I was under the impression, at first, that this was a article written as a joke, until I learned that this was really written by an OB/GYN currently practicing in the state of Texas.

"How to Guarantee a Failed VBAC" by Dr. Gerald Bullock

Doctors...be noncommittal enough in the early interviews: the issues won't come up again until later in the pregnancy. It is the rare patient indeed who has the presence of mind and strength of conviction to change doctors later in pregnancy.

...During the pregnancy, be sure to add to the mystique of the previous cesarean by ordering several ultrasounds, and suggesting an amniocentesis, so the mother will understand how different and potentially dangerous her situation is. Never mind informing her that the risk of amniocentesis is higher to the baby than the risk of VBAC...

If by chance the mother hears about cesarean prevention classes or VBAC group meetings, tell her they are a bunch of crazy radicals who have only their own crosses to burn and do not have her best interest in mind.

Be sure to spell out whatever criteria you have in considering a VBAC for them. Tell them that the baby must not weight more than whatever is your own limit (never mind that your guess at the weight is often as much as 2 pounds off). Give her your own personal allowances for the amount of time you feel is safe for her to labor. Make sure she understands that she will be laboring against a deadline.

If you are not successful in getting the patient to consent to a repeat cesarean early in labor, do not despair. All is not lost. There are several ways in which you can get her to give up her notion of VBAC. Make sure she remembers what a high risk patient she is, and keep an ever constant vigil for "catastrophe". Don't give in to the frivolous request to ambulate. It is imperative that you know exactly what the contraction pattern is, she must be therefore confined to bed from the time of arrival to the time of delivery. Have the perseverance to insist upon monitoring.. .Be kind and considerate, and apologize for not being able to allow her more flexibility.

..Say things like "of course, your baby's safety is our primary concern"
When the patient arrives early in labor, look at her critically and say something like "Do you really think that you are going to have that big thing from below?" A note from the anesthesiologists: Come in fairly early to do your "routine pre-op history review". If you do it right you can leave the impression that almost all VBAC mothers eventually go ahead with a repeat cesarean. The return to her room frequently to check her progress...Explain what will happen "while" she has the cesarean, not "if" she has it. If you are not trained in conduction anesthesia, explain to her why general anesthesia is safer for her and the baby...Finally (for other staff members standing outside the door) you may say something like "Is that blood ready? get it stat! what if she ruptures?""

-Dr. Gerald Bullock.