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.
- 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.
