Vaginal Birth Under Special Circumstances

Last week Tarrant County Birth Network and ICAN presented a meeting on vaginal birth after special scar cesarean, featuring Dr. Frederick Cummings and Katie Grannan Perez, LM, CPM. 


Dr. Cummings is the go-to guy in DFW if you have a special circumstance and want a vaginal birth. When everyone else says no, he says yes. Dr. Cummings catches babies at Denton Presbyterian hospital, and limits his case load to only those families that won’t be supported in their goal of a vaginal birth anywhere else. Vaginal births after multiple cesareans (VBAMCs), after special scars, breech vaginal birth, and twin vaginal births are all welcomed by Dr. Cummings.

Katie Grannan Perez is a three time cesarean mom, one with an inverted T incision, and had a successful hospital VBA3C with Dr. Cummings. She was a doula and is now a licensed homebirth midwife and self-proclaimed VBAC geek who loves reading and studying literature about VBACs. She also loves helping moms achieve this goal safely. Katie is also a founding board member of Special Scars~Special Women ( ), a group that is committed to supporting women who have had special scar cesareans.

The Dallas Fort Worth area is very luck to have these two providers, and I know I was not the only one who felt inspired by their talk and the discussion after. Here are some highlights-


Question- why are doctors telling women they can’t VBAC, that their risk is too high, that their uterus will rupture?

“Because they will say anything to prevent you from pursuing a vaginal birth. Very few doctors want to do VBACs, because it takes time, and the liability goes up. But if the Vegas odds were 99.90% to win, you’d bet every OB in the country would put money on that. But then you take 0.07% rate of uterine rupture and they won’t touch it.”

Dr. Cummings was trying to reframe the statistics and the way we look at them. Uterine rupture is most people’s biggest concern with VBAC, and the rate is commonly cited at around 0.07%. He also looked at uterine rupture like any of the other potential labor or birth complications- something to be watched for and fixed when it comes up. He conveyed two stories of uterine rupture, neither of which were catastrophic to baby or mom. They may be more accurately described as dehiscence. He described them as holes or tears in the uterus, one that required repair and one that didn’t. It’s commonly misunderstood that the rate quoted to those planning a VBAC is the rate at which catastrophic ruptures occur, but even of the small percentage only 6% are catastrophic. More info on this here.

Dr. Cummings on his tough love, no fear approach-

“My office is a no fear zone. We don’t do fear when you’re in labor; depend upon your God, depend upon yourself, your doula, your partner, your doctor.”

“There’s no magic about what I do or how I feel about it, women have their babies.”


Katie Grannan Perez, LM, CPM on Special Scars Special Women:

“Our group doesn’t exist to promote one birth over another but to offer support to women with special scars.”

Katie also shared some statistics from her group – 64 women VBAC’ed with inverted T scars.


With everything Dr. Cummings does to support women having vaginal births, I asked why he does what he does-

“Because when I graduated from medical school I signed up to be an OB.”

dr cummings vbac doula

Planning a VBAC, breech delivery, or twin vaginal birth? Hire a doula! Contact me to learn more.


-VBAC – Twins – Breech – Natural Birth – Fort Worth – Dallas – Denton – Doula –


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