I’m in an online group for labor & delivery nurses where the discussion of vaginal birth after cesarean (VBAC) at home came up. While some understood the massive VBAC barriers many women face, others simply said, “Find a hospital that supports VBAC.”
I left a late-night comment stating that “finding another hospital that supports VBAC” is just not a reality in many areas of the country. It’s literally not possible. Not even in the highly populated state of California. (Barger, 2013)
I also suggested rather than calling women stupid or debating the validity of the decision to have a home VBAC, we should consider why women make this decision.
First, it is not one they take lightly. Every parent wants a safe, healthy birth for themselves and their baby. It takes more research, work, and energy to plan a home VBAC—and it usually means thousands of out-of-pocket dollars up front. It is most certainly not the easy way out.
Women choose out-of-hospital birth due to disrespectful and abusive care, including obstetric violence and forced/coerced cesareans, delivered by hospitals. Parents also choose out-of-hospital VBAC due to VBAC bans and restrictive VBAC policies (i.e., repeat CS scheduled at 39 weeks, labor can only last 12 hours, baby must weigh less than _____, no induction/ augmentation, etc.).
These are serious issues:
Restrictive VBAC policies.
And this isn’t a comprehensive list of why women choose home VBAC, but it’s the ones that many nurses, providers, and administrators have control over.
In my comment on the nurses’ group, I posted the link to my California Medical Board testimony addressing these barriers and the resulting importance of access to out-of-hospital VBAC.
We shouldn’t be asking why women are so stupid and reckless. We should be asking:
“What can we do to make women feel safe coming to our hospital to give birth?”
“How can we increase access to VBAC in all hospital settings?”
I also suggested that coming from a place of judgment on this option may very well color the tone of their communication. Even if they’re not using the words “stupid” or “reckless,” parents will pick up on what’s not being said. That’s not good for the provider-patient relationship. People want to be heard, understood, and respected. All of us.
It’s important to hear parents when they talk about their past hospital experiences, without being defensive.
Hear them and see it as an opportunity to make a change. Consider, how can you make a difference in your practice and facility?
If this were any other business, we would probably say that this is a services and marketing problem.
If you have a restaurant, and you start to lose customers to a competitor, you figure out why your customers are leaving and appeal to that.
You don’t slam the other restaurant.
You don’t call your customers stupid because someone else is offering a product that they like better.
Even if you would never personally eat there, that other restaurant is offering something that people want. And they are leaving your restaurant to get it.
So, find out what that thing is and change it.
Yes, I said all that in this nurses’ group. The next morning, I checked to see how my comments were taken, because I know from experience that not everyone wants to hear or acknowledge the realities I outlined.
I smiled to see that the conversation had remained respectful, even from some folks who disagreed with me. There was no name calling. No personal attacks. My comments even had a couple likes!
It is possible to disagree without being disagreeable. And I think it’s so important to consider that many women around the country do not have access to respectful care in a facility that supports VBAC.
What are some other reasons that women choose out-of-hospital birth? Leave your comment below.
Askins, L., & Pascucci, C. (n.d.). Retrieved from Exposing the Silence Project: http://www.exposingthesilenceproject.com/
Barger, M. K., Dunn, T. J., Bearman, S., DeLain, M., & Gates, E. (2013). A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy Childbirth. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636061/pdf/1471-2393-13-83.pdf
Kamel, J. (2014, Dec 17). What I told the California Medical Board about home VBAC. Retrieved from VBAC Facts: http://vbacfacts.com/2014/12/17/what-i-told-medical-board-home-vbac-part-1/
Kamel, J. (2016, Jan 6). “No one can force you to have a cesarean” is false. Retrieved from VBAC Facts: http://vbacfacts.com/2016/01/06/no-force-cesarean-false/
Pascucci, C. (2014, Feb 17). Home Birth vs. Hospital Birth: YOU’RE MISSING THE POINT, PEOPLE. Retrieved from Improving Birth: http://improvingbirth.org/2014/02/versus/