Category Archives: California

Contra Costa Regional Medical Center Supports VBAC & Wins Award

Below I’ve included an article from MartinezPatch and I highlighted some sections.  This hospital boasts a 90% VBAC success rate.  That is huge!

As I shared in A father asks “Why invite the risk of VBAC?:

I had the opportunity to attend the March 2010 National Institutes of Health VBAC Conference where the ability of rural hospitals to safely attend VBACs was extensively discussed. One doctor spoke during the public comment period and stated that her rural hospital had a VBAC rate of over 30%! It turns out, if a hospital is supportive of VBAC and motivated, they can absolutely offer VBAC safely. (I also welcome you to read the commentary of two obstetricians and one certified nurse midwife who argued against the VBAC ban instated at their local rural hospital.) Read more about the policies that this hospital implemented: VBAC Ban Rationale is Irrational.

It just goes to show that if a hospital is willing to make the effort, they can offer VBAC safely and with “no long-term complications among patients who attempt a VBAC birth or to their babies.”  Kudos Contra Costa!

Contra Costa Regional Medical Center Wins Award for Perinatal Program

County hospital receives top honors for its program to reduce repeat cesarean sections.

December 20, 2011

Contra Costa Regional Medical Center (CCRMC) in Martinez has been honored for its perinatal program that helps more women who have had a cesarean delivery avoid the surgery with their next pregnancy.

CCRMC received the award earlier this month from the California Association of Public Hospitals and Health Systems and its quality improvement affiliate, the California Health Care Safety Net Institute. The award is given to a public hospital program that best represents an innovative approach to improving health care.

Historically, most medical providers advised women who have had a C-section not to attempt a non-surgical delivery because of the slight risk of a tear in the uterine wall during labor that can be dangerous to the mother and baby. However, in recent years established medical science has recognized that a vaginal birth after a cesarean (VBAC) is possible and preferable whenever it can be achieved safely, according to Judith Bliss, MD, chair of CCRMC’s Obstetrics and Gynecology Department.

“A non-surgical delivery carries less risk to mom and baby and allows them to bond more quickly.  The key is being able to offer this option to women who’ve had a cesarean while ensuring the safest outcome possible,” Dr. Bliss said. “It’s a great joy to be able to offer many women this choice when they thought the option didn’t exist.”

The 166-bed county hospital is part of Contra Costa Health Services and about 15 percent of all babies born in Contra Costa County are delivered there. CCRMC’s perinatal unit was able to provide previous C-section patients with the VBAC option by developing a specific set of interventions, known as a “bundle,” to ensure staff could respond quickly to any complications that might occur during labor or delivery. The interventions include the ability to perform an emergency C-section, which should be started immediately in the unlikely event that a uterine rupture should occur.

Since initiating the program in October 2009, CCRMC has had significant success in reducing the percentage of repeat C-sections among eligible patients. This year, the average vaginal delivery rate for VBAC patients at CCRMC has averaged close to 90 percent through September; the national success rate for VBAC births ranges from 60 – 80 percent.   CCRMC’s success rate has been attained with no long-term complications among patients who attempt a VBAC birth or to their babies, noted Dr. Bliss, who heads the team for the VBAC project.

CCRMC developed the VBAC program in close collaboration with the Institute for Healthcare Improvement, a not-for-profit organization based in Cambridge, Massachusetts that works with health care providers and leaders throughout the world to achieve safe and effective health care.  “At a time when many providers have shied away from offering women the VBAC option because of the challenges involved, it’s very gratifying to see this hospital make such a strong commitment to doing what it takes to give patients this opportunity,” said Peter Cherouny, MD, chair of the Perinatal Improvement Community with IHI. “They’re clearly putting their patients first and doing what’s best for both mother and child.”

“We know that there are times that we have no choice but to perform a C-section,” Dr. Bliss said. “But today women have the option of having a non-surgical delivery knowing every step has been taken to assure their safety and their baby’s. To see mom and newborn together right after the birth – skin-to-skin, breastfeeding, with their families nearby – lets us know that our efforts and our vigilance are paying off.

Go here to see a video about CCRMC’s award-winning “Vaginal Birth after Cesarean (VBAC) Improvement Project.”

Monterey County hospital reverses VBAC ban

This is great!  A hospital reversing their VBAC ban!  I really wish articles like this would talk less about "the experience" and more about the life-long benefits of vaginal birth for mom and baby. 

May 28, 2009

Natural birth after c-section possible at NMC again

By Leslie Griffy
lgriffy@thecalifornian.com

Monterey County women who’ve had a c-section don’t have to leave the county to give birth naturally anymore.

Natividad Medical Center announced Wednesday that so-called VBACs vaginal birth after cesarean are back.

Like hospitals throughout the country, those in the county dropped the practice of allowing women who have had cesarean sections to give birth vaginally because of a slight increase in complications for such births. Still demand for the service was there.

"This is something that I’ve heard women wanting for as long as I’ve lived here," said Judy Rasmussen, the hospital’s director of prenatal services.

Increasingly, expectant mothers are pushing for natural birth over c-sections. But many women who have had caesareans in the past were told they’d not be able to find a hospital to give birth naturally.

When Cindy Laurance gave birth to her second child in 1990, she hunted for a place to have her daughter through VBAC and ended up at Natividad, then one of the few to provide the service.

"I wanted the experience of natural birth," she said. "You are much more present when you don’t have a lot of drugs in you."

Her first born, Alex McCloskey, didn’t nurse right away because of the drugs required for the c-section, Laurance said. It was different with daughter Anna, born using VBAC. Her own healing time, Laurance said, was much quicker, and she was empowered by experiencing the birthing process.

"VBAC is a really good opportunity for women to have the experience has nature intended," Laurance said.

Natividad’s insurer, BETA Healthcare, approved the facility for the procedure. It required the hospital to have an obstetrician and anesthesiologist at the hospital 24 hours a day, as well as an operating room on standby should something go wrong, said Dr. Peter Chandler.

"You can’t wait for doctors to come in from home," Chandler said. Natividad had met those requirements for the past year.

The announcement won plaudits from the Birth Network of Monterey County, a group that aims to education families about birthing options.

"The old adage ‘Once a c-section, always a c-section’ no longer holds true," said the group’s Joy Weston.

For more information, call 831-755-4156.


VBAC & Cesarean Rates of California Hospitals, 2007

This information is so important for any woman seeking VBAC.  It’s not enough that your hospital “allows” VBAC.  In order to see how supportive that hospital is of vaginal birth, you need to know what their VBAC rate is in addition to their primary CS rate.  Be sure to read, “Why if your hospital ‘allows’ VBAC isn’t enough” for more information as well as I’m pregnant and want a VBAC, what do I do?.

From 2006 to 2007, the total cesarean rate increased from 27.9% to 28.8% and the primary cesarean rate grew from 16.6% to 17.1 whereas the overall VBAC rate decreased from 8.9% to 8.1%.

You can also read excerpts from a January 2008 press release from the California Office of Statewide Health Planning and Development (OSHPD) where they categorize cesarean section and primary cesarean section as “POSSIBLE OVER UTILIZATION” and VBAC as “POSSIBLE UNDER UTILIZATION” here.  On that same page, OSHPD further describes how they categorized cesareans vs. VBACs:

  • Cesarean Delivery Rate
    Number of Cesarean Section Deliveries per 100 Deliveries (excludes abnormal presentation, preterm birth, fetal death, multiple gestations, and breech procedure). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Cesarean Delivery Rate – Primary
    Number of Cesarean Deliveries per 100 deliveries among women who have not previously had a Cesarean section (excludes abnormal presentation, preterm, fetal death, multiple gestation, and breech procedures). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Vaginal Birth After Cesarean (VBAC) Rate
    Number of vaginal births per 100 women with a previous Cesarean delivery. VBAC may be underused in some facilities, so higher rates may represent better care, though this rate includes some women who were probably not good candidates for vaginal birth.
  • Vaginal Birth After Cesarean (VBAC) Rate, Uncomplicated
    Number of vaginal births per 100 women with a previous Cesarean delivery (excludes abnormal presentation, preterm birth, fetal death, multiple gestation, and breech procedures). VBAC may be underused in some facilities, so higher rates may represent better care.

Below, I will use the VBAC Rate which includes all VBACs performed at that hospital.

Top 5 California Hospitals: VBACs Performed 2007

  1. Santa Clara Valley Medical Center – 289
  2. Alta Bates Summit Medical Center – Alta Bates Campus – 227
  3. California Hospital Medical Center – Los Angeles – 160
  4. Kaiser Fnd Hosp – South Sacramento – 133
  5. Sutter Memorial Hospital – 123

Top 5 California Hospitals: VBAC Rate 2007

  1. San Francisco General Hospital – 33.0% (53 VBACs)
  2. Kaiser Fnd Hosp – Redwood City – 32.1% (42 VBACs)
  3. Kaiser Fnd Hosp – South Sacramento – 31.7% (133 VBACs)
  4. Santa Clara Valley Medical Center  – 31.3% (289 VBACs)
  5. Seton Medical Center – 28.8% (20 VBACs)

Top 5 Hospitals: Primary Cesareans Performed 2007

  1. Sharp Mary Birch Hospital For Women – 1338 (22.2%)
  2. Cedars Sinai Medical Center – 1,231 (21.0%)
  3. Citrus Valley Medical Center – Qv Campus – 1,173 (30.7%)
  4. St. Francis Medical Center – 1,054 (21.8%)
  5. Pomona Valley Hospital Medical Center – 1,003 (17.7%)

Top 5 Hospitals: Overall Cesareans Performed 2007

  1. Sharp Mary Birch Hospital For Women – 2,469 (33.4%)
  2. Pomona Valley Hospital Medical Center – 2,318 (34.0%)
  3. Citrus Valley Medical Center – Qv Campus – 2,178 (46.4%)
  4. St. Francis Medical Center – 2,114 (37.1%)
  5. Cedars Sinai Medical Center – 1,968 (27.9%)

Top 6 Hospitals: Overall Cesarean Rate 2007

  1. Stanford Hospital – 89.1% (4 CS)
  2. Los Angeles Community Hospital-62.2% (341 CS)
  3. East Valley Hospital Medical Center – 58.3% (204 CS)
  4. Community And Mission Hsp Of Hntg Park – Slauson – 51.8% (735 CS)
  5. El Centro Regional Medical Center – 48.2% (641 CS)
  6. Pacifica Hospital Of The Valley – 48.0% (453 CS)

Inland Empire Hospitals – VBAC vs. Primary CS Rates

  1. Loma Linda University Medical Center – 15.8% vs. 16.2%
  2. Kaiser Fnd Hosp – Riverside – 15.7% vs. 16.2%
  3. Kaiser Fnd Hosp – Fontana – 13.5% vs. 12.4%
  4. Riverside County Regional Medical Center – 7.3% vs. 9.9%
  5. St. Bernardine Medical Center – 5.9% vs. 10.8%
  6. Pomona Valley Hospital Medical Center – 4.2% vs.  17.7%
  7. St. Mary Regional Medical Center – 2.2% vs. 9.1%
  8. Hi-Desert Medical Center – 1.4% vs. 23.6%
  9. Redlands Community Hospital – 1.4% vs. 15.3%
  10. Parkview Community Hospital Medical Center – 1.3% vs. 20.2%
  11. Corona Regional Medical Center – Main – 1.0% vs. 16.4%
  12. Community Hospital Of San Bernardino – 0.8% vs. 28.6%
  13. Montclair Hospital Medical Center – 0.6% vs. 27.2%
  14. San Antonio Community Hospital – 0.5% vs. 25.3%
  15. Hemet Valley Medical Center – 0.4% vs. 31.4%
  16. Riverside Community Hospital – 0.2% vs. 19.0%
  17. Mountains Community Hospital – 0.0% vs. 16.4%
  18. Eisenhower Memorial Hospital – No births reported
    Chino Valley Medical Center – No births reported
    Kindred Hospital Ontario – No births reported

Hospitals with VBAC Bans?  All these hospitals had 5 or fewer VBACs in 2007.  I wonder if it is because they have banned them.  There are 257 hospitals that reported births and the 109 listed below represents 42.4% of them (up from 39% in 2006).  I guess they should read this and this.

