Melonie Cadwell is due this month, but doesn't know where she will have her baby because of the local hospital resistance to offering the choice of a vaginal birth after caesarean section.

"I am not sure yet," Cadwell said. "I don't want to go into Wyoming Medical Center and we are thinking of driving to Douglas (Converse County Memorial Hospital)."

She and her husband Will joined several dozen more women -- some pregnant, some not -- and their husbands and children to raise awareness at the improving birth rally across the street from the Wyoming Medical Center on Labor Day.

"Women need a voice when it comes to having babies," Cadwell said. "I think that doctors sometimes just do what is best for them and not what's best for the patient and I think women don't realize that they can just say 'no' when their doctors are doing something that they don't want."

Local rally organizer Becky Dever said nationally and locally, one in three births is delivered by caesarean section, and scientific studies say half of those are unnecessary.

The United States spends the most on maternity care, but it has some of the worst outcomes such as maternal death rates in the western world, Dever said.

"We intervene more often than maybe we should.," Dever said. "So we're just trying to bring awareness that there are some evidence-based practices that we think could be put into place not only here in Casper but around the nation."

In her experience, a vaginal birth and a vaginal birth after caesarean costs between $5,000 and $7,000, she said. "With a C-section, it is at least $10,000, maybe more."

In January, VBAC-Casper chairwoman Chelse DePaolo-Lara Chelsea submitted a petition to the Wyoming Medical Center asking for more birth options.

The WMC responded the procedure was costly, the hospital lacked the resources, its insurance carrier did not cover the procedure, and medical malpractice insurance premiums for doctors probably would rise if they offered VBACs.

DePaolo-Lara responded that the hospital was operating on outdated VBAC guidelines from the American Congress of Obstetricians and Gynecologists, which now says vaginal birth after caesarean is a safe alternative to having an additional caesarean surgery in a subsequent pregnancy.