Brittany Ranchoff, PhD, MPH, highlights limited labor after cesarean access

A recent study led by Brittany L. Ranchoff, PhD, MPH, Research Fellow at the Harvard Pilgrim Health Care Institute and Harvard Medical School, investigated access to labor after cesarean (LAC) across US counties using birth certificate data from 2016 to 2021.

The study defined access as the presence of at least 1 hospital in a county offering vaginal birth after cesarean (VBAC) services. Findings revealed that only 15.9% of US counties had LAC access during the study period, with availability stable over time. Metropolitan counties were more likely to provide these services than non-metro areas.

Regionally, Northeast and Western counties had higher proportions of hospitals offering VBAC than those in the South and Midwest. In a subgroup analysis focusing on counties with hospitals offering obstetric services, only 30.9% provided LAC access, again showing no significant change across years.

Ranchoff emphasized the significance of these findings: despite modest increases in national VBAC rates between 2011 and 2021, access has not expanded geographically. Instead, LAC appears concentrated in a smaller group of hospitals and providers. This confirms reported challenges that many birthing people face in securing VBAC opportunities. With fewer than 1 in 6 counties offering access, the majority of individuals with prior cesareans lack meaningful choice in delivery method for subsequent pregnancies.

Expanding LAC is crucial for improving maternal health outcomes and patient autonomy. The United States maintains a persistently high cesarean delivery rate, which increases risks for complications in future pregnancies, including placenta previa accreta, maternal morbidity, and mortality. By broadening VBAC access, health care systems can help reduce repeat cesarean rates, improve safety, and preserve pregnant individuals’ ability to choose their mode of delivery.

For clinicians, Ranchoff advised advocating for hospital policy changes that encourage VBAC. She acknowledged that many hospitals and providers avoid offering LAC because of liability concerns, outdated clinical practices, and the convenience of scheduling repeat cesareans. However, the American College of Obstetricians and Gynecologists (ACOG) has long recognized VBAC as a reasonable option for most patients with a prior cesarean.

Ranchoff suggested clinicians engage in dialogue with hospitals about updating policies, emphasizing that VBAC can provide better outcomes for many patients. Overall, the study highlights the limited and uneven access to VBAC services across the United States and underscores the need for systemic changes to expand options, improve equity, and enhance obstetric care.

No relevant disclosures.

References

1. Access to vaginal labor after C-section is limited to some 16% of U.S. counties. University of Massachusetts Amherst. August 26, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1095975.
2. Ranchoff BL, Geissler KH, Goff SL, Bertone-Johnson ER, Paterno MT, Attanasio LB. Trends in labor after cesarean delivery access in the US. JAMA Netw Open. 2025;8(8):e2526224. doi:10.1001/jamanetworkopen.2025.26224