  1. Anaheim General Hospital
  2. Banner Lassen Medical Center
  3. Barstow Community Hospital
  4. Barton Memorial Hospital
  5. Bellflower Medical Center
  6. Beverly Hospital
  7. Central Valley General Hospital
  8. Coalinga Regional Medical Center
  9. Coastal Communities Hospital
  10. Colusa Regional Medical Center
  11. Community Hospital Monterey Peninsula
  12. Community Hospital Of San Bernardino
  13. Corona Regional Medical Center – Main
  14. Delano Regional Medical Center
  15. Desert Valley Hospital
  16. Doctors Hospital Of Manteca
  17. East Los Angeles Doctors Hospital
  18. East Valley Hospital Medical Center
  19. Eden Medical Center
  20. El Centro Regional Medical Center
  21. Fairchild Medical Center
  22. Feather River Hospital
  23. Foothill Presbyterian Hospital-Johnston Memorial
  24. French Hospital Medical Center
  25. George L Mee Memorial Hospital
  26. Goleta Valley Cottage Hospital
  27. Greater El Monte Community Hospital
  28. Hazel Hawkins Memorial Hospital
  29. Hemet Valley Medical Center
  30. Henry Mayo Newhall Memorial Hospital
  31. Hi-Desert Medical Center
  32. John F Kennedy Memorial Hospital
  33. La Palma Intercommunity Hospital
  34. Little Company Of Mary – San Pedro Hospital
  35. Lodi Memorial Hospital
  36. Lompoc Healthcare District
  37. Los Angeles Community Hospital
  38. Los Angeles Metropolitan Med Ctr
  39. Mammoth Hospital
  40. Marshall Medical Center (1-Rh)
  41. Los Angeles Co Martin Luther King Jr/Drew Med Ctr
  42. Mayers Memorial Hospital
  43. Memorial Hospital Los Banos
  44. Memorial Hospital Medical Center – Modesto
  45. Memorial Hospital Of Gardena
  46. Mendocino Coast District Hospital
  47. Mercy Medical Center
  48. Mercy Medical Center Mt. Shasta
  49. Modoc Medical Center
  50. Montclair Hospital Medical Center
  51. Monterey Park Hospital
  52. Moreno Valley Community Hospital
  53. Mountains Community Hospital
  54. North Bay Medical Center
  55. Northern Inyo Hospital
  56. Oak Valley District Hospital (2-Rh)
  57. Oroville Hospital
  58. Pacific Alliance Medical Center, Inc.
  59. Pacific Hospital Of Long Beach
  60. Pacifica Hospital Of The Valley
  61. Palo Verde Hospital
  62. Paradise Valley Hospital
  63. Parkview Community Hospital Medical Center
  64. Petaluma Valley Hospital
  65. Pioneers Memorial Hospital
  66. Plumas District Hospital
  67. Pomerado Hospital
  68. Providence Holy Cross Medical Center
  69. Redbud Community Hospital
  70. Redlands Community Hospital
  71. Regional Medical Of San Jose
  72. Ridgecrest Regional Hospital
  73. Riverside Community Hospital
  74. Salinas Valley Memorial Hospital
  75. San Antonio Community Hospital
  76. San Dimas Community Hospital
  77. San Gorgonio Memorial Hospital
  78. San Ramon Regional Medical Center
  79. Santa Barbara Cottage Hospital
  80. Santa Monica – Ucla Medical Center
  81. Sierra Kings District Hospital
  82. Sierra Nevada Memorial Hospital
  83. Sierra View District Hospital
  84. Simi Valley Hospital And Health Care Svcs-Sycamore
  85. Sonoma Valley Hospital
  86. Sonora Regional Medical Center – Greenley
  87. St. Elizabeth Community Hospital
  88. St. Helena Hospital
  89. St. John’s Pleasant Valley Hospital
  90. St. John’s Regional Medical Center
  91. St. Joseph Hospital – Eureka
  92. St. Louise Regional Hospital
  93. St. Rose Hospital
  94. Stanford Hospital
  95. Sutter Amador Hospital
  96. Sutter Auburn Faith Hospital
  97. Sutter Coast Hospital
  98. Sutter Davis Hospital
  99. Sutter Medical Center Of Santa Rosa
  100. Sutter Tracy Community Hospital
  101. Tahoe Forest Hospital
  102. Tulare District Hospital
  103. Twin Cities Community Hospital
  104. Valley Memorial Hospital – Livermore
  105. Verdugo Hills Hospital
  106. Victor Valley Community Hospital
  107. Western Medical Center Hospital – Anaheim
  108. Whittier Hospital Medical Center
  109. Woodland Memorial Hospital

Utilization Rates* for Selected Medical Procedures in California Hospitals, 2007
Office of Statewide Health Planning and Development, Hospital Patient Data**
  (Here is the info as a Adobe Acrobat PDF for easy printing.)

      

