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TOPLINE:

Fewer than 16% of US counties between 2016 and 2021 were home to a hospital offering labor after cesarean (LAC) services or the planned attempt to deliver vaginally by a person who previously had a cesarean.

METHODOLOGY:

• While recent clinical guidelines encourage hospitals and clinicians to enable patients to undergo a vaginal birth even after a prior cesarean, researchers set out to find out the availability of these services using the proxy of labor after cesarean (LAC) delivery, which is associated with a decreased maternal morbidity and the risk of complications in future pregnancies.
• In this cross-sectional study, researchers examined hospitals that offered LAC services and the county in which the facility was located.
• This was determined by looking at county-level rates of LAC, vaginal births after cesarean, and prior cesarean births.

TAKEAWAY:

• Residents living in metropolitan counties had an access rate of 30.5% compared with 7.4% in metro-adjacent and 6.8% in metro-nonadjacent counties.
• In counties with only hospital-based obstetric services, 30.9% had access to LAC.
• Access to LAC did not vary across years, but regional differences were noted, with more prevalent access in the Northeast and West regions.

IN PRACTICE:

“Although the American College of Obstetricians and Gynecologists states is a reasonable option for many individuals with a prior cesarean delivery, many birthing people may not be able to access LAC due to a lack of local availability,” the authors of the study wrote.

SOURCE:

This study was led by Brittany L. Ranchoff, PhD, MPH, of the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston. It was published online on August 8, 2025, in JAMA Network Open.

LIMITATIONS:

The quality of items on birth certificates could potentially lead to misclassification when defining counties that offer LAC services. Despite the observed increases in the rates of vaginal birth after cesarean, the limited access to LAC suggested that these services may have become concentrated among fewer hospitals or clinicians.

DISCLOSURES:

This study did not report any specific funding. Two authors reported receiving grants or funding, while another author disclosed receiving contracts outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.