the following recommendation emerging from the nih vbac conference panel in march 2010, "we recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor." the u.s department of health and human services' healthy people 2020 initiative includes objectives to reduce the primary caesarean rate and to increase the vbac rate by at least 10% each. the american congress of obstetricians and gynecologists (acog) modified the guidelines on vaginal birth after previous caesarean delivery in 1999, 2004, and again in 2010. in 2004, this modification to the guideline included the addition of the following recommendation: because uterine rupture may be catastrophic, vbac should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care. in 2010, acog modified these guidelines again to express more encouragement of vbac, but maintained it should still be undertaken at facilities capable of emergency care, though patient autonomy in assuming increased levels of risk should be respected (acog practice bulletin number 115, august 2010). the recommendation for access to emergency care during trial of labor has, in some cases, had a major impact on the availability of vbacs to birthing mothers in the us. for example, a study of the change in frequency of vbac deliveries in california after the change in guidelines, published in 2006, found the vbac rate fell to 13.5% after the change, compared with 24% vbac rate before the change. the new recommendation has been interpreted by many hospitals as indicating a full surgical team must be standing by to perform a caesarean section for the full duration of a vbac woman's labor. hospitals that prohibit vbacs entirely are said to have a 'vbac ban'. in these situations, birthing mothers are forced to choose between having a repeat caesarean section, finding an alternate hospital in which to deliver their babies or attempting delivery outside the hospital setting. most recently, enhanced access to vbac has been recommended based on updated scientific data on the safety of vbac as compared to repeat caesarean section, including the following recommendation emerging from the nih vbac conference panel in march 2010, "we recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor." the u.s department of health and human services' healthy people 2020 initiative includes objectives to reduce the primary cesarean rate and to increase the vbac rate by at least 10% each. position statements acog recommends that obstetricians offer most women with one prior cesarean section with a low-transverse incision a trial of labor (tolac) and that obstetricians should discuss the risks and benefits of vbac with these patients. this vbac success calculator is a useful educational tool (noted by the us agency for healthcare research and quality) for clinicians who are discussing the risks and benefits of vbac with their patients.