  Hospital Total CS # Total CS % Primary CS # Primary CS % VBAC Uncomp # VBAC Uncomp % VBAC # VBAC %
  Statewide 140,559 28.8 70,889 17.1 6,289 8.3 7,034 8.1
Alameda ALAMEDA CO MED CTR – HIGHLAND CAMPUS 253 20.2 126 11.3 50 27.7 55 27.3
Alameda ALAMEDA HOSPITAL . . . . . . . .
Alameda ALTA BATES SUMMIT MED CTR-ALTA BATES CAMPUS 1634 22.5 814 13.2 209 20.4 227 19.2
Alameda ALTA BATES SUMMIT MED CTR-SUMMIT CAMPUS-HAWTHORNE . . . . . . . .
Alameda CHILDRENS HOSPITAL AND RESEARCH CTR AT OAKLAND . . . . . . . .
Alameda EDEN MEDICAL CENTER 231 25.2 122 15.3 0 0.0 1 0.7
Alameda KAISER FND HOSP – FREMONT . . . . . . . .
Alameda KAISER FND HOSP – HAYWARD 689 24.1 415 17.0 83 23.3 90 22.8
Alameda KAISER FND HOSP – OAKLAND CAMPUS 607 25.0 352 17.0 52 17.2 59 17.4
Alameda KINDRED HOSPITAL – SAN FRANCISCO BAY AREA . . . . . . . .
Alameda SAN LEANDRO HOSPITAL . . . . . . . .
Alameda ST. ROSE HOSPITAL 247 26.9 129 15.6 2 1.6 2 1.4
Alameda VALLEY MEMORIAL HOSPITAL – LIVERMORE 442 30.5 241 20.0 3 1.5 4 1.7
Alameda WASHINGTON HOSPITAL – FREMONT 702 24.8 351 14.8 27 7.2 34 8.2
Amador SUTTER AMADOR HOSPITAL 65 25.6 33 14.3 1 3.0 2 4.3
Butte BIGGS GRIDLEY MEMORIAL HOSPITAL . . . . . . . .
Butte ENLOE MEDICAL CENTER- ESPLANADE CAMPUS 339 24.7 183 14.9 7 4.3 7 3.9
Butte FEATHER RIVER HOSPITAL 182 25.4 98 15.0 1 1.2 2 1.9
Butte OROVILLE HOSPITAL 143 30.1 65 15.2 3 3.6 4 3.9
Calaveras MARK TWAIN ST. JOSEPH’S HOSPITAL . . . . . . . .
Colusa COLUSA REGIONAL MEDICAL CENTER 72 38.0 39 23.8 0 0.0 0 0.0
Contra Costa CONTRA COSTA REGIONAL MEDICAL CENTER 423 22.0 220 12.8 80 27.9 87 26.7
Contra Costa DOCTORS MEDICAL CENTER – SAN PABLO . . . . . . . .
Contra Costa JOHN MUIR MEDICAL CENTER-CONCORD CAMPUS . . . . . . . .
Contra Costa JOHN MUIR MEDICAL CENTER-WALNUT CREEK CAMPUS 624 22.7 276 12.6 56 14.2 58 13.0
Contra Costa KAISER FND HOSP – RICHMOND CAMPUS . . . . . . . .
Contra Costa KAISER FND HOSP – WALNUT CREEK 994 23.4 569 15.8 79 15.8 81 13.9
Contra Costa KAISER FOUND HSP-ANTIOCH 28 20.7 17 13.6 0 0.0 0 0.0
Contra Costa SAN RAMON REGIONAL MEDICAL CENTER 261 34.8 148 25.0 0 0.0 0 0.0
Contra Costa SUTTER DELTA MEDICAL CENTER 207 23.5 97 12.6 12 9.8 12 8.4
Del Norte SUTTER COAST HOSPITAL 62 20.4 32 11.0 0 0.0 0 0.0
El Dorado BARTON MEMORIAL HOSPITAL 140 29.8 73 18.0 1 1.5 2 2.7
El Dorado MARSHALL  MEDICAL CENTER (1-RH) 163 29.2 88 17.9 4 5.0 5 5.8
Fresno COALINGA REGIONAL MEDICAL CENTER 0 0.0 0 0.0 . 0.0 0 0.0
Fresno COMMUNITY MEDICAL CENTER – CLOVIS 975 32.9 470 19.4 34 6.3 38 6.4
Fresno COMMUNITY REGIONAL MEDICAL CENTER-FRESNO 1563 29.0 645 13.8 72 7.2 95 7.8
Fresno FRESNO HEART AND SURGICAL HOSPITAL . . . . . . . .
Fresno FRESNO SURGICAL HOSPITAL . . . . . . . .
Fresno KAISER FND HOSP – FRESNO 289 23.9 147 14.4 43 23.1 44 20.7
Fresno KINGSBURG MEDICAL CENTER . . . . . . . .
Fresno SAN JOAQUIN VALLEY REHABILITATION HOSPITAL . . . . . . . .
Fresno SIERRA KINGS DISTRICT HOSPITAL 498 36.5 229 19.9 0 0.0 0 0.0
Fresno ST. AGNES MEDICAL CENTER 1207 34.3 649 21.4 24 4.1 28 4.2
Fresno UNIVERSITY MEDICAL CENTER . . . . . . . .
Glenn GLENN MEDICAL CENTER . . . . . . . .
Humboldt JEROLD PHELPS COMMUNITY HOSPITAL . . . . . . . .
Humboldt MAD RIVER COMMUNITY HOSPITAL 118 23.1 75 16.4 13 23.0 14 22.8
Humboldt REDWOOD MEMORIAL HOSPITAL 62 22.4 22 9.1 6 12.8 6 12.8
Humboldt ST. JOSEPH HOSPITAL – EUREKA 180 31.6 97 19.4 0 0.0 0 0.0
Imperial EL CENTRO REGIONAL MEDICAL CENTER 641 48.2 340 32.4 3 1.0 3 0.9
Imperial PIONEERS MEMORIAL HOSPITAL 386 28.6 162 13.7 1 0.4 1 0.4
Inyo NORTHERN INYO HOSPITAL 55 31.6 26 17.3 0 0.0 0 0.0
Inyo SOUTHERN INYO HOSPITAL . . . . . . . .
Kern BAKERSFIELD HEART HOSPITAL . . . . . . . .
Kern BAKERSFIELD MEMORIAL HOSPITAL- 34TH STREET 501 24.1 178 9.7 29 8.1 32 8.1
Kern DELANO REGIONAL MEDICAL CENTER 215 26.2 71 10.0 1 0.7 1 0.6
Kern GOOD SAMARITAN HOSPITAL-BAKERSFIELD . . . . . . . .
Kern KERN MEDICAL CENTER 820 24.5 281 9.8 99 15.3 113 14.9
Kern KERN VALLEY HEALTHCARE DISTRICT . . . . . . . .
Kern MERCY HOSPITAL – BAKERSFIELD 754 23.2 374 13.3 80 17.1 89 16.6
Kern RIDGECREST REGIONAL HOSPITAL 180 39.3 88 22.8 3 3.1 3 2.8
Kern SAN JOAQUIN COMMUNITY HOSPITAL 497 21.9 188 9.1 29 8.5 29 8.1
Kern TEHACHAPI HOSPITAL . . . . . . . .
Kings CENTRAL VALLEY GENERAL HOSPITAL 690 37.3 309 20.0 0 0.0 1 0.2
Kings CORCORAN DISTRICT HOSPITAL . . . . . . . .
Kings HANFORD COMMUNITY MEDICAL CENTER 299 34.4 146 19.5 5 3.1 7 3.8
Lake REDBUD COMMUNITY HOSPITAL 35 23.1 9 6.7 2 6.9 2 6.9
Lake SUTTER LAKESIDE HOSPITAL 98 31.4 56 20.5 7 14.2 7 12.4
Lassen BANNER LASSEN MEDICAL CENTER 58 28.4 25 14.0 2 5.6 2 5.5
Los Angeles ALHAMBRA HOSPITAL . . . . . . . .
Los Angeles ANTELOPE VALLEY HOSPITAL 1565 31.1 750 17.2 14 1.7 19 2.1
Los Angeles BARLOW RESPIRATORY HOSPITAL . . . . . . . .
Los Angeles BELLFLOWER MEDICAL CENTER 597 39.6 322 25.2 0 0.0 1 0.3
Los Angeles BEVERLY HOSPITAL 478 36.4 226 20.3 0 0.0 0 0.0
Los Angeles BROTMAN MEDICAL CENTER . . . . . . . .
Los Angeles CALIFORNIA HOSPITAL MEDICAL CENTER – LOS ANGELES 1045 28.7 532 16.9 133 20.4 160 20.8
Los Angeles CATALINA ISLAND MEDICAL CENTER . . . . . . . .
Los Angeles CEDARS SINAI MEDICAL CENTER 1968 27.9 1231 21.0 100 12.3 112 12.3
Los Angeles CENTINELA FREEMAN REG MED CTR-MARINA CAMPUS . . . . . . . .
Los Angeles CENTINELA HOSPITAL MEDICAL CENTER 848 33.3 395 18.5 28 5.8 30 5.3
Los Angeles CENTURY CITY DOCTORS HOSPITAL . . . . . . . .
Los Angeles CHILDREN’S HOSPITAL OF LOS ANGELES . . . . . . . .
Los Angeles CITRUS VALLEY MEDICAL CENTER – IC CAMPUS . . . . . . . .
Los Angeles CITRUS VALLEY MEDICAL CENTER – QV CAMPUS 2178 46.4 1173 30.7 10 1.0 14 1.2
Los Angeles CITY OF ANGELS MEDICAL CENTER-DOWNTOWN CAMPUS . . . . . . . .
Los Angeles CITY OF HOPE HELFORD CLINICAL RESEARCH HOSPITAL . . . . . . . .
Los Angeles COAST PLAZA DOCTORS HOSPITAL . . . . . . . .
Los Angeles COMMUNITY AND MISSION HSP OF HNTG PK – SLAUSON 735 51.8 384 35.2 9 2.5 9 2.3
Los Angeles COMMUNITY HOSPITAL OF LONG BEACH . . . . . . . .
Los Angeles DOCTORS HOSPITAL OF WEST COVINA, INC . . . . . . . .
Los Angeles DOWNEY REGIONAL MEDICAL CENTER 344 22.6 149 11.4 27 12.1 30 11.5
Los Angeles EARL AND LORRAINE MILLER CHILDRENS HOSPITAL 1391 29.2 643 16.4 104 12.2 121 11.7
Los Angeles EAST LOS ANGELES DOCTORS HOSPITAL 318 46.4 142 26.6 1 0.6 1 0.5
Los Angeles EAST VALLEY HOSPITAL MEDICAL CENTER 204 58.3 113 42.3 0 0.0 0 0.0
Los Angeles ENCINO-TARZANA REGIONAL MED CTR-ENCINO . . . . . . . .
Los Angeles ENCINO-TARZANA REGIONAL MED CTR-TARZANA 611 29.8 326 20.1 16 5.5 17 5.3
Los Angeles FOOTHILL PRESBYTERIAN HOSPITAL-JOHNSTON MEMORIAL 278 40.6 147 27.3 1 0.8 1 0.7
Los Angeles GARFIELD MEDICAL CENTER 1226 37.0 607 23.3 13 2.1 14 1.9
Los Angeles GLENDALE ADVENTIST MEDICAL CENTER – WILSON TERRACE 760 34.6 427 23.4 23 6.4 26 6.2
Los Angeles GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER 487 30.5 224 17.0 14 5.1 14 4.5
Los Angeles GOOD SAMARITAN HOSPITAL-LOS ANGELES 1306 26.7 641 15.6 44 6.2 52 6.5
Los Angeles GREATER EL MONTE COMMUNITY HOSPITAL 171 30.9 57 12.5 0 0.0 1 0.8
Los Angeles HENRY MAYO NEWHALL MEMORIAL HOSPITAL 370 28.5 173 16.4 1 0.5 2 0.9
Los Angeles HOLLYWOOD COMMUNITY HOSPITAL OF HOLLYWOOD . . . . . . . .
Los Angeles HOLLYWOOD PRESBYTERIAN MEDICAL CENTER 1512 38.3 843 25.1 50 6.9 56 6.8
Los Angeles HUNTINGTON MEMORIAL HOSPITAL 1024 31.9 572 21.9 18 3.9 20 3.7
Los Angeles KAISER FND HOSP – BALDWIN PARK 676 22.8 329 13.3 82 19.3 89 18.7
Los Angeles KAISER FND HOSP – BELLFLOWER 703 23.5 380 14.9 110 25.4 118 23.4
Los Angeles KAISER FND HOSP – HARBOR CITY 455 25.9 239 16.4 47 18.0 49 17.2
Los Angeles KAISER FND HOSP – PANORAMA CITY 409 29.4 245 20.9 31 15.9 38 15.5
Los Angeles KAISER FND HOSP – SUNSET 673 32.1 437 24.8 41 15.0 44 14.2
Los Angeles KAISER FND HOSP – WEST LA 317 23.0 181 15.2 29 17.7 32 16.5
Los Angeles KAISER FND HOSP – WOODLAND HILLS 390 22.6 202 14.2 51 21.6 59 21.7
Los Angeles KINDRED HOSPITAL – LA MIRADA . . . . . . . .
Los Angeles KINDRED HOSPITAL – LOS ANGELES . . . . . . . .
Los Angeles LAC/RANCHO LOS AMIGOS NATIONAL REHAB CENTER . . . . . . . .
Los Angeles LAKEWOOD REGIONAL MEDICAL CENTER . . . . . . . .
Los Angeles LANCASTER COMMUNITY HOSPITAL . . . . . . . .
Los Angeles LITTLE COMPANY OF MARY – SAN PEDRO HOSPITAL 185 25.4 75 11.6 1 0.9 1 0.8
Los Angeles LITTLE COMPANY OF MARY HOSPITAL 713 28.6 441 20.6 5 1.8 6 2.0
Los Angeles LONG BEACH MEMORIAL MEDICAL CENTER . . . . . . . .
Los Angeles LOS ANGELES CO HARBOR-UCLA MEDICAL CENTER 274 28.9 158 19.1 26 18.3 29 18.0
Los Angeles LOS ANGELES CO USC MEDICAL CENTER 394 31.2 191 18.8 44 17.9 54 17.7
Los Angeles LOS ANGELES COMMUNITY HOSPITAL 341 62.2 206 48.4 2 1.4 2 1.4
Los Angeles LOS ANGELES COUNTY OLIVE VIEW-UCLA MEDICAL CENTER 245 28.2 97 14.3 52 25.7 57 24.0
Los Angeles LOS ANGELES METROPOLITAN MEDICAL CENTER 340 35.2 158 19.5 1 0.5 1 0.5
Los Angeles MARTIN LUTHER KING JR.-HARBOR HOSPITAL 40 31.8 20 19.0 2 9.2 4 16.9
Los Angeles MEMORIAL HOSPITAL OF GARDENA 571 41.2 275 24.3 0 0.0 0 0.0
Los Angeles METHODIST HOSPITAL OF SOUTHERN CALIFORNIA 568 26.5 307 16.9 19 6.8 24 7.2
Los Angeles MIRACLE MILE MEDICAL CENTER . . . . . . . .
Los Angeles MISSION COMMUNITY HOSPITAL – PANORAMA CAMPUS . . . . . . . .
Los Angeles MONTEREY PARK HOSPITAL 656 42.7 331 26.2 0 0.0 0 0.0
Los Angeles MOTION PICTURE AND TELEVISION HOSPITAL . . . . . . . .
Los Angeles NORTHRIDGE HOSPITAL MEDICAL CENTER 881 34.9 424 20.7 9 1.9 11 2.1
Los Angeles NORWALK COMMUNITY HOSPITAL . . . . . . . .
Los Angeles OLYMPIA MEDICAL CENTER . . . . . . . .
Los Angeles PACIFIC ALLIANCE MEDICAL CENTER, INC. 726 37.5 366 22.3 5 1.4 5 1.3
Los Angeles PACIFIC HOSPITAL OF LONG BEACH 377 33.1 105 11.4 1 0.4 1 0.3
Los Angeles PACIFICA HOSPITAL OF THE VALLEY 453 48.0 248 32.8 1 0.5 1 0.4
Los Angeles POMONA VALLEY HOSPITAL MEDICAL CENTER 2318 34.0 1003 17.7 55 4.0 64 4.2
Los Angeles PRESBYTERIAN INTERCOMMUNITY HOSPITAL 954 29.2 474 17.5 51 9.6 63 10.4
Los Angeles PROMISE HOSPITAL OF EAST LOS ANGELES-EAST L.A. CAMPUS . . . . . . . .
Los Angeles PROVIDENCE HOLY CROSS MEDICAL CENTER 825 34.6 461 22.1 1 0.3 1 0.2
Los Angeles PROVIDENCE SAINT JOSEPH MEDICAL CENTER 869 29.6 500 19.6 9 2.4 9 2.0
Los Angeles SAN DIMAS COMMUNITY HOSPITAL 188 25.3 85 13.8 1 1.0 1 0.9
Los Angeles SAN GABRIEL VALLEY MEDICAL CENTER 723 32.1 360 19.8 11 3.0 13 3.0
Los Angeles SANTA MONICA – UCLA MEDICAL CENTER & ORTHOPAEDIC HOSPIT 490 34.6 278 25.0 3 1.4 3 1.3
Los Angeles SHERMAN OAKS HOSPITAL . . . . . . . .
Los Angeles SHRINERS HOSPITAL FOR  CHILDREN – L.A. . . . . . . . .
Los Angeles ST. FRANCIS MEDICAL CENTER 2114 37.1 1054 21.8 94 8.0 111 8.2
Los Angeles ST. JOHN’S HEALTH CENTER 510 25.1 339 19.6 9 5.3 9 4.6
Los Angeles ST. MARY MEDICAL CENTER 751 28.9 393 17.1 29 7.4 31 7.2
Los Angeles ST. VINCENT MEDICAL CENTER . . . . . . . .
Los Angeles TEMPLE COMMUNITY HOSPITAL . . . . . . . .
Los Angeles TORRANCE MEMORIAL MEDICAL CENTER 1248 34.7 634 22.5 15 2.4 15 2.1
Los Angeles TRI-CITY REGIONAL MEDICAL CENTER . . . . . . . .
Los Angeles UCLA MEDICAL CENTER 415 23.9 242 16.5 60 25.9 61 23.4
Los Angeles USC KENNETH NORRIS, JR. CANCER HOSPITAL . . . . . . . .
Los Angeles USC UNIVERSITY HOSPITAL . . . . . . . .
Los Angeles VALLEY PRESBYTERIAN HOSPITAL 1887 39.6 932 23.7 26 2.6 29 2.5
Los Angeles VERDUGO HILLS HOSPITAL 305 33.8 184 25.2 0 0.0 0 0.0
Los Angeles VISTA HOSPITAL OF SAN GABRIEL VALLEY . . . . . . . .
Los Angeles VISTA HOSPITAL OF SOUTH BAY . . . . . . . .
Los Angeles WEST HILLS HOSPITAL AND MEDICAL CENTER 424 34.3 230 23.7 6 3.1 6 2.9
Los Angeles WHITE MEMORIAL MEDICAL CENTER 821 34.4 427 21.5 70 14.9 84 14.4
Los Angeles WHITTIER HOSPITAL MEDICAL CENTER 606 31.8 288 17.8 2 0.6 2 0.6
Madera CHILDREN’S HOSPITAL CENTRAL CALIFORNIA . . . . . . . .
Madera MADERA COMMUNITY HOSPITAL 464 28.3 211 14.7 20 7.3 22 6.9
Marin KAISER FND HOSP – SAN RAFAEL . . . . . . . .
Marin KENTFIELD REHABILITATION HOSPITAL . . . . . . . .
Marin MARIN GENERAL HOSPITAL 360 21.4 189 13.4 51 23.5 56 20.9
Marin NOVATO COMMUNITY HOSPITAL . . . . . . . .
Mariposa JOHN C FREMONT HEALTHCARE DISTRICT . . . . . . . .
Mendocino FRANK R HOWARD MEMORIAL HOSPITAL . . . . . . . .
Mendocino MENDOCINO COAST DISTRICT HOSPITAL 34 22.9 21 15.1 0 0.0 0 0.0
Mendocino UKIAH VALLEY MEDICAL CENTER/HOSPITAL DRIVE 172 23.1 94 14.1 19 19.5 19 17.7
Merced MEMORIAL HOSPITAL LOS BANOS 160 25.7 50 9.4 1 0.9 1 0.8
Merced MERCY MEDICAL CENTER MERCED-COMMUNITY CAMPUS 609 26.2 249 12.2 14 3.7 17 3.9
Modoc MODOC MEDICAL CENTER 0 0.0 0 0.0 0 0.0 0 0.0
Modoc SURPRISE VALLEY COMMUNITY HOSPITAL . . . . . . . .
Mono MAMMOTH HOSPITAL 38 31.6 17 17.4 0 0.0 0 0.0
Monterey COMMUNITY HOSPITAL MONTEREY PENINSULA 345 27.2 190 17.6 2 1.3 2 1.2
Monterey GEORGE L MEE MEMORIAL HOSPITAL 174 31.0 73 15.1 1 1.0 2 1.7
Monterey NATIVIDAD MEDICAL CENTER 592 29.6 223 12.9 5 1.3 7 1.6
Monterey SALINAS VALLEY MEMORIAL HOSPITAL 679 30.6 311 16.5 1 0.3 2 0.5
Napa N M HOLDERMAN MEMORIAL HOSPITAL (VET’S HOME OF CAL . . . . . . . .
Napa QUEEN OF THE VALLEY HOSPITAL – NAPA 191 21.6 88 11.3 15 12.6 19 14.4
Napa ST. HELENA HOSPITAL 81 29.3 40 17.5 0 0.0 0 0.0
Nevada SIERRA NEVADA MEMORIAL HOSPITAL 107 25.9 62 16.5 2 4.2 2 3.7
Nevada TAHOE FOREST HOSPITAL 91 18.9 51 11.7 0 0.0 1 2.1
Orange ANAHEIM GENERAL HOSPITAL 159 31.0 69 15.7 1 1.1 1 1.0
