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Mom encounters VBAC ban and requests advice

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Amber recently left this comment on the Quick Facts page:

i am pregnant for the second time my first child was delivered by c-section my goal is to have my second child natural but the obgyns in my area will not allow someone who has had a c-section to have a natural birth they said it is hospital policy what would you recommend?

Amber,

First educate yourself and then you can take action. You have many options.

I suggest you review the following documents and provide a copy to your health care provider: the most recent ACOG VBAC guidelines, the National Institute of Heath’s 2010 VBAC Statement, and the article VBAC ban rationale is irrational.

Next, read through the steps of planning a VBAC and familiarize yourself with the misinformation that some OBs have used to persuade women to schedule repeat cesareans, so if you hear these same lies, you can identify them: Another VBAC Consult Misinforms, Scare tactics vs. informed consent, Hospital VBAC turned CS due to constant scare tactics, VBACing against the odds, and A father says, Why invite the risk of VBAC?.

Additionally, it’s important to know that there are many birth myths rampant on the internet that misrepresent the primary risk of VBAC by minimizing the risk of uterine rupture such as “the risk of uterine rupture in a VBAC mom is similar to (or double) that of an unscarred mom’s risk,” or “the risk of uterine rupture in an induced, unscarred mom is the same as a VBAC mom,” or “a VBAC mom is more likely to be bitten by a shark or struck by lightning than have an uterine rupture.” Again, all these statements are false. And if you see a blog report really low uterine rupture or mortality rates, it’s likely the result of incorrect math.

On to your question. . . Unfortunately, I don’t have any personal experience of pursuing a VBAC in a VBAC ban hospital because I planned a home VBAC in order to avoid all that (almost certain) drama in the hospital. So, I went to my Facebook peeps and got their suggestions and they did not disappoint!

Here are their ideas in their own words…

1. Let hospital administrators and the board of directors know.

Mamas that are passing on a hospital because of their VBAC policy, need to then write the hospital administrators and the boards of directors to tell them that they birthed at XXX Hospital instead of theirs because of their VBAC policy. Hospitals need to hear that they are losing births (aka $$$) because of their policies.

2. Find an ICAN chapter near you.

She needs to get in touch with her closest local ICAN chapter TODAY. They will know details on the exact situation in her area. She should not put stock in what one person tells her- there is a lot of misinformation and myth out there. She can find both a local chapter and information about fighting a VBAC ban at www.ican-online.org

3. Sign a waiver and exercise your legal right to refuse surgery.

I had a VBAC at a hospital where no doctor staff supported it but low and behold all the nurses were amazing! I went in at 5 cm and 3 hours later baby was in my arms. Strong support is a must – I had a midwife, my husband, mom and sister. Stay focused. Don’t sign anything- except the refusal of c/section form- get in there and push your baby out!

and . . .

I would encourage her to ask to see this policy & ask if she would be allowed to sign a waiver. Ask friends if anyone they know has VBAC’d there or at another area facility. I had an experience in my last VBAC where I was told of a “policy” that didn’t really exist except in that person’s mind.

and . . .

Under the right to informed decision making she has the right to say “no thank you”. Absent a court order for a cesarean they cant force her. I’m not a huge fan of the “show up pushing” crowd, but it may appeal to her. Or she could labor in a nearby hotel with a midwife or montrice to monitor the baby and then go in to the hospital at the last minute. Again, not a fan but we’re looking at options here.

and . . .

Regarding stories of VBAC-ban hospitals. I don’t have experience myself, as my VBAC was done with a CNM at a supportive facility – but I’ve attended a VBAC at a local hospital with a VBAC ban. Mama had a RCS [repeat cesarean section] scheduled (though she didn’t intend on going in) but went into spontaneous labor 6 days prior. She labored at home several hours until contractions were about 3 minutes apart. When we arrived and they realized she had a previous c/s, they began calling in a team to prep the OR.

The mama was beyond calm – and in the middle of labor – requested to speak with the staff. The nurses (there were maybe 4 in there?), the attending OB, and the anesthesiologist (who had already been paged for the spinal for surgery) were in her room (ready to wheel her to the OR). Between contractions, she quickly and quietly explained that she was aware it wasn’t typical policy to attend a VBAC, but she was there and it was their legal duty to treat her and she was exercising her legal right to refuse unnecessary surgery.

The nurses looked shocked, the anesthesiologist said something about he was clearly not needed, and the OB (who I swear was VBAC accepting but just was staffed at a VBAC-ban hospital) told her that she was correct, they had to treat her and couldn’t force her to do anything unless her baby was in danger but she’d need to sign quite a bit of paperwork documenting the situation. He had the most odd grin/smirk on his face while he said that as if to somehow thank her for having the nerve to stand up for herself. He left the room and we didn’t see him again until she was crowning.

I in no way, shape, or form feel that that scenario is typical of a VBAC-ban situation, but it was certainly enjoyable and entertaining to have experienced that with my client.

and . . .

