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Dear Friends,

As you are likely aware, many women are denied access to VBAC (vaginal birth after cesarean) because of hospital policies and outright bans. Attorneys with the Northwest Women’s Law Center in Seattle are looking at this issue.

It requires that the woman is planning a hospital birth, in a hospital that bans VBAC, because she has no other options (not feeling comfortable with a homebirth is an acceptable reason to not have a homebirth for this purpose, so it doesn’t have to be in an area where there are also no midwives available). The reason for not having options can be geographic (no close hospitals to go to) or something like restrictions placed on her because of insurance or lack of insurance. But she definitely has to be planning a hospital birth.

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I’m a lawyer with the Northwest Women’s Law Center in Seattle. I’m investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states Alaska, Idaho, Montana, Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and regardless of whether it is actually medically necessary, and you are willing to consider working with a lawyer on this, we’d like to talk with you. Please respond to
vbacbanhelp at ican-online dot org.

Even if you are not in one of the states listed, you can still help by emailing this out to any email lists you are on and asking everyone who receives it to email it to all the lists THEY are on as well so that it is distributed far and wide. Thanks.

Sincerely,
Susan Hodges, “gatekeeper”

Take the time to get and read your records.  You may find that your “emergency” cesarean was no rush at all.

Medical Records Copying Charges by State

Roberts RG, Deutchman M, King VJ, Fryer GE, Miyoshi TJ.
Department of Family Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin 53715, USA.

BACKGROUND: The issue of vaginal birth after cesarean (VBAC) has become highly visible and contentious. In 1999, the American College of Obstetricians and Gynecologists advocated a policy that surgical capability be “immediately available” for women in labor attempting VBAC.

METHODS: Every hospital in Colorado, Montana, Oregon, and Wisconsin was contacted by telephone at least once during the period 2003 to 2005. Using a semistructured interview, respondent hospitals were asked whether and when their policies for VBAC had changed and what was the availability of VBAC services before and after the 1999 policy was issued.

RESULTS: Of 314 hospitals contacted, 312 responded to the survey (response rate 99.4%). Babies were delivered at 230 (74%) respondent hospitals. Almost one-third, 68 of 222 (30.6%), of responding delivery hospitals that previously offered VBAC services had stopped doing so; seven hospitals had never allowed VBAC. Of the hospitals that still allowed VBAC, 68 percent had changed their VBAC policies since 1999, with the most frequent changes requiring the in-house presence of surgery (53%) and anesthesia (44%) personnel when women desiring VBAC presented in labor. Compared with hospitals that stopped allowing VBAC, those that currently permit VBAC were larger (156.6 vs 58.1 beds, t = 7.02, p < 0.001), closer to other delivery hospitals (20.9 vs 39.2 miles, t = 4.33, p < 0.001), annually delivered more babies (1009.9 vs 458.3, t = 4.41, p < 0.001), and annually had more cesarean deliveries (226.7 vs 105.7, t = 3.91, p < 0.001).

CONCLUSIONS: In the years following advocacy of the 1999 policy, the availability of VBAC services significantly decreased, especially among smaller or more isolated hospitals.

PMID: 18021147 [PubMed - in process]

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.

If there is a hospital near you that has imposed a VBAC ban, contact your local newspaper and let them know.  Offer information, statistics, and your own experience.  I think it’s important that we stress how banning VBACs is no different than banning vaginal birth. 

Read more about hospital safety and banning VBACs here: http://vbacfacts.com/vbac/#BV

Based on the most recent evidence, in March 2005 the American Academy of Family Physicians (AAFP) revised its VBAC guidelines and now encourages women to consider labor after a prior cesarean and maternity care providers to support women’s choice. The AAFP found no scientific evidence that having a surgical team and anesthesia "immediately available" when a VBAC mom labors to significantly improved outcomes. The complete guidelines are available as a pdf file from the AAFP web site.

I personally would not feel safe at a hospital that does not permit VBACs, whether my uterus was scarred or not. If they cannot accommodate a medical emergency such as uterine rupture, how could they possibly respond and treat other real, but rare, labor emergencies such as cord prolapse or placental abruption, both of which require the baby being born ASAP usually by immediate cesarean sections?  We know that babies have a 10 times greater risk of dying for reasons other than uterine rupture. (Lyndon-Rochelle 2001)  How could any mother labor in confidence knowing that if something went drastically wrong, that hospital could not quickly respond? At which point, why even go to a hospital? I always thought that was the point of hospitals in terms of birth – to treat the very rare complications that require immediate surgical intervention. If hospitals eliminate their ability to rapidly respond to a medical emergency requiring a surgical birth, how is laboring at a hospital like that any different than laboring at home? People labor in the hospital for that minute "what if" chance thinking that they will be safe. Thinking that laboring at a hospital is safer than home. But if a hospital labels itself as non-VBAC friendly, they have labeled themselves unsafe for any laboring woman. Hospitals which do not permit VBACs are unsafe to all women and laboring women should avoid them. We need to send a message with our money and our babies by only laboring at VBAC-friendly hospitals or electing to birth at home.

Please sign the petition urging St. Peter’s Hospital in Helena, MT to repeal their VBAC Ban: http://www.ipetitions.com/petition/NoVBACban/signatures.html