Orange ANAHEIM MEMORIAL MEDICAL CENTER 418 24.3 200 13.5 6 2.7 9 3.6
Orange CHAPMAN MEDICAL CENTER . . . . . . . .
Orange CHILDREN’S HOSPITAL AT MISSION . . . . . . . .
Orange CHILDREN’S HOSPITAL OF ORANGE COUNTY . . . . . . . .
Orange COASTAL COMMUNITIES HOSPITAL 876 41.9 438 25.8 1 0.2 1 0.2
Orange COLLEGE HOSPITAL COSTA MESA . . . . . . . .
Orange FOUNTAIN VALLEY RGNL HOSP AND MED CTR – EUCLID 896 25.2 506 16.6 34 8.1 36 7.4
Orange GARDEN GROVE HOSPITAL AND MEDICAL CENTER 855 32.8 379 17.5 19 3.8 21 3.7
Orange HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1595 30.2 896 21.0 26 3.7 27 3.4
Orange HUNTINGTON BEACH HOSPITAL . . . . . . . .
Orange IRVINE REGIONAL HOSPITAL AND MEDICAL CENTER 554 29.3 278 18.5 19 6.5 19 6.2
Orange KAISER FND HOSP – ANAHEIM 709 22.1 378 14.0 93 22.1 102 21.1
Orange KINDRED HOSPITAL BREA . . . . . . . .
Orange KINDRED HOSPITAL WESTMINSTER . . . . . . . .
Orange LA PALMA INTERCOMMUNITY HOSPITAL 67 22.3 33 12.3 0 0.0 0 0.0
Orange LOS ALAMITOS MEDICAL CENTER 456 25.9 192 13.0 5 1.9 7 2.4
Orange MISSION HOSPITAL REGIONAL MEDICAL CENTER 793 28.1 421 17.7 18 4.7 23 5.2
Orange ORANGE COAST MEMORIAL MEDICAL CENTER 379 25.6 176 14.4 7 3.4 9 4.0
Orange PLACENTIA LINDA HOSPITAL . . . . . . . .
Orange SADDLEBACK MEMORIAL MEDICAL CENTER 626 23.9 299 14.3 60 15.9 67 15.3
Orange SADDLEBACK MEMORIAL MEDICAL CENTER – SAN CLEMENTE . . . . . . . .
Orange SOUTH COAST MEDICAL CENTER 189 28.4 101 18.6 10 10.3 10 9.8
Orange ST. JOSEPH HOSPITAL – ORANGE 1469 32.2 735 19.7 54 6.9 60 6.8
Orange ST. JUDE MEDICAL CENTER 523 26.3 295 17.8 30 11.8 32 11.1
Orange TUSTIN HOSPITAL MEDICAL CENTER . . . . . . . .
Orange UNIVERSITY OF CALIFORNIA IRVINE MEDICAL CENTER 255 26.1 132 15.7 34 21.6 43 19.3
Orange WESTERN MEDICAL CENTER – SANTA ANA 992 34.4 437 18.4 11 1.9 12 1.8
Orange WESTERN MEDICAL CENTER HOSPITAL – ANAHEIM 721 28.4 240 11.2 3 0.6 5 1.0
Placer KAISER FND HOSP – SACRAMENTO/ROSEVILLE-EUREKA . . . . . . . .
Placer SUTTER AUBURN FAITH HOSPITAL 121 26.2 62 14.9 0 0.0 0 0.0
Placer SUTTER ROSEVILLE MEDICAL CENTER 655 24.1 295 12.9 41 10.2 42 9.8
Plumas EASTERN PLUMAS HOSPITAL-PORTOLA CAMPUS . . . . . . . .
Plumas PLUMAS DISTRICT HOSPITAL 22 24.3 11 13.6 0 0.0 0 0.0
Plumas SENECA HEALTHCARE DISTRICT . . . . . . . .
Riverside CORONA REGIONAL MEDICAL CENTER-MAIN 527 28.7 265 16.4 3 1.1 3 1.0
Riverside DESERT REGIONAL MEDICAL CENTER 1027 33.2 500 19.2 25 4.5 28 4.5
Riverside EISENHOWER MEMORIAL HOSPITAL 0 0.0 0 0.0 0 0.0 0 0.0
Riverside HEMET VALLEY MEDICAL CENTER 578 44.6 361 31.4 1 0.5 1 0.4
Riverside JOHN F KENNEDY MEMORIAL HOSPITAL 953 34.3 427 17.9 4 0.7 5 0.8
Riverside KAISER FND HOSP – RIVERSIDE 909 25.8 488 16.2 79 15.7 87 15.7
Riverside MENIFEE VALLEY MEDICAL CENTER . . . . . . . .
Riverside MORENO VALLEY COMMUNITY HOSPITAL 372 25.9 139 11.0 0 0.0 0 0.0
Riverside PALO VERDE HOSPITAL 41 41.8 30 32.6 1 8.2 1 5.8
Riverside PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER 603 36.8 274 20.2 4 1.2 5 1.3
Riverside RIVERSIDE COMMUNITY HOSPITAL 948 32.0 492 19.0 1 0.2 1 0.2
Riverside RIVERSIDE COUNTY REGIONAL MEDICAL CENTER 674 25.4 226 9.9 36 7.3 41 7.3
Riverside SAN GORGONIO MEMORIAL HOSPITAL 128 33.1 52 15.5 0 0.0 0 0.0
Riverside SOUTHWEST HEALTHCARE SYSTEM-MURRIETA 854 25.6 394 13.7 13 2.7 14 2.7
Riverside VISTA HOSPITAL OF RIVERSIDE . . . . . . . .
Sacramento KAISER FND HOSP – SACRAMENTO/ROSEVILLE-MORSE 868 24.5 474 15.7 89 18.5 101 17.8
Sacramento KAISER FND HOSP – SOUTH SACRAMENTO 532 15.8 270 9.2 116 30.8 133 31.7
Sacramento KINDRED HOSPITAL – SACRAMENTO . . . . . . . .
Sacramento MERCY GENERAL HOSPITAL 644 28.3 354 17.4 35 10.6 38 10.3
Sacramento MERCY HOSPITAL – FOLSOM 257 23.1 105 11.7 10 6.3 10 6.0
Sacramento MERCY SAN JUAN HOSPITAL 674 25.1 360 15.0 52 14.1 58 13.1
Sacramento METHODIST HOSPITAL OF SACRAMENTO 266 24.6 144 15.3 21 14.7 22 12.8
Sacramento SHRINERS HOSPITALS FOR CHILDREN NORTHERN CALIF. . . . . . . . .
Sacramento SUTTER GENERAL HOSPITAL . . . . . . . .
Sacramento SUTTER MEMORIAL HOSPITAL 1305 27.2 640 15.8 111 14.3 123 13.4
Sacramento UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER 539 25.1 307 16.6 88 27.4 96 25.5
San Benito HAZEL HAWKINS MEMORIAL HOSPITAL 166 33.0 80 18.2 1 1.1 2 2.1
San Bernardino ARROWHEAD REGIONAL MEDICAL CENTER 965 28.9 415 14.3 51 8.4 54 7.9
San Bernardino BARSTOW COMMUNITY HOSPITAL 88 31.1 37 14.7 3 5.4 4 6.8
San Bernardino BEAR VALLEY COMMUNITY HOSPITAL . . . . . . . .
San Bernardino CHINO VALLEY MEDICAL CENTER 0 0.0 0 0.0 0 0.0 0 0.0
San Bernardino COLORADO RIVER MEDICAL CENTER . . . . . . . .
San Bernardino COMMUNITY HOSPITAL OF SAN BERNARDINO 1109 45.2 584 28.6 3 0.6 5 0.8
San Bernardino DESERT VALLEY HOSPITAL 116 32.3 46 15.3 1 1.4 1 1.3
San Bernardino HI-DESERT MEDICAL CENTER 151 36.7 89 23.6 1 1.6 1 1.4
San Bernardino KAISER FND HOSP – FONTANA 942 22.9 440 12.4 82 14.0 90 13.5
San Bernardino KINDRED HOSPITAL ONTARIO 0 0.0 0 0.0 0 0.0 0 0.0
San Bernardino LOMA LINDA UNIVERSITY MEDICAL CENTER 595 28.2 289 16.2 61 16.4 75 15.8
San Bernardino MONTCLAIR HOSPITAL MEDICAL CENTER 335 40.6 196 27.2 1 0.7 1 0.6
San Bernardino MOUNTAINS COMMUNITY HOSPITAL 32 28.0 17 16.4 0 0.0 0 0.0
San Bernardino RANCHO SPECIALTY HOSPITAL . . . . . . . .
San Bernardino REDLANDS COMMUNITY HOSPITAL 538 25.7 285 15.3 1 0.4 4 1.4
San Bernardino SAN ANTONIO COMMUNITY HOSPITAL 756 36.2 431 25.3 2 0.6 2 0.5
San Bernardino ST. BERNARDINE MEDICAL CENTER 363 21.8 165 10.8 14 6.5 15 5.9
San Bernardino ST. MARY REGIONAL MEDICAL CENTER 459 19.6 198 9.1 7 2.6 7 2.2
San Bernardino VICTOR VALLEY COMMUNITY HOSPITAL 479 33.9 160 13.9 3 0.9 4 1.1
San Diego ALVARADO HOSPITAL . . . . . . . .
San Diego FALLBROOK HOSPITAL DISTRICT 147 33.8 79 21.7 6 8.1 6 7.2
San Diego GROSSMONT HOSPITAL 965 30.6 530 19.7 77 15.0 83 14.3
San Diego KAISER FND HOSP – SAN DIEGO 1061 26.8 621 18.4 81 15.6 90 15.2
San Diego KINDRED HOSPITAL – SAN DIEGO . . . . . . . .
San Diego PALOMAR MEDICAL CENTER 1104 29.4 531 16.9 88 13.2 90 12.6
San Diego PARADISE VALLEY HOSPITAL 357 25.6 163 13.7 1 0.5 2 0.9
San Diego POMERADO HOSPITAL 326 30.7 152 17.7 1 0.6 1 0.5
San Diego PROMISE HOSPITAL OF SAN DIEGO . . . . . . . .
San Diego RADY CHILDREN’S HOSPITAL – SAN DIEGO . . . . . . . .
San Diego SAN DIEGO HOSPICE AND PALLIATIVE CARE-ACUTE CARE CTR . . . . . . . .
San Diego SCRIPPS GREEN HOSPITAL . . . . . . . .
San Diego SCRIPPS MEMORIAL HOSPITAL – ENCINITAS 330 21.7 152 12.0 41 18.8 44 19.0
San Diego SCRIPPS MEMORIAL HOSPITAL – LA JOLLA 1255 30.7 715 22.2 66 11.2 69 10.6
San Diego SCRIPPS MERCY HOSPITAL 517 24.2 300 16.0 77 26.2 83 25.6
San Diego SCRIPPS MERCY HOSPITAL – CHULA VISTA 629 35.3 393 24.4 11 4.4 12 4.4
San Diego SHARP CHULA VISTA MEDICAL CENTER 1021 33.8 405 16.7 7 1.1 7 1.0
San Diego SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER . . . . . . . .
San Diego SHARP MARY BIRCH HOSPITAL FOR WOMEN 2469 33.4 1338 22.2 104 8.4 122 8.4
San Diego SHARP MEMORIAL HOSPITAL . . . . . . . .
San Diego TRI-CITY MEDICAL CENTER 933 28.1 523 18.0 60 12.6 67 12.2
San Diego UNIVERSITY OF CALIF-SAN DIEGO MEDICAL CENTER 712 30.5 447 22.1 35 11.8 45 12.0
San Francisco CALIFORNIA PACIFIC MED CTR-PACIFIC CAMPUS 1197 19.5 711 13.6 64 12.2 74 11.7
San Francisco CHINESE HOSPITAL . . . . . . . .
San Francisco KAISER FND HOSP – GEARY S F 638 25.0 401 18.7 47 17.0 53 16.9
San Francisco LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER . . . . . . . .
San Francisco SAN FRANCISCO GENERAL HOSPITAL 202 18.3 110 11.1 47 33.6 53 33.0
San Francisco ST. FRANCIS MEMORIAL HOSPITAL . . . . . . . .
San Francisco ST. LUKE’S HOSPITAL 195 18.7 108 11.4 9 9.3 9 8.1
San Francisco ST. MARY’S MEDICAL CENTER, SAN FRANCISCO . . . . . . . .
San Francisco UCSF MEDICAL CENTER 335 19.2 216 14.2 48 29.5 53 25.8
San Joaquin DAMERON HOSPITAL 575 27.2 300 16.2 12 4.2 20 5.5
San Joaquin DOCTORS HOSPITAL OF MANTECA 164 24.7 65 11.1 0 0.0 2 1.8
San Joaquin KAISER FND HOSP-MANTECA . . . . . . . .
San Joaquin LODI MEMORIAL HOSPITAL 414 36.9 220 22.9 0 0.0 1 0.5
San Joaquin SAN JOAQUIN GENERAL HOSPITAL 630 28.1 241 12.5 18 4.4 22 4.8
San Joaquin ST. JOSEPH’S MEDICAL CENTER OF STOCKTON 583 27.9 276 14.9 11 3.4 11 3.0
San Joaquin SUTTER TRACY COMMUNITY HOSPITAL 204 29.2 97 16.5 1 0.9 1 0.8
San Luis Obispo ARROYO GRANDE COMMUNITY HOSPITAL . . . . . . . .
San Luis Obispo FRENCH HOSPITAL MEDICAL CENTER 158 20.2 99 13.6 1 1.7 1 1.5
San Luis Obispo SIERRA VISTA REGIONAL MEDICAL CENTER 346 31.1 161 18.6 38 17.2 40 16.0
San Luis Obispo TWIN CITIES COMMUNITY HOSPITAL 154 25.8 79 14.7 4 5.0 5 5.3
San Mateo KAISER FND HOSP – REDWOOD CITY 197 14.6 114 9.6 40 32.9 42 32.1
San Mateo KAISER FND HOSP – SOUTH SAN FRANCISCO . . . . . . . .
San Mateo MENLO PARK SURGICAL HOSPITAL . . . . . . . .
San Mateo PENINSULA MEDICAL CENTER 398 21.3 221 13.9 12 6.5 13 5.5
San Mateo SAN MATEO MEDICAL CENTER . . . . . . . .
San Mateo SEQUOIA HOSPITAL 365 25.8 190 17.1 24 12.6 24 11.2
San Mateo SETON MEDICAL CENTER 144 22.8 100 17.4 19 30.0 20 28.8
Santa Barbara GOLETA VALLEY COTTAGE HOSPITAL 66 23.0 31 12.5 0 0.0 0 0.0
Santa Barbara LOMPOC HEALTHCARE DISTRICT 105 27.0 57 16.0 0 0.0 1 1.9
Santa Barbara MARIAN MEDICAL CENTER 885 34.3 370 17.2 4 0.8 6 1.0
Santa Barbara SANTA BARBARA COTTAGE HOSPITAL 580 26.5 269 14.5 3 1.0 4 1.1
Santa Barbara SANTA YNEZ VALLEY COTTAGE HOSPITAL . . . . . . . .
Santa Clara COMMUNITY HOSPITAL OF LOS GATOS 189 24.4 97 15.5 14 13.4 14 12.8
Santa Clara EL CAMINO HOSPITAL 1167 26.2 649 17.6 10 1.9 10 1.7
Santa Clara GOOD SAMARITAN HOSPITAL-SAN JOSE 1065 30.7 634 22.4 17 3.9 22 4.4
Santa Clara KAISER FND HOSP – SAN JOSE 484 20.4 268 13.1 59 21.5 64 21.4
Santa Clara KAISER FND HOSP – SANTA CLARA 432 21.5 275 15.9 58 27.1 64 25.8
Santa Clara KAISER FND HOSP – SANTA CLARA 432 21.5 275 15.9 58 27.1 64 25.8
Santa Clara LUCILE SALTER PACKARD CHILDREN’S HOSP. AT STANFORD 983 20.6 488 12.1 108 18.3 116 15.8
Santa Clara O’CONNOR HOSPITAL – SAN JOSE 983 27.7 500 16.7 11 2.2 11 2.0
Santa Clara REGIONAL MEDICAL OF SAN JOSE 189 28.3 87 15.9 3 2.9 4 3.4
Santa Clara SANTA CLARA VALLEY MEDICAL CENTER 945 20.0 418 10.2 265 33.2 289 31.3
Santa Clara ST. LOUISE REGIONAL HOSPITAL 122 26.0 59 14.0 1 1.6 2 2.8
Santa Clara STANFORD HOSPITAL 4 89.1 4 85.9 0 0.0 0 0.0
Santa Cruz DOMINICAN HOSPITAL-SANTA CRUZ/SOQUEL 232 22.5 101 12.0 39 23.0 42 21.0
Santa Cruz SUTTER MATERNITY AND SURGERY CENTER OF SANTA CRUZ 183 19.6 112 13.7 20 22.4 20 20.6
Santa Cruz WATSONVILLE COMMUNITY HOSPITAL 388 27.6 172 14.2 16 6.9 19 7.2
Shasta MAYERS MEMORIAL HOSPITAL 22 22.7 10 11.3 0 0.0 0 0.0
Shasta MERCY MEDICAL CENTER 472 27.1 220 14.2 2 0.8 2 0.7
Shasta NORTHERN CALIFORNIA REHABILITATION HOSPITAL . . . . . . . .
Shasta PATIENTS’ HOSPITAL OF REDDING . . . . . . . .
Shasta SHASTA REGIONAL MEDICAL CENTER . . . . . . . .
Siskiyou FAIRCHILD MEDICAL CENTER 77 39.2 47 27.2 2 6.2 2 5.5
Siskiyou MERCY MEDICAL CENTER MT. SHASTA 39 26.6 19 14.4 1 4.7 1 4.3
Solano KAISER FND HOSP – REHABILITATION CENTER VALLEJO 567 25.0 309 15.8 45 14.8 49 15.0
Solano NORTH BAY MEDICAL CENTER 370 27.7 174 14.7 2 1.0 3 1.3
Solano NORTH BAY VACAVALLEY HOSPITAL . . . . . . . .
Solano SUTTER SOLANO MEDICAL CENTER 228 26.1 115 15.1 23 16.8 25 16.1
Sonoma HEALDSBURG DISTRICT HOSPITAL . . . . . . . .
Sonoma KAISER FND HOSP – SANTA ROSA 381 22.0 203 13.7 32 15.3 39 16.8
Sonoma PALM DRIVE HOSPITAL . . . . . . . .
Sonoma PETALUMA VALLEY HOSPITAL 124 24.1 62 13.5 1 1.6 1 1.4
Sonoma SANTA ROSA MEMORIAL HOSPITAL-MONTGOMERY 279 24.7 110 12.2 43 20.2 48 20.3
Sonoma SONOMA VALLEY HOSPITAL 43 22.8 19 11.3 0 0.0 0 0.0
Sonoma SUTTER MEDICAL CENTER OF SANTA ROSA-CHANATE CAMPUS 273 17.8 144 10.0 0 0.0 1 0.7
Stanislaus DOCTORS MEDICAL CENTER 1308 33.3 585 17.6 50 6.4 50 5.8
Stanislaus EMANUEL MEDICAL CENTER, INC 558 21.0 223 9.6 16 4.5 16 4.4
Stanislaus MEMORIAL HOSPITAL MEDICAL CENTER – MODESTO 551 29.2 285 17.3 1 0.4 3 1.0
Stanislaus OAK VALLEY DISTRICT HOSPITAL (2-RH) 70 26.2 33 13.7 0 0.0 1 2.6
Stanislaus STANISLAUS SURGICAL HOSPITAL . . . . . . . .
Sutter FREMONT MEDICAL CENTER 515 27.0 217 13.1 30 9.0 35 9.5
Tehama ST. ELIZABETH COMMUNITY HOSPITAL 152 25.4 76 13.8 0 0.0 0 0.0
Trinity TRINITY HOSPITAL . . . . . . . .
Tulare KAWEAH DELTA DISTRICT HOSPITAL 1175 34.3 559 19.3 22 3.4 25 3.3
Tulare SIERRA VIEW DISTRICT HOSPITAL 546 29.8 285 17.2 1 0.4 1 0.4
Tulare TULARE DISTRICT HOSPITAL 419 40.8 202 23.3 1 0.5 1 0.4
Tuolumne SONORA REGIONAL MEDICAL CENTER – GREENLEY 158 32.9 79 19.1 0 0.0 0 0.0
Tuolumne TUOLUMNE GENERAL MEDICAL FACILITY . . . . . . . .
Ventura COMMUNITY MEMORIAL HOSPITAL-SAN BUENAVENTURA 820 30.4 363 16.3 8 1.7 8 1.5
Ventura LOS ROBLES HOSPITAL & MEDICAL CENTER 598 31.4 326 21.3 20 7.0 24 7.0
Ventura OJAI VALLEY COMMUNITY HOSPITAL . . . . . . . .
Ventura SIMI VALLEY HOSPITAL AND HEALTH CARE SVCS-SYCAMORE 146 27.2 80 17.2 1 1.5 1 1.4
Ventura ST. JOHN’S PLEASANT VALLEY HOSPITAL 79 17.1 43 10.2 1 2.7 1 2.5
Ventura ST. JOHN’S REGIONAL MEDICAL CENTER 372 24.1 193 13.9 2 1.1 2 0.9
Ventura THOUSAND OAKS SURGICAL HOSPITAL . . . . . . . .
Ventura VENTURA COUNTY MEDICAL CENTER 735 26.5 284 11.7 10 2.1 12 2.2
Yolo SUTTER DAVIS HOSPITAL 181 14.8 83 7.4 0 0.0 1 0.9
Yolo WOODLAND MEMORIAL HOSPITAL 153 24.4 71 12.7 2 2.4 2 2.1
Yuba RIDEOUT MEMORIAL HOSPITAL . . . . . . . .

