who achieved a VBAC increased from 47% to 61%. - In Missouri, Certified Nurse-Midwives (CNMs) are authorized to provide a wide range of services, including prenatal care, delivery, and postpartum care. However, state law requires CNMs to have a collaborative practice agreement with a physician. - The overall success rate for women attempting a VBAC is between 60% and 80%. Factors that increase the likelihood of success include having had a previous vaginal birth and going into labor spontaneously. - Mercy Hospital St. Louis operates a Midwifery-Led Birthing Center, which has reported a VBAC success rate of 84%, significantly higher than the national average. This center is designed to be a home-like environment with low interventions. - A successful VBAC is associated with several benefits compared to a repeat cesarean section, including a shorter hospital stay, lower risk of infection, and less blood loss. - For individuals planning larger families, a successful VBAC can help them avoid the risks associated with multiple cesarean sections, such as an increased risk of placental problems in subsequent pregnancies. - Many hospitals have restrictive VBAC policies or do not offer them at all, which can be a barrier for patients seeking this option. Hospital policies often require the immediate availability of a physician and anesthesia in case an emergency C-section is needed.
Key numbers
- - The risk of uterine rupture during a trial of labor after cesarean (TOLAC) for a patient with one prior low transverse uterine incision is between 0.2% and 1.5%.
- One study found that when a hospital switched to a midwife-led model, the percentage of women who achieved a VBAC increased from 47% to 61%.
- The overall success rate for women attempting a VBAC is between 60% and 80%.
- Louis operates a Midwifery-Led Birthing Center, which has reported a VBAC success rate of 84%, significantly higher than the national average.
Quick answers
What happened in Missouri Hospital Restricts Midwife-Led VBACs?
The Mercy hospital system in Missouri has changed its policy to exclude midwives from participating in high-risk vaginal birth after cesarean (VBAC) deliveries. The new rule restricts midwifery-led care for patients with prior cesareans deemed high-risk, forcing some to find new providers mid-pregnancy.
Why does Missouri Hospital Restricts Midwife-Led VBACs matter?
The risk of uterine rupture during a trial of labor after cesarean (TOLAC) for a patient with one prior low transverse uterine incision is between 0.2% and 1.5%. This rare but serious complication is a central factor in hospital policy-making for VBACs. Studies have shown that midwife-led care can increase the likelihood of a successful VBAC. One study found that when a hospital switched to a midwife-led model, the percentage of women who achieved a VBAC increased from 47% to 61%. In Missouri, Certified Nurse-Midwives (CNMs) are authorized to provide a wide range of services, including prenatal care, delivery, and postpartum care. However, state law requires CNMs to have a collaborative practice agreement with a physician. The overall success rate for women attempting a VBAC is between 60% and 80%. Factors that increase the likelihood of success include having had a previous vaginal birth and going into labor spontaneously. Mercy Hospital St. Louis operates a Midwifery-Led Birthing Center, which has reported a VBAC success rate of 84%, significantly higher than the national average. This center is designed to be a home-like environment with low interventions. A successful VBAC is associated with several benefits compared to a repeat cesarean section, including a shorter hospital stay, lower risk of infection, and less blood loss. For individuals planning larger families, a successful VBAC can help them avoid the risks associated with multiple cesarean sections, such as an increased risk of placental problems in subsequent pregnancies. Many hospitals have restrictive VBAC policies or do not offer them at all, which can be a barrier for patients seeking this option. Hospital policies often require the immediate availability of a physician and anesthesia in case an emergency C-section is needed.
