Pamela Paul, who wrote the article The Trouble with Repeat Cesareans two days ago, published Childhood without Choice on the Huffington Post yesterday.
I’d like to thank Pamela for drawing more attention to this issue in a passionate, yet clear and concise way. But where did her passion originate? Turns out, she is a fellow VBAC mom and she shares her experience with her VBAC supportive OB:
The doctor on call when I ended up giving birth on Thanksgiving weekend, was, needless to say, very much put out by my inconveniencing him [by VBACing rather than scheduling a repeat cesarean]. His revenge? He refused to talk to me while I was in labor, and didn’t answer his pager when I was ready to push. So that’s an example of a hospital that allows VBAC and supposedly pro-VBAC doctors for you. The truth is, doctors who are truly VBAC-friendly are few and far between. The good news is, I gave birth, via VBAC, to a perfectly healthy little boy and had a much quicker, easier recovery than I did with my C-section (which was hell, but another story).
Two things that she experienced: 1. a doctor who initially said that they were supportive only to change their tune at 6 months aka “the bait and switch” and 2. why a hospital that “allows VBAC” isn’t enough.
Next, cost:
Now, I think most of us realize that many hospitals are for-profit institutions and that doctors need to make money too, increasingly hard in this era of managed care. It is nonetheless tough to hear a physician talk about medical care in such bare-bones financial terms. So, um, we can’t get the most appropriate care because it costs too much?
She goes on to state that it’s not the cost of VBAC vs. repeat cesarean, because VBAC is a less costly procedure. It’s the cost to the doctor, specifically the high price of malpractice insurance, which leads us back to OB lists reasons for rising cesarean rate where fear of litigation is listed as reason number one.
And, the most startling quote. She discussed this in the Time article, but it bears repeating. Practically everyone who has looked into VBAC knows how difficult it can be to find a doctor and hospital who are really on-board.
Meanwhile, according to the International Cesarean Awareness Network (ICAN), out of 2,849 hospitals with labor and delivery wards nationwide, 28% have total outright bans on VBAC and an additional 21% have de facto bans in that they say they’ll do it but none of the doctors on staff will do it. That’s half of American hospitals, but the numbers are probably much worse. Many of the rest will allow what’s often termed “Cinderella VBACs” (a term coined by Henci Goer ) — “yes, you can have a VBAC as long as you have it Monday – Friday, between 8 am and 5pm and you aren’t over 40 weeks and we don’t think your baby is too big”.
49% of hospitals have VBAC bans. Is it any wonder that women, like me, chose to have homebirth VBACs?
Yeah, that last line is along the lines of what I thought, when thinking about the hospital VBAC bans — although almost half of American hospitals have VBAC bans, VBAC attempts are allowed in 100% of American homes!
I had the “Bait and Switch” doctor… and so has almost every single VBAC’ing mom I’ve known. Most of them weren’t as lucky as I was though.