The contractions began just after midnight on Sept. 7. Gwen Cornell got out of bed, wondering if she should wake her husband, Ira. He was exhausted after working all day in his business as an electrical contractor.

She was seized with another contraction. Had it been only 10 minutes?

She let Ira know she was in labor but encouraged him to get a little sleep first. It would be awhile yet before they had to pack their two toddlers in the motor home and drive from their Oak View house to Los Robles Regional Medical Center in Thousand Oaks.

Gwen, 31, planned the 40-mile trip to Los Robles because it is the only hospital in Ventura County that will accommodate a vaginal birth after Caesarean — or VBAC. Her obstetrician, Dr. Thomas Vangeem, is one of only three at Los Robles who will do VBAC deliveries.

"The decision is made by the physician and the patient," said Medical Center spokeswoman Kris Carraway-Bowman.

Many physicians feel there are too many risks involved for women who want a vaginal birth after having given birth via Caesarean section. Caesarean, or C-section, is the process of cutting into the uterus to remove the baby. One of the biggest concerns about a VBAC delivery, according to the American College of Obstetrics and Gynecology, is that the uterus will tear at the incision site, although VBAC supporters argue that the risks are low.

Mothers like Gwen Cornell find themselves caught between the medical and insurance communities committed to safe, cost-effective practices and their own instincts toward natural childbirth.

It is a complex issue that a local group, the Birth Action Coalition, hopes to demystify a bit during a public event next weekend in Ventura; the one-day panel and fair — featuring a scheduled appearance by Ricki Lake, producer of the new documentary "The Business of Being Born" — is to familiarize the public with its efforts to get more hospitals to allow VBACs, one of many items on its agenda.

"We are helping to empower and educate women and their families to find care providers who are supportive of what they want in childbirth, whether that's a natural birth or planned Caesarean," said BAC coordinator Kimberly Rivers of Piru.

The community activist group wants Ventura County's other six hospitals to consider allowing VBACs.

"A lot of physicians feel it's dangerous," explained Simi Valley Hospital spokeswoman Alicia Gonzalez.

"I think vaginal births after Caesarean should be available to women," said Los Robles gynecologist Ronald De La Pena. "It should require scrutiny by the physician."

Gwen, who is a member of BAC, said she believes the danger of VBACs is overstated. She and the other 150 or so BAC members want hospitals to understand the importance of giving women the option of delivering vaginally, even if they've had a previous C-section.

"I feel it's important because it's what I was made to do as a woman and a mother," Gwen said. "I have faith and confidence that I can do it. Once you've had a vaginal or natural birth, you're very empowered as a woman and a mother afterward."

Addy, Cali and Levi

Gwen's first child, Addy, was born May 14, 2004, at Community Memorial Hospital in Ventura. She was delivered via C-section because the doctor was concerned the baby's heart rate was slowing, Gwen said.

Gwen knew the risks, but she wanted her second child, Cali, to be born vaginally, with help from a licensed midwife. Gwen also wanted hospital support nearby in case there was a problem.

Her doctor saw to her prenatal care, but Gwen planned to start laboring with Cali in the couple's motor home, which they parked in the lot of a church near Los Robles.

Gwen would have help from a doula, which essentially is a nonmedical support person — a midwife — trained and licensed to assist in the birthing process.

Gwen wanted to labor as long as possible before entering the hospital.

"When you're in a hospital, they have more chance to interfere," she said, adding, "It's hard to relax when you've got lights and people walking in and out."

So, as soon as Gwen went into labor on June 2, 2006, the couple drove their RV to the church parking lot. There, Ira and the doula supported Gwen as she labored.

When the doula noted that delivery was near, Gwen was driven over to Los Robles.

"We basically walked in, put me in a gown and, 45 minutes later, I had my daughter," Gwen said.

The VBAC birth was successful, so, when Gwen learned she was pregnant with Levi, she wanted to deliver him the same way. Apparently, Levi had other plans.

A bumpy ride

Ira couldn't sleep in the early hours of Sept. 7. He could hear Gwen in the bathroom, exhaling hard through her contractions. It was time.

He dressed Addy and Cali and buckled them into their car seats in the back of the RV.

He stopped in Casitas Springs, when Gwen asked to go into the back of the RV. He helped her, then returned to the driver's seat and drove south on the 101 as his wife groaned behind him.

"We're passing Victoria (in Ventura) and I said, Do I need to pull over?' No! Just get there!'" Ira recalled.

"We're passing Rice (in Oxnard)," Ira recalled, "and I said, Do I need to pull over?' No! Just get there!'

"Then we get to Central," he said, "and I hear, PULL OVER!'"

He pulled off the road on the Central exit between Oxnard and Camarillo and put on the flashers. He grabbed towels. By the time he got back to his wife, Levi was crowning.

"Ira said, You need to stand up,'" Gwen said. "I did and he watched the baby turn one way, then the other, and then he basically caught my son. We rubbed his back and he started to cry."

The girls were introduced to their brother, then the family turned around and went home.

Gwen took the baby for a checkup with Vangeem three days later.

VBAC pros and cons

For 70 years, the dictum in obstetrical communities was, "Once a Caesarean, always a Caesarean." Caesarean deliveries reached a statistical high between 1970 and 1988, rising from 5 percent of all deliveries to 25 percent.

According to a series of guidelines co-written by ACOG board member Dr. Carolyn Zelop, the spike probably was a result of pressure on doctors to take the safest route possible if there were any pregnancy complications.

If a baby were upside-down, for example — in a breech position — the doctor was discouraged from delivering the baby vaginally.

Then, improvements in perinatal care began to change the dictum. In the late 1980s, the National Institutes of Health and ACOG began embracing the idea of VBACs.

According to an ACOG report, between 1989 and 1996, VBAC deliveries increased from less than 19 percent to more than 28 percent.

"We went through a period where people didn't understand there were any limitations and everybody was eligible for a VBAC," said Zelop, who is director of maternal fetal medicine and associate chairwoman of St. Francis Hospital and Medical Center in Hartford, Conn.

According to the report, some health insurance companies even pressured doctors to offer VBACs to unsuitable candidates, which resulted in well-publicized reports of uterine ruptures and other complications.

As a result, many hospitals stopped offering VBACs. The Caesarean delivery rate in the U.S. rose again, to an all-time high of 26.1 percent of all deliveries in 2002. In contrast, the VBAC rate has decreased by 55 percent to 12.6 percent of all deliveries.

The BAC, founded in Ventura County in February, wants to see that changed.

"We really want to show this is something the community thinks is important," said Rivers, explaining the event scheduled Saturday in Ventura's Mission Park. "There are so many moms in this community who want access to VBACs."

De La Pena said some doctors do want to offer VBACs and other services, but there are hoops to clear. De La Pena served as head of the OB/GYN department at Los Robles for four years, so he's had a lot of experience with hoops.

"It's an ongoing tug-of-war between what hospitals want to do and what doctors want to do in many areas," he said. "I have conversations like that on a regular basis."

"The problem here is that there are doctors practicing who are not going to get coverage from their insurance companies if they choose to do a VBAC," Zelop said.

She added that she believes the pendulum has swung too far the other way and VBACs have gotten a bad rap.

According to ACOG, uterine ruptures occur in 1 to 3.7 percent of cases, but Zelop's report stresses that there are many variables, including the type of C-section the mother had previously.

If a mother is a VBAC candidate, both Zelop and De La Pena agree it should never be attempted at home. "Home delivery is for pizza," De La Pena said. "Births should be in the hospital."