The evidence shows that vaginal birth after cesarean (VBAC) is a safe option for many families, but it's still frequently inaccessible to them. In this episode, Dr. Rebecca Dekker and Dr. Nicholas Rubashkin discuss the systemic barriers that limit families' opportunities to choose a VBAC. They explore how hospital policies, outdated guidelines, and clinical tools like the VBAC calculator have shaped who's a "good candidate" and who is not.

Dr. Rubashkin also shares insights from his research on inequities in maternity care, including how race-adjusted algorithms reinforce disparities, why the "immediately available" standard still impacts hospital policies today, and how geography, provider practices, and induction policies can influence VBAC access. Plus, hear evidence-based strategies for advocating for a VBAC, including how to evaluate providers and interpret VBAC rates.

(01:36) Dr. Rubashkin's background and path into obstetrics
(08:32) Major barriers to VBAC access in the U.S.
(11:37) The "immediately available" standard explained
(14:38) Misconceptions about emergency cesarean availability
(16:58) Ethical and legal implications of VBAC restrictions
(18:02) Institutional barriers
(20:17) The VBAC calculator and how it influenced access
(26:12) Racism, bias, and interpretation of VBAC data
(30:02) Induction and VBAC: evidence vs. practice
(36:17) What informed consent for VBAC should include
(37:18) Identifying supportive vs. reluctant providers

Resources

ACOG's VBAC guidelines and recommendations: acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery

Human Rights in Childbirth: humanrightsinchildbirth.org/

UCSF's Better Birth Research Initiative: betterbirth.ucsf.edu/

International Cesarean Awareness Network: ican-online.org/

For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

EBB 396 - Inequities in VBAC Access with Dr. Nicholas Rubashkin, MD, PhD

Evidence Based Birth®