* Agency for Healthcare Research and Quality, Inpatient Quality Indicators, Version 3.1. All indicators are age-adjusted and laparoscopic cholecystectomy is also sex-adjusted.

**Patient Discharge Data 2007

OSHPD

Note: Blank cells indicate that no procedures were performed; VBAC = Vaginal Birth After Cesarean; CS = Cesarean Section.
(go here for rate explanation  )

Is VBAC Illegal? Is homebirth illegal?

This post was originally published June 14, 2008.  It has since been updated to include more information on the technicalities of homebirth.

I have incredible software on this website called StatCounter and through that I’m able to see what search engine queries bring people to the site.

I’ve noticed more queries asking if VBAC is illegal.

VBAC is not illegal anywhere in the USA.

It is legal to have a hospital VBAC in all 50 states.

It is legal to have a out-of-hospital VBAC in all 50 states.

If someone has told you that VBAC is illegal, they are either misinformed or are outright lying to you.  Ask them to show you the law.  This is something you should be able to easily look up through a google search.  You won’t find it because it doesn’t exist.

Linda Bennett, a retired midwife, clarifies the issue:

I also think it is important for women to know that OOH (out-of-hospital) VBAC whether home or boat or rv in the parking lot of the hospital or motel or unlicensed birthing center is also legal everywhere.

What may not be “allowed” by state regulation or law varies from state to state but if restrictions are present, it is in the form of restrictions on the license or practice of the practitioner IF she is a midwife (MDs can do what they want, although their peers may give them other headaches for attending an OOH birth).

Birth Centers with a license from their state often have restrictions specified in the law or their regulations (force of law) which mean they could lose their license if…and then VBAC.. breech.. multiples.. may be specified along with other restrictive language decided by their state regulatory board.

And I know what I am speaking about, because the small group of midwives I originally worked with in Santa Cruz took our arrests to California’s State Supreme Court over the licensing issue!

So when you hear the term “it is illegal to VBAC,” it is referring to the fact that it is illegal for a non-doctor to attend homebirths.  The physical act of giving birth in your home is not illegal.  If you are planning a hospital birth, and you don’t make it it the hospital in time and end up giving birth in your bathtub, you did not do anything illegal.