I just refused the c-section at a VBAC ban hospital. With my first, I pushed for 4 hours, and he didn’t get past the 0 station (he was presenting transverse) — We lived too far away from the hospital for a homebirth at our own home, but I hired the homebirth midwife for concurrent care. She was going to monitor us at a hotel near the hospital for labor, but thankfully everything went so fast we just met her at the hospital. She served as doula there. I found out from an OB nurse that one of the OBs did support a woman’s right to refuse (though not enthusiastically). I knew I needed care I could trust, so that the only c-section I got was medically necessary. You can read where my midwife tells our story here.

You have every right to refuse an unnecessary c-section, I’d just HIGHLY recommend laboring out of the hospital, and having a doula or knowledgeable advocate with you!

and . . .

This is my advice for VBACing at a banned hospital -
- Sign your informed refusal ahead of time, and be aware that when presented with the risks of VBAC, it will majorly underplay RCS risks; it might be a good idea not to bring your husband to this appointment if he’s feeling nervous about VBAC. [Or have your husband read this article beforehand.]
- Don’t let them give you a late term ultrasound for anything other than a medical problem (in other words — refuse the late ultrasound for size)
- Plan to labor out of the hospital; use a monitrice if you are nervous about that, or a good doula
- Have a smart advocate with you at the hospital so you don’t have to fight any battles yourself and can just focus on laboring
- Get good prenatal care — I did acupuncture and chiropractic, and both of those people had offered to help me in labor if I needed; having that support and belief was very empowering, because my OB absolutely didn’t think we “could” VBAC
- Own your decision; don’t be wishy-washy… be stubborn… this is YOUR BODY. I had a personal mantra that I repeated to myself over and over, “I will only have a medically necessary c-section.”
- Learn ways to get through labor naturally; I really liked the strategies in “Birthing from Within” — even more than hypno or Bradley techniques
- Show up in advanced labor (I was complete when we got to the hospital)
- Know your personal hang-ups — I pushed for 4 hours with my son and am SO GLAD that I labored down in a small bathroom until my urge to push was really strong and spontaneous; I am so glad I wasn’t on the bed pushing for a long time, because this would have brought back too many bad memories and made me feel panicky, tired, and out of control. When I got on the bed to push, I was practically crowning. THAT was very empowering for a “failure to descend” mama

To bottom line – do what you have to to get the care you need, even with limited options; own your body and decision, and give yourself every advantage and tool that you can to help ensure success.

and a VBAC supportive OB who worked in a VBAC ban hospital says:

I’m supposed to tell patients that they have to go elsewhere if they want a VBAC, that they can’t stay in their own community, that they have to drive 50 miles. … I’m not supposed to tell them that they have the option of showing up in labor and refusing surgery. The hospital actually put in writing that I should avoid telling them that. They’re telling me to skew my counseling, and they have no shame in doing so.

4. Ask a different person at the hospital.

Remember that not everyone is knowledgeable about VBAC or a specific hospital’s VBAC policy, even if they work at that hospital.

I have heard an OB tell a mother that her only option was repeat cesarean because the hospital didn’t allow VBAC. The director of Maternal Child Health said it absolutely wasn’t true and gave her the names of VBAC friendly providers.

5. Find another hospital via the VBAC Policies by US Hospitals database compiled by ICAN.

Remember you are buying a service. Why pay for something you don’t want. Shop elsewhere.

6. Find another provider and ask these questions.

7. Birth in another city, county, or state.

Know what you’re comfortable with, hire a doula as well as a midwife or doctor especially if you have a hospital birth, and do your research so you know your rights and options. I’m currently about to “relocate” to Seattle at 37 weeks, from Juneau, AK where there is a hospital VBAC ban at our one hospital in town so I can try to have a VBAC in a more supportive environment. I didn’t think I wanted to fight the VBAC ban while in labor, I’d rather do my political activism in a clearer state of mind! It has been a stressful journey but I know I’m doing what’s right for me so I’m feeling really good about things now. I know this isn’t an option for many and a few women since the beginning of 2011 have refused repeat c/s at our hospital. Good luck!

and . . .

Go somewhere else. . . I traveled 40 mins for my vbac in 2010 because the 6 hospitals around here wouldn’t let them either.

and . . .

I even know a family who crossed state lines to have her baby the way she desired because her states laws wouldn’t allow her.

Joy Szabo said

I found a sane doctor 5 hours away. I got slightly famous for it, too.

and I’ve heard of women traveling to Mexico to VBAC at Plenitude with Dr. José Luis.

8. Consider a homebirth.

Fighting the hospital system while trying to push out a baby is not a simple task. Yes, a support team can be a big help. Personally, I felt more comfortable staying home than going to the hospital with my boxing gloves. It’s a personal choice and she’ll have to see what she’s most comfortable with. At the end of the day, I played out both options in my mind and went with the one that I felt most at peace with.

and. . .

