Pregnant women who want to deliver a child vaginally after a previous cesarean section will face more limited options as hospitals across the region reconsider the procedure amid safety and insurance concerns.

In Redmond, hospital officials and physicians recently decided to no longer offer vaginal births after cesarean sections, known in medical terminology as VBACs, said Ruth Brumagin, manager of the birth and family center at Central Oregon Community Hospital.

”A lot of the literature out there is saying be very wary and careful in doing VBACs,” Brumagin said. ”Our physicians made the decision with information from their insurance company.”

Brumagin said the decision was also based on the low number of VBACs – seven in 2002 – delivered at COCH.

VBACs present a small but significant risk of uterine rupture that could threaten both baby and mother, according to the American College of Obstetricians and Gynecologists, or ACOG. The chance of a previous c-section scar tearing during labor is less than 1 percent for women who are not given medication to speed up delivery. The risk rises to about 2.5 percent among women who are given the medication, according to ACOG.

At St. Charles Medical Center in Bend, women can still have a VBAC but they will now be required to go through a more involved, informed-consent process with their physicians to evaluate whether they are a safe candidate for the procedure, said Marj Gold, leader and manager of the hospital’s Family Birthing Center.

Gold said hospitals like St. Charles and Central Oregon Community Hospital (COCH) recently reviewed their procedures to make sure they follow guidelines set by ACOG.

”There is a movement to make sure our customers are well-informed of the risks and benefits,” Gold said.

VBACs have been performed safely here in the past, Gold said. Last year, St. Charles had 29 successful VBAC deliveries and 17 cases of attempted VBACs that ended up in repeat c-sections because labor did not progress.

When done successfully, VBACs can save women from major surgery and longer, more expensive hospital stays.

But problems that have occurred in other parts of the country have raised red flags about VBACs, Gold said. Liability concerns also has played a role in people taking another look at the procedure.

The insurance company that covers both St. Charles and COCH, Farmers Insurance Professional Liability in Salem, asks hospitals to follow the ACOG guidelines for the procedures, and it’s up to the professionals to determine how they can follow them, said spokeswoman Petra Berger.

The insurance company sticks to guidelines from reputable professional organizations and does not impose their own, she said.

Because of the risk of uterine rupture, ACOG advises that VBACs only be attempted in hospitals equipped to respond to emergencies and have physicians immediately available to perform emergency c-sections.

The ACOG guidelines have been in effect since 1999. But a new interpretation of the guidelines by insurance companies has caused doctors and hospitals to reconsider the procedure, said Dr. Jonathan Sidell, an obstetrician and gynecologist practicing in Madras.

Sidell said the insurance companies’ interpretation of having physicians immediately available means having physicians in-house who could perform emergency c-sections. Sidell lives a block from the hospital and he could be there within minutes to provide immediate help. But the hospital is still required to have someone at the facility.

”The debate comes down to what’s immediately available,’” he said.

Still, Sidell said the medical community in Madras is committed to continuing to offer VBACs and will staff the hospital as required for a three-month trial basis.

”It’s tough,” he said. ”It gets to be pretty expensive and time-consuming.”

Rebecca Merritt can be reached at 541-383-0348 or at rmerritt@bendbulletin.com.