Gretchen Humphries, Advocacy Director, ICAN, explains:

[If] there aren’t laws specifically naming midwives as illegal… it leaves the impression that they aren’t illegal — which isn’t true.  They are illegal because they are practicing Medicine without a license.  They aren’t illegal because they ARE midwives, they are illegal because they AREN’T doctors.  Unless there is legal language making them legal, they aren’t.  Now, fortunately, this is pretty irrelevant in most states, still…..

Some states, like New Jersey, permit midwives to attend homebirths, but not homebirth VBACs (HBACs).

In other states, like California, homebirth and HBAC are legal for midwives to attend though you technically need to use your right of informed refusal to have a HBAC. 

Some states have legislation prohibiting homebirths or birth center births with midwives, and in those states HBAC would also be considered illegal for them to attend. 

Then there are states that permit some midwives, but not others, to attend homebirth.  Iowa and North Carolina permit certified nurse midwives (CNMs) to attend homebirths, but not certified professional midwives (CPMs.)  There is currently a bill providing for licensure of CPMs in Iowa.  Learn more about House Study Bill 229 at Friends of Iowa Midwives.

So why would someone tell you that VBAC is illegal?  Three reasons.  First, it ends the conversation.  One might be apt to debate or look for another care provider if they are told “our hospital doesn’t permit them” or “this OB doesn’t attend them.”  But if you are told it’s illegal, well, most women would just resign themselves to a scheduled repeat cesarean since many women do not want a OOH VBAC.  Linda Bennett gives us the second reason, “It is often convenient ‘shorthand’ to speak of ‘illegal’ HBACs but I find this convenience to serve the purposes of the doctors who oppose any OOH births. The HBAC is not illegal.”  Third, to say something is illegal makes it sound really dangerous, risky, and against the common good.  So by continuing the myth that homebirth is illegal, it’s feeding into the “homebirth is for wackos” machine, when it reality, it is perfectly legal for your OB to deliver your baby at home.  What stops them is a mix malpractice insurance pressures, pressure from other doctors, and the real belief that many OB have that birth is a dangerous event.

So, what do you do if you live in an “illegal” state?  There is hope, as Gretchen explains:

In a state where there is no Midwifery Practice Act, you’ll need to depend on your midwives to know what the “climate” for them is like — mine practice openly, advertise widely, go with all their transports, etc. But they ain’t legal.

So, look around.   You may find that you have options you didn’t even know about.

Ready to plan your VBAC?  Start here: I’m pregnant and want a VBAC, what do I do?.

I’m pregnant and want a VBAC, what do I do?

I recently received this comment.

Hi…thank you so much for your site! Very informative. I live in Glendale and I had a c-section last year with my first daughter. I went in to be induced even though I wasn’t looking forward to it. No contractions. No mucus plug. No water broken. I guess I just wasn’t ready for labor yet. They hooked me up to an epidural because they said I was going to feel immense pain so I went with it. 26 hours went by and I never dilated so they gave me a c-section at citrus valley medical center. I saw them on your list for high c-section rate. Now, I am pregnant again (a year and a month later) I really want to have a VBAC! Any suggestions? I can see that you have touched many women…any information to spare would be awesome- Rose

Rose,

There are so many women who have experienced your exact story.  They trust their OB because, hey, they didn’t go to medical school, right?  So, here is your body, so obviously not ready to birth and yet we feel like if we force your body to birth by giving you drugs, somehow this will result in a normal labor.  Did your OB discuss the risks of induction?  How it increases the likelihood that you will need a cesarean either by the induction “not working” or your labor starting and then stopping or by the induction stressing the baby resulting in a “fetal distress” diagnosis?  I’m guessing no.  Let me make one suggestion.  If you want a VBAC, don’t go back to that OB and certainly don’t go back to Citrus Valley.  With a 28.7% primary cesarean rate, a 43.3% total cesarean rate, and a sad 1.5% VBAC rate, your chances of VBACing there are zero.  Put it another way: in 2006, there were 2105 cesareans and 17 VBACs there.  And I bet that if we knew your OB’s cesarean rate, it would probably be about the same as Citrus’ total cesarean rate.  So, you need a new care provider and a new location for your birth!  YOU CAN DO THIS!

So, first things, first.  Congratulations on your pregnancy! This is such an exciting time of your life!  But know that if you want a VBAC, this is not something that is just going to fall into your lap.  Especially if you want a hospital birth, you need to become informed, empowered, and ready for (a likely) battle.  If you pick a homebirth, you can relax a bit.  But more on that later.

Here are your marching orders!

1. Read. Rikki Lake’s My Best Birth is an excellent overview of birth.  Once you read that, if you are ready for more I recommend Ina May Gaskin’s Ina May’s Guide to Childbirth, Dr. Marsden Wagner’s Born in the USA, Henci’s Goer’s The Thinking Woman’s Guide, Jennifer Block’s Pushed, Tina Cassidy’s Birth in that order.  (While I want to give you all the great books I love, I also know that a lot of women only have time to read one or two.)

Please don’t waste your money or time on The Girlfriend’s Guide or What to Expect When You Are Expecting.  I’ve read them both and was so surprised that these are some of the top selling pregnancy books in the US.  They are dumb.  And lame.  And dumb.

Let me give you a recap of What to Expect: Can I take baths?  Can I exercise?  Can I have sex while pregnant?  Yes (not to hot), yes (not to strenuous), and yes (provided you have a normal pregnancy without a history of preterm labor.)

And The Girlfriend’s Guide?  Basically tells you to go to the hospital and get your epidural.  Oh, and your body is going to hell after a baby.  After I read that book, I was truly terrified of what my post-baby body would look like.

Seriously, skip them both.  There are so many great books to read, don’t waste your time on that dribble.  And yes, your boobs and butt will sag after having a baby, but at the end of your days, I don’t think you, or your children, will care one bit about your flabby boobs.

2. Home vs hospital. I had a homebirth, I had a good outcome and it was amazing.  You can read my birth story here: My HBAC Birth story.   But homebirth comes with real risks and even though the risk of uterine rupture is low, it does and will happen.  And in about 6% of uterine ruptures, the baby will die (Guise, 2010).  Chances are, you will be fine, but those statistics represent real moms and real babies.  With what we gain in homebirth (privacy, control, peace, limited pressure, etc), the primary thing that we lose is immediate access to surgical intervention.  You can read my extended thoughts on homebirth here: Why Homebirth.

So, read, think, reflect and decide what feels best. Of course, this also depends on your health and if you would qualify for a homebirth.

Someone suggested this to me when I was early pregnant with my VBAC son and I learned a lot: Imagine for a week that you are having a hospital birth. How do you feel? Are you nervous or at peace?  Are you excited or anxious?  Now do the same with  homebirth.

Other articles you might find interesting: Homebirth vs hospital birth for the number cruncher, OB lists reasons for rising cesarean rate, and Neonatal nurse has a homebirth VBAC.

2a. Hospital birth. If you chose to birth in a hospital, find the hospital with the highest VBAC rate.  Since you are in California, you can easily do this by going here: VBAC & Cesarean Rates of California Hospitals, 2007 and be sure to read Why if your hospital “allows” VBAC isn’t enough.

I think that if you want a hospital VBAC, your best bet is Kaiser.  Just looking at their 2006 California statistics, they had a 20.8% VBAC rate, a 15% primary cesarean rate and a 22.4% total cesarean rate.  Some Kaiser locations even permit CNMs (certified nurse midwives) to manage VBAC labors.  The national VBAC rate is 10% and in California it’s 9%, so 20% is excellent.

If you have a hospital birth and good insurance, you will likely save money in comparison to a homebirth (unless you have a PPO which may pay for some of your homebirth costs or you live in a state like Florida), but take that money you save and invest it in a doula.  I strongly recommend you have a doula if you have a hospital birth.  Labor requires concentration.  Dealing with medical professionals who may think you are a bit odd for wanting a VBAC requires concentration.  Your typical laboring woman does not have enough concentration and energy to deal with both things.  Read VBACing Against the Odds and Hospital VBAC turned CS due to constant scare tactics.

Hospitals vary greatly. Here is a wonderful birth story of a woman who VBACed at a Southern California Kaiser: The Birth Story of James Liam.

2b. Home birth. If you are at home, I think a doula is something you can get if you want, but skip if you don’t feel the need.  But this is really a personal preference.  At home, you have the freedom that you just don’t have at the hospital and you need not worry about hospital personnel trying to talk to you mid-contraction.

However, with homebirth you have other issues to attend to.  The most important thing when interviewing midwives is experience.  You need to know how many births she has attended and of those, how many was she the primary midwife (the responsible person at the birth as opposed to assisting a senior midwife.)  If you have an inexperienced midwife with limited informal or formal education, you are taking on additional risk that is really unnecessary.

Additionally, you want a midwife who has enough experience to know when to go to the hospital as well as the professionalism to interface, and even take crap from, hospital employees.  You and your baby’s well being should come well before her possible discomfort.  In states where it is illegal for a midwife to attend a OOH (out-of-hospital) VBAC, your midwife is not likely to present herself as your midwife if you transfer and this is understandable.

You also want to be aware of the birth myths that are sometimes propagated amongst midwives.  It is a massive red flag if your midwife repeats any of these myths to you.

I personally think that hiring a midwife who has experience and knowledge is more important than hiring one that you “click” with.  That really should come secondary to the ability to make quick decisions regarding your health as well as the health of your baby.

3. Find a provider. After you read The Three Types of Care Providers Amongst OBs and Midwives, Questions to Ask a Provider, Scare tactics vs. informed consent aka why I started this website, you can go to Finding a VBAC Supportive OB or Midwife and start using the resources listed there to find referrals for OBs or midwives.  I think the best way to find a care provider is through word of mouth.  I have heard many ‘bait & switch’ stories at 36 weeks. A provider says everything the mom wants to hear in the interview and then did a 180 once the woman was to far along in her pregnancy to expend the effort of finding another care provider.  It’s best to hear from multiple women, if possible, how a provider is during birth. 

4. Childbirth Education.  I think Bradley classes are great because you learn a ton.  The tone of a particular class can vary greatly depending on who is teaching it. I took the Hypnobabies Home Study course with my VBAC baby and I thought it was good, but it had a completely different emphasis.  I would also encourage you to find a “Truth About VBAC” workshop in your area.

Bradley had far more information about interventions, pros, cons, physiology and anatomy.  Hypnobabies was more about relaxation, visualization, positive thinking, calm, and peace.  My VBAC labor was very manageable until the last hour or so and I attribute that to maintaining a calm and peaceful state of mind, being in the peace of my own home, and, since I was drug-free and at home, having the freedom to move into the most comfortable position at the moment however and whenever I wanted.

There are many things that I enjoyed about Hypnobabies and if it’s possible, I would suggest doing both.  Hypnobabies is very clear that they don’t want you to take any other course and that they don’t want you to be exposed to the idea that childbirth is painful.  They even discuss pain like it’s a four letter word.  Pain doesn’t have to be negative though.

5. Finding support. 92% of women in the US have a repeat cesarean (Martin, 2009).  I personally believe this is due to misinformation, unsupportive medical professionals, a lack of social support, and hospital VBAC bans.  If you plan to VBAC, you are likely to come across many women who were lead to believe by their OBs that VBACs are to dangerous, illegal, or that “no one does them.” I know women in real life who knew one person who didn’t think they were complete whack-a-dos for planning a VBAC, and that person was me.

It can be hard and it can be isolating, but you can find support, you just need to know where to look.   Go back to the Finding a VBAC Supportive OB or Midwife list of resources and go to a couple La Leche League, ICAN, or Holistic Moms meetings.

And rest assured that even if you don’t know anyone in real life who supports your decision, you can find loads of support on-line.  Please don’t feel alone.  It can be so hard when you are so excited about your upcoming VBAC and the rest of the world is looking at you like you are crazy.  But you are not.

The cost of getting your medical records

When considering your post-cesarean birth options, it’s good to know what type of uterine incision you have.  The only way to verify this is by getting a copy of your operative report from the hospital where you had your cesarean.  I recommend bringing copies of your operative report when interviewing care providers as most will want to confirm your uterine incision type.

Sometimes women have a different incision on their skin than their uterus, so just because you have a low transverse (“bikini cut”) incision on your skin, doesn’t necessarily mean you have the same incision on your uterus.   Low transverse incisions are the most commonly used method in America and come with the lowest uterine rupture rare.

You may also want to get a copy of your medical records from your care provider to complete the picture of your prior pregnancy/pregnancies.

Read more here: Medical Records Copying Charges by State

Last updated October 9, 2012

Cesarean & VBAC Rates of Hospitals – AL, AK, CA, FL, ME, MA, NJ, NY, OR, TX

This article has links to cesarean and VBAC rates by hospital for the following states: Alabama, Alaska, California, Florida, Maine, Massachusetts, New Jersey, New York, Oregon, Texas, and Utah.  (For more information on California hospitals, go here.)

