Choice Matters

This chapter analyzes the effect of reproductive regimes on VBAC (vaginal birth after cesarean), midwife-attended birth, and homebirth. Many hospitals have formal or de facto bans on VBAC, even though 60–80% of women who attempt a VBAC will have a successful vaginal birth. Providers have increasingly restricted VBAC since July 1999, but forcing a woman to have major abdominal surgery (or any medical procedure) without her consent is a violation of her civil rights. An analysis of how state-level reproductive rights laws affected the odds of VBAC reveals that VBAC is less likely in fetus-centered regimes with restrictive abortion laws, especially after June 1999. Midwife-attended birth and out-of-hospital birth are also less likely in fetus-centered regimes. Taken together, these results point in the same direction: fetus-centered reproductive rights regimes constrain pregnant women’s ability to make reproductive decisions about birth, not just abortion.