Hello, my personal story in a nutshell… iatrogenically necessitated c/s with my first. For #2, it was a last minute change of plans… I’m a physician and I discovered through the grapevine that OB was planning to resection me without medical indication so #2 turned into planned HBAC. Homebirth VBAC successful with my second. The second was so beautiful, so peaceful, so uncomplicated!

9. Connect with resources for more ideas.

Stratton, B. (2006). 50 Ways to Protest a VBAC Denial. Retrieved from Midwifery Today: http://www.midwiferytoday.com/articles/50ways_vbac.asp

A good closing thought:

The term “will not allow” always bothers me. Perhaps they “won’t attend a VBAC” but they definitely can not stop you. Stand up for your rights. Show them the ACOG recommendation which is to allow a trial of labor! Seek out support. Call every OB you can think of. Look into a midwife. Hire a doula. You can do this.

Do you have more ideas?

Did you deliver at a VBAC ban hospital?

What was your strategy?

Are you a health care provider at a VBAC ban hospital and have some insight?

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9 comments to Mom encounters VBAC ban and requests advice

  • Shelly

    Where is this mama located? I interviewed 3 doctors before I found my perfect doctor (I didn’t particularly want a Perinatologist, but I’m high-risk due to Pre-e with baby #1 so I “qualified” to become one of his patients, and lemme tell ya, it was patient love at first intro. He is the true epitome of what a care provider should be. He was absolutely supportive of me seeking a VBA2C, the only reason my VBA2C failed is because my baby girl was OP and not descending past 0 station, even after 2 hours of pushing in multiple positions. My doctor approved me to attempt my VBA3C whenever I decided the time was right at my 6 week PP visit. Amber if your being Sectioned had anything to do with positioning I would recommend going to see a Webster-certified Chiropractor, as well as checking out Spinningbabies.com.

    • Jen Kamel

      Shelly,

      To protect this mom’s privacy, she does not want her location revealed.

      That is wonderful that you have such a supportive care provider!

      Warmly,

      Jen

  • melissa

    please help in a tuff situation im wanting to attempt vbac2 have never had a vag birth i have tried vbac once was failed i believe i was unesscary forced im in the eugne oregon area lots of midwives are taking the month off or over booked (Aug) all my ob’s have laughed in my face and told me i would never be able to have a normal birth (snobunnis510@hotmail.com) thanxs

  • Lacey

    I just found this site. I am actually looking for a site that has the statistics of successful vbacs by state and hospital. It would be great information & I am having trouble finding it. Maybe they don’t want it out there.

    Anyways, I had a c-section the 1st time after an extremely long labor and pushing for 2 hours. Her heart rate dropped. With my 2nd, I found a hospital and clinic that would allow it. They actually had midwives I could see at the office for my appointments. Now, I knew upfront that whoever the doctor, even though I want to deliver with a midwife, who was on call had the final say so at the hospital of whether or not I could try. God lined everything up even though nurses, doctors, residents, etc. tried to persuade me to just get a c-section. That is where my God given strong personality helped me out. I say to women to go for it. If a hospital will not even open up the dialogue and consider you doing it, then take your business elsewhere b/c it is a business for them. When I was in the little curtain area, signing papers, and waiting to be admitted, I had a long list of stuff I had to read and initial next to each. In between contractions, I read to my husband, “A vbac is safer than a repeat c-section,” really! Wow!! Then, why are they pushing me so. I was so thankful I had a successful v-bac. There was a resident doctor also present alongside the doctor. I remember praying that God would use this experience to change his future practice and make him open to allowing women to have vbacs.

    If any of you have a site for vbac statistics/rate, please share. Thanks!

  • Alise

    I just had my baby via cesarean 6 weeks ago. We ended up having a cesarean because she flipped breech just a few days before delivery, coming into the hospital we didn’t know this had happened. In the end we ended up with a cesarean because the u/s measurement for her head had it measuring larger than the Dr. was comfortable delivering breech. We don’t “plan” to have another baby for a while yet but I like to do my research.

    So my question is: Even though a hospital has a ban on VBAC they still have to deliver your baby if you come there? The reason I’m asking is because we would have to drive 40 minutes if that isn’t the case. I’d rather deliver closer to home if I could. I realize this means we would have to be ready to fight for our choices, but I’m okay with that. Is there anything else that I can do to possibly get the hospital to change their policy on VBAC? Also, the consent forms you sign at the hospital, can you read them prior to being admitted/the day you go in to get admitted?

    I’m just hoping to get some answers so I know what I’m up against when the time comes.

  • I had a successful VBAC at a hospital that has a VBAC ban. I showed up in labor at a six and refused the c-section. Our first nurse wanted to pressure me into, thankfully I have a supportive husband and other nurses were supportive. I also had an amazing doula. You can find my VBAC birth story here: http://www.survivingtoddlerhood.com

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