This is great info for women of those states! 

Compliments of Our Bodies Ourselves: Finding and Comparing C-Section Rates by Hospital

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Physician Credential Verification by State

Want to know if your doctor has been subject to a board hearing or disciplinary note? 

Here is a link to the State Board sites for all 50 states.

A letter to a hospital questioning their VBAC ban

A mom in Southern California sent me this letter that she sent to her local hospital.  With her permission, I’m sharing it here.  The hospital did respond to her in writing, which you can read here.

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February 18, 2008

Dear _________,

I am a mother of a toddler who was born by cesarean. I recently moved to the area and was disappointed to learn that in 2003, [Hospital] system banned vaginal birth after cesareans (VBACs). According to [a local newspaper] article that covered the decision,

The American College of Obstetricians and Gynecologists recommended in 1999 that physicians, including an anesthesiologist, be ‘immediately available’ 24 hours a day at any facility that sanctions a so-called VBAC […] [Hospital] cannot meet the staffing standard…. ‘Very few hospitals outside of universities are going to be offering this.’ The prime concern is that during labor a woman’s uterus can rupture along her existing C-section scar line. Critics are quick to note what several sources report — that such tears happen less than 1 percent of the time. […] ‘The problem is when things go awry, things change immediately and that could be a dramatic outcome for the mother or the baby.

Recent research shows the risk of uterine rupture among women with one prior low uterine segment cesarean in spontaneous, naturally occurring labors to be about 0.5%.

I have several concerns about this situation that I hope you will address:

  • Women go to hospitals to give birth because they often feel that a hospital is best equipped to handle birth emergencies. According to the [Hospital] website, the hospital handles 2400 births a year. I am concerned that if [Hospital] can’t meet the staffing standard for VBACs, that means the hospital doesn’t have the ability to perform an emergency cesarean 24 hours a day/seven days a week. If the hospital cannot accommodate a medical emergency such as uterine rupture, how can they respond and treat other real, but rare, labor emergencies such as cord prolapse (approximately 0.14-0.62% of births) or placental abruption (approximately 0.65% of births), both of which require the baby to be born ASAP usually by immediate cesarean sections?
  • The cesarean rate in this country has risen well above the World Health Organization’s recommended rate of 10-15%. According to [a newspaper] article from 2003, at that time approximately 28% of births at [Hospital] were cesareans. Add to that the approximately 4% that were VBACs but are now required repeat cesareans and you get a 32% cesarean section rate — more than twice that recommended by the WHO. Healthy People 2010 recommends a reduction in cesarean births in the US to 15% by 2010. I am concerned that the cesarean rate in [our city] is so high, because cesareans are not risk-free operations, and I would like to know what the hospital is doing to address the over use of cesareans.
  • I am concerned that [Hospital] is understating the risks of primary or subsequent cesarean surgeries yet exaggerating the risks of VBAC. Cesareans pose serious risks to mothers, including two to four times a greater chance of maternal death, increased risk of emergency hysterectomy, injury to blood vessels and other organs, chronic pain due to internal scar tissue, increased chance of re-hospitalization and complications involving the placenta in subsequent pregnancies. Cesareans also pose risks to the infant, including an increased risk of respiratory distress syndrome, prematurity, the development of childhood asthma, and a 1-9% chance the baby will be cut during surgery. The recovery from a cesarean is much longer than for a vaginal birth, involving more pain, more difficulty establishing breastfeeding, and a longer hospital stay.

I understand that having an anesthesiologist at the hospital at all times is expensive, and cannot be billed to a patient’s insurance unless he or she ends up being needed. However, I am concerned that emergency anesthesia should be available at all times if [Hospital] is going to be a safe place for women to be in labor and deliver babies.

As suggested by the 2003 article, I understand that fear of litigation drives a decision to ban VBAC in many hospitals. However, many hospitals have women who want to attempt a VBAC sign a form stating that they understand the risks of VBAC. Could [Hospital] do this?

Giving birth is a life-changing event in the life of a woman. She needs to be able to work with her care provider to make decisions that are best for her so that she will feel good about the experience for the rest of her life. With the exception of the VBAC ban, I have heard good things about the birth centers in the [Hospital] system. I hope that you will re-examine this policy and give women who have had a previous cesarean and are candidates for VBAC the chance to choose between VBAC and repeat cesarean. Thank you for taking the time to consider my request. I would like to follow up with you with a phone conversation next week and I look forward to hearing your thoughts on this matter.

Sincerely,

___________________

A letter from a hospital explaining why they banned VBAC

I was sent this letter by a mom from Southern California who wants to VBAC at her local hospital, but can’t since they have a VBAC ban.  She wrote a letter to them, which can be found here, and below is what she received in response.  She gave me permission to post both letters.

The letter was written on hospital letterhead.  I have included the entire letter here and it is typed exactly as it was written except for some identifying information that I have removed for the privacy of the OB who wrote the letter as well as the hospital’s name.  Who he is isn’t as important as what he says since he is speaking on behalf of the hospital.

After the letter, I include some commentary.

Also, please read: Two Doctors Respond to the Hastings Indian Medical Center VBAC Ban and Encourage Native American Women to VBAC! and A VBAC Supportive OB’s Response to the AMA’s Statement on Homebirth.

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March 10, 2008

Dear Ms. B,

I was asked to respond to your letter inquiring about Hospital’s VBAC policy.  Your letter is well written and asks some valid questions.  I will do my best to answer your questions by giving you a historical perspective as well as direct answers.

[….]

Although my primary role involves patient care and administrative duties, I continue to lecture across the country on a variety of obstetrical subjects, with the “Risks and Benefits of Cesarean Section” and “Risks of VBAC” being the two most requested talks I give.  I have personally delivered, or supervised the delivery of over 15,000 births, and continue to be involved in over 5,000 patient encounters per year.

Historically, when Cesarean sections were being performed 40 years ago they were performed through vertical uterine incisions.  These incisions were found to have a uterine rupture rate of 6% in subsequent labors, therefore the standard then was clearly “once a Cesarean, always a Cesarean”.  With the advent of transverse uterine incisions, it was found that women presenting in labor prior to their surgery had a much lower uterine rupture rate than previously documented, and hence the VBAC was born.  Unfortunately, the new uterine rupture rate was simply not known.

In the 70’s, Women’s Right’s groups as well as insurance companies trying to increase profits, pushed the VBAC fury to a point where many institutions began forcing women to VBAC against their wills.  Those of us who knew the procedure was not benign complained of inadequate consent for their patients, and women’s loss of autonomy.  It was not until almost 20 years later, that good modern VBAC data was available, and that the 1/200 (0.5%) uterine rupture rate was documented.

Once the data was available, questions were raised worldwide as to the appropriateness of the procedure.  Here at Hospital, our own obstetricians discussed for over 3 years the both the Ethics and logic behind the VBAC controversies.  The key question is simply whether or not a 1 in 200 risk of fetal death is “acceptable”, and whether or not a woman has a right to make that decision on behalf of an unborn term fetus.  Ultimately, the argument was made that most people would not board an airplane that had a 1 in 200 risk of crashing.  Moreover, we do not allow events to transpire that carry a much lower risk.  For example, it is illegal for a mother to take her newborn baby home from the hospital without a child protective seat (and most parents would not think of doing such a thing).  Yet, the risk of actually being in a car accident on the way home from the hospital is about 100 times less than the risk of a VBAC.  Discussion then took place regarding how good we are at saving mothers and babies that have catastrophic events such as uterine ruptures.  We concluded that “being good” at dealing with disasters was not a good reason for inviting them.  Moreover, in the airline analogy, if we were to invite mom’s to board an airliner that had a 1 in 200 risk of crashing, telling the passengers that only a small percentage of the people onboard would actually die because the hospital and the doctors are good at what they do, is not likely to change their original opinion of declining the flight.

Answering some of your other questions:

I am concerned that if [Hospital] can’t meet the staffing standard for VBACs, that means the hospital doesn’t have the ability to perform an emergency cesarean 23 hors [sic] a day/seven days per week.

[Hospital] is ready to perform emergency cesareans 24×7.  In fact, we are remarkably good at it, and can boast about some of the best outcomes in the world.  Not meeting some of the recommended requirements for VBAC does not infer a lower standard.  Even though we do not have ‘in-house’ anesthesia 24 hours per day, our surgical response time in many cases is better than larger institutions with “in-house” staff.  A large University setting may have in-house staff but simply walking from one side of campus to the other may take more time than driving in from home in our small community.  Moreover, the volume at some of these large centers and logistic delays often encumber those institutions and negatively impact on their response time, whereas [Hospital] has the ability to mobilize and act quickly when needed.

Nevertheless, being good at handling emergencies is not justification for inviting them.  There will always be emergencies in medicine that cannot be staffed or prepared for.  It is a sad fact of life that some women in labor will have heart attacks, and some will have brain tumors or brain aneurysms, and some will have emboli, but no system can have a Cardiologist, a Neurosurgeon, and a pulmonologist available on site 24 x 7 waiting for these things to occur.

We identify these challenges, and we set systems and protocols in place to efficiently handle these emergencies with available resources.  These systems work remarkably well, and fortunately in the majority of cases there is enough time for the mobilization of resources to result in the best possible outcome.

The cesarean rate in this country has risen well above the World Health Organization’s recommended rate of 10%-15%.. I am concerned that the cesarean rate in [our city] is so high…

The WHO recommended cesarean rate is not based on data.  In fact, there are no good published recommendations for cesarean rates that are based on data.  That is for a very good reason, and the reason is that the optimal cesarean rate depends on the goal desired.  If the goal is to optimize neonatal outcome, one can make a very clear and elegant mathematical argument that the cesarean rate should be almost 100%, and that is not a statement that appeals to many, therefore the issue is left mute.  When looking at the morbidity of cesarean sections at term, the majority of complications arise from surgical intervention after failed attempted vaginal delivery.  The actual equations get quite complicated, and depend on multiple factors including the health of the mother, and the planned number of Cesarean sections, and timing between pregnancies. 

When attempted vaginal deliveries are removed from the equation, such as in elective cesarean deliveries at term without labor, the outcomes are much better for the newborns than in vaginal deliveries and the morbidity to the mother can be equivalent or even lower than in attempted vaginal deliveries.  Although we do not consent women for vaginal deliveries, the risks of attempting a vaginal delivery are actually quite high, and carry many of the same risks, if not more, than cesarean sections.  Realize that Cesarean delivery virtually eliminates the risk of birth trauma.  The numbers you quote for fetal injury during Cesarean section are not accurate.  I can tell you the rates you report for newborn injury from Cesarean delivery would not be tolerated and would certainly be identified by quality assurance measures.

You quote statistics in this part of your letter, which are not accurate.  The complication rates for Cesarean sections in the last 20 years have dropped to levels that now are arguably safer than vaginal delivery, and although retained neonatal lung fluid is a very real increased morbidity to the newborns, it carries no long term sequelae in the absence of prematurity, and is more than compensated for by the benefits.

Delivering premature babies, whether by cesarean or vaginal delivery, both have the long-term implications you suggest but are not associated with the route of delivery.

I am concerned that [Hospital] is understating the risks of primary or subsequent cesarean surgeries yet exaggerating the risks of VBAC

The risks of VBAC are very real.  The 1 in 200 risk is an average risk of “catastrophic” uterine rupture taken from many studies across the country.  They do not count smaller ruptures whereupon the baby has not “fallen out” of the uterus yet, as these are often called “windows”.  This leads to the variations in the reporting of uterine rupture.  Those of us who provide care on a regular basis can tell you we see these ruptures frequently, even in the absence of VBACs.  I have seen 3 in the last 6 months at [Hospital].  All were handled well and had good outcomes, but even when trying to minimize these events they happen due to factors beyond our control.  The national death rate from Cesarean sections is less than 1 per 100,000 in most studies.  Unavoidable death due to pregnancy complications unrelated to route of delivery is 1 in 10,000.  When comparing these risks of uterine rupture in VBAC of 1 in 200, you see that the equation very much supports our decision to take the safest route and discourage these procedures.

In summary, the physicians at [Hospital] are very much aware of the dichotomy between what is safest for the unborn fetus and maternal preferences and autonomy.  These controversies are often complicated by lack of data, poorly understood data, and strong emotional components.

I can assure you that we strive to provide the safest medical environment while supporting as much of the autonomy and patient desires as possible.  Nevertheless, we ultimately have to be true to ourselves, and do what science tells us is best for our patients, even if sometimes we cannot please 100% of the clients.

You may find it interesting that since our decision to not offer VBACs, the majority of our patients responded very favorable, with a majority of women reporting a feeling of freedom in not having to justify to others their desire to not VBAC.  Although we expected a backlash of unhappy patients, we were pleasantly surprised to find the majority of women understanding the rationale and supporting our decision.  I now receive less than 2 complaints per year on our decision to not offer VBACs at [Hospital.]

In fact, the greatest increase in our Cesarean section rate the last few years has come from women demanding a Cesarean delivery and refusing vaginal delivery.  The acceptance of women’s autonomy and right to choose their mode of delivery has led to a significant number of women simply choosing Cesarean as the preferred mode of delivery.

If you continue to have strong desires to VBAC despite the risks involved, I am sure your obstetrical provider can help refer you to a University Center where the procedure is still being offered.  Although the risks may not be lower there, they may have chosen to offer the service both for patients and for training of their residents.

Sincerely,

OB

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This letter was so fascinating for me to read.  I want to make a few comments…

Note the names of his two most requested topics: “The Risks and Benefits of Cesarean Section” and “The Risk of VBACs.”  So interesting that cesareans have benefits, yet VBACs only offer risk.

He says, “If the goal is to optimize neonatal outcome, one can make a very clear and elegant mathematical argument that the cesarean rate should be almost 100%.”  So I wonder of the 15,000 births he has been involved with, how many of those women had cesareans?

He quotes a 6% uterine rupture rate in vertical incisions, which seems very high to me.  This is something I intend to research.  If you have studies you can quote, please leave a comment with that information.

He says, “Historically, when Cesarean sections were being performed 40 years ago they were performed through vertical uterine incisions.  These incisions were found to have a uterine rupture rate of 6% in subsequent labors, therefore the standard then was clearly ‘once a Cesarean, always a Cesarean’.”  Yet, that phrase, when coined 92 years ago, was not a anti-VBAC statement.  Here is the history of that phrase from ACOG themselves (Obstet Gynecol 1997;90:312-5. c 1997 by The American College of Obstetricians and Gynecologists):

The phrase, “once a cesarean, always a cesarean” dates back to an article by Edwin Cragin entitled “Conservatism in Obstetrics” published in 1916. Although cesarean delivery rarely was performed in that era, Cragin’s purpose was to urge physicians to avoid unnecessary cesareans. He termed the cesarean operation “radical obstetric surgery” and urged his colleagues to practice sound obstetrics to avoid having to resort to it. The famous “once a cesarean, always a cesarean” phrase came in the final paragraph of the article and clearly was meant to emphasize that one of the risks of a primary cesarean is that repeat operations might be required.  Interestingly, the author went on to point out that there are many exceptions to this rule and that one of his own patients had 3 vaginal births after cesarean without difficulty. This is remarkable given that vertical uterine incisions were standard at that time. The low transverse uterine incision would be championed by Kerr a decade later.

He says, “Once the data was available [on the risk of uterine rupture with a transverse scar,] questions were raised worldwide as to the appropriateness of the procedure.”  This is something I want to look into further.  I have done little research on VBAC philosophies outside of the USA.

He incorrectly states that 1 in 200 VBAC babies will die.  Landon 2004 stated, “Overall, our data suggest a risk of an adverse perinatal outcome at term among women with a previous cesarean delivery of approximately 1 in 2000 trials of labor (0.46 per 1000), a risk that is quantitatively small but greater than that associated with elective repeated cesarean delivery.” In other words, while the rate of uterine rupture in a spontaneous labor with one prior cesarean is approximately 1 in 250 (0.4%), 1 in 2000 (0.05%) VBAC babies will have a bad outcome.  I have more specific information on infant outcomes here

The OB who wrote our letter above then says, “The key question is simply whether or not a 1 in 200 risk of fetal death is ‘acceptable.'”   I find it ironic that the risk of miscarriage from an first-trimester amniocentesis is greater than the risk of uterine rupture yet that risk is acceptable when women want a diagnostic test. 

From the March of Dimes:

Serious complications from second-trimester amniocentesis are uncommon. However, the procedure does pose a small risk of miscarriage.  According to the Centers for Disease Control and Prevention (CDC), between one in 400 and one in 200 women have a miscarriage after amniocentesis. . . Studies suggest that the risk of miscarriage after first-trimester amniocentesis may be 3 times higher than the risk after second-trimester amniocentesis.

So the risk of miscarriage in a first-trimester amniocentesis is between one in 66 (1.5%) and one in 133 (0.75%), whereas the risk of adverse perinatal outcome in a VBAC labor is one in 2000 (.05%).  Miscarriage is death of a baby.  Rupture does not equal death, as Landon 2004 established.  Yet the March of Dimes describes the risk of miscarriage vis-à-vis amniocentesis as “small” while the number of VBAC-friendly hospitals decrease.  Why is it, when a woman wants a diagnostic test, this risk is ‘acceptable,’ yet when a woman wants a vaginal birth, the normal biological consequence of pregnancy, a smaller risk is unacceptable? I have yet to hear one person make a woman feel guilty about having an amniocentesis because she might kill her baby, yet it is quite common for women seeking VBAC to be treated as if they are accepting an excessive amount of risk.  Yet, I have met women who will not VBAC because the risk is to great, yet, when their OB suggested an amniocentesis, they consent.  (Read more here: Comparing Fetal Death and Injury: VBAC vs. Amniocentesis/CVS.)

He says, “We concluded that ‘being good’ at dealing with disasters was not a good reason for inviting them.”  Is an unnecessary miscarriage from an amniocentesis a disaster?  It certainly is for the mom.  And I have to wonder, does he induce labor?  Because that invites more risk as many hospital procedures do.  More on that later.

He says, “The WHO recommended cesarean rate is not based on data.”  Yet, he did not offer any medical studies that show that women and babies are benefiting from the USA’s 31% cesarean rate.  He only states that he believes babies would benefit from an almost 100% cesarean rate.  I think the burden of proof lies with the person wishing to impose surgery.  Show us how women benefit.  Show us how babies benefit.  Show us how you can ensure that my baby is ready to be born at 38 weeks via scheduled cesarean.  Prove to us that our babies won’t be in the NICU because they simply were not ready to be born and have problems breathing.  A quick google search led me to this commentary from the medical Journal Epidemiology published in July 2007 which states:

Twenty years ago, the World Health Organization recommended that no more than 15% of deliveries should be delivered by C-section, pending evidence that higher levels benefit either mothers or their offspring. Of 60 medium- and high-income countries reviewed in a recent study, the majority (62%) had national rates of C-section above 15%. If we assume, based on the World Health Organization recommendations, that C-section rates above 15% lack medical justification, then there are 3.5 million medically unjustified interventions performed among these countries yearly.

This article cited World Health Organization. Appropriate technology for birth. Lancet. 1985;2:436-437 as the source of the WHO recommended 15% cesarean rate.

The commentary continues: (emphasis mine)

What are the consequences of these trends for the health of women and babies? To the extent that high rates of C-sections are not medically indicated [this includes repeat cesareans], they unnecessarily expose the mother and child to consequences that are not fully understood.  In such procedures, the mother and her partner have no active participation in the birth of their child. The costs and benefits of this elective procedure, both physical and emotional, should be seriously explored before accepting the liberalization of its use.

Elective caesarean section may provide some benefits. A systematic review of 79 studies of elective C-sections versus vaginal deliveries, including observational and randomized trials, has shown that women with C-section have decreased urinary incontinence at 3 months and decreased perineal pain in comparison with those having a vaginal delivery.  On the other hand, C-section was associated with a higher risk of maternal mortality, hysterectomy, ureteral tract and vesical injury, abdominal pain, neonatal respiratory morbidity, fetal death, placenta previa, and uterine rupture in future pregnancies.  One limitation of observational studies is that the associations with poor outcomes could be due to the conditions that trigger the C-section rather than the C-section itself, despite statistical efforts to adjust for these confounders.  Consequently, the strength of this evidence should be considered with caution.

Two recent reviews of observational or ecological studies have examined the association of C-section rates with maternal and neonatal mortality and morbidity. One is the study mentioned above, using data on 60 medium- and high-income countries of all regions, and the other is based on data from Latin American countries.  Both reviews found no evidence for reductions in maternal and neonatal mortality and morbidity with increases in C-section rates to above 10%. In fact, higher rates of C-section were associated with higher rates of maternal and neonatal mortality and morbidity.  For example, Barros et al showed that, between 1982 and 2004, the C-section rate in one city in southern Brazil increased from 28% to 43%, whereas the preterm birth rate has increased from 6% to 16%. The increase in preterm births occurred despite improvements in socioeconomic and nutritional conditions in the population.  The increase in C-section rates and also an increase in elective induction of labor contributed to this trend.

Our doctor from the hospital then discusses recent uterine ruptures.  “Those of us who provide care on a regular basis can tell you we see these ruptures frequently, even in the absence of VBACs.  I have seen 3 in the last 6 months at [Hospital.]”  This is very odd.  Since the hospital does not ‘perform’ VBACs, we can imply that these 3 ruptures occurred to unscarred women.  If you look at this post of mine, you will see that Dr. Marsden Wagner states that the risk of uterine rupture in an unscarred uterus is 1 in 33,000.  We know from medical studies that inducing, especially with Cytotec, results in higher rates of rupture.  In VBACing women, the use of Cytotec to induce increases rupture rates to 1 in 20.  This hospital had 2800 births annually.  Using those numbers, approximately 1400 women gave birth during those 6 months.  If he has seen 3 uterine ruptures in the last 6 months, that means 1 in 467 unscarred, non-VBACing women are rupturing at this hospital.  That is an extremely high number – over 80 times greater than the 1 in 33,000 rate.

“You may find it interesting that since our decision to not offer VBACs, the majority of our patients responded very favorable, with a majority of women reporting a feeling of freedom in not having to justify to others their desire to not VBAC.  Although we expected a backlash of unhappy patients, we were pleasantly surprised to find the majority of women understanding the rationale and supporting our decision.  I now receive less than 2 complaints per year on our decision to not offer VBACs.”  Clearly, the VBAC seeking women need to let their local hospitals know that they are not happy with this policy.  I wonder, of the women seeking VBAC, what percentage went to the next closest hospital offering VBAC vs. had a home VBAC (HBAC) vs. had the repeat cesarean.

“In fact, the greatest increase in our Cesarean section rate the last few years has come from women demanding a Cesarean delivery and refusing vaginal delivery.  The acceptance of women’s autonomy and right to choose their mode of delivery has led to a significant number of women simply choosing Cesarean as the preferred mode of delivery.”  Women have the autonomy and right to choose their mode of delivery as long as it is not a VBAC.  They don’t have that right.

Ladies, this is what we are up against.  Reading this letter makes me wonder what is more likely: To convince hospitals like this to change their policy or to educate women on home VBACs?  I don’t think hospital with VBAC bans are going to change their policy.  Why should they?  Scheduled cesareans are easier for the OB and the hospital and it is certainly the fashion to not ‘do’ VBACs. 

If we are going to change VBAC bans, we need to identify how permitting VBACs are to the hospitals’ advantage.  And I think the best way of doing this is by affecting the hospitals’ pocketbook.  If all hospital birthing women, scarred and not, could ban together and birth ONLY at hospitals that permit VBACs, that would make an impact.  The question is, how do we accomplish this?

My local hospital instituted a VBAC ban just last week and there is a part of me that wants to ‘do something.’  But then I wonder, how many women will ‘discover’ homebirth/home VBAC/HBAC as a result of VBAC bans?  How many women will be forever changed by giving birth in their living room?  How many women will never have another hospital birth simply because their local hospital wouldn’t permit it and those women had to either expand their mind to homebirth or be cut once again? 

There is a part of me that sees these VBAC bans as a positive thing.  If we couple publicity of these bans with information on homebirth, we could turn this tide against VBAC around one woman at a time.  In looking at the stats for this website, one of the most common searches is on the legality of homebirth, VBAC, and HBAC.  I want women to know that it is legal to VBAC.  Just because you local hospital has banned it, or your local OB doesn’t ‘do VBAC,’ doesn’t mean that it is illegal in your state.  So many women are told by medical professionals and hospital personnel that VBACs are illegal.  I don’t know if these med pros are actively lying or have been mislead to think that VBACs are illegal, but they are not.  I want women to know that if their hospital has banned VBAC, you have options.  There are other ways to find VBAC supportive hospitals, OBs, and, of course, midwives. 

You do not have to have another cesarean.  You can birth your child.  A good place to start?  Join the ICAN email support group and start planning your VBAC.  Contact your local, county, and state representatives and tell them that you want VBAC available in your local hospitals, that you want midwives to be able to attend VBACs, that you don’t want to have surgery again.  Write your local hospital so they know that women are not happy with their VBAC ban.  And if you local hospital supports VBAC, send them a thank you note and let them know how much you appreciate the option.