Category Archives: New Jersey

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?.

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

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 RN’s Perspective on the 2 NJ CS Deaths & Her Own Birth Experience

As I’m sure you can imagine there was much discussion on the ICAN list of the two moms who died within days of each other after their cesareans at Underwood, a New Jersey hospital.

I’m sharing the following post, with permission.

********************************************

I am a registered nurse, and have no intention of ever working within a hospital setting again. It really is all about the business and not about the patient. The human life we are caring for. In NJ, where I reside, there is a nursing shortage. In addition to a nursing shortage, there are very poor unregulated nurse patient ratios, making quality care hard to provide when the nurse is spread thin. I don’t know what the mother baby ratio was at Underwood, but I do believe that with the appropriate monitoring, these cases if truly resulting in hemorrhage and a clot perhaps may have been prevented. But there are a lot of questions that need to be asked.

At what point in their stay did the episodes occur?

Where was the clot? Was it a pulmonary embolism? Clot went to the lungs. A myocardial infarction? Clot went to the heart. A stroke? Clot went to the brain. Was her PT/PTT time measured before or after the surgery? Bleeding time. What were her platelets? Clotting component. These measure clotting predictability. Was she wearing compression boots on her legs and if so, for how long. This is to prevent clot formation, which is very often where clots form s/p surgeries due to venous stasis, and platelet formation at the incision site. How often was the nursing staff in the room? How often were her vitals measured? Did she complain of any DVT pain? Leg pain, heat, swelling of the leg at the location of the clot? There is clot busting medication available IV for emergency situations. But if no one was in her room for hours upon hours, no one would have seen the signs. I know from my 4 c/s that nurses don’t frequent the room as often as they should
and they don’t respond quickly to your calls on the call bell.

Hemorrhage. Where did it originate? Was her CBC monitored? Was her vitals monitored? If so, how often? What was her PT/PTT pre-operatively & postoperatively? Was something nicked? Was it vaginally? Did they attempt a blood transfusion? Did they attempt to stop the cause of the bleed?
There are so many unanswered questions here.

My horror story,

[After my cesarean] they medicated me and took my baby back to the nursery. They told me they would bring him back at 1am to breastfeed. They did not. I awoke at 6am when they did my vitals, which was done by a tech, at the beginning of each 12 hour shift. Q 12 hour vitals are not enough to detect a potential postoperative problem. They never brought my baby back. I asked for him, and was told, soon. I called again at 7am and they were in the middle of a shift change. I called again at 7:45am and was told the babies were being seen by the docs and he would be brought to me after. 8:30am I called down and was told that he was being seen by the doc. 9 am, the doc came into my room, no baby. No nurse. It had not even been 24 hours since his c/s birth. I was still medicated, still could not feel my legs, I was in compression boots, still had the foley catheter, still had the IV. The doc sat at the foot of my bed and proceeded to tell me that my baby had stopped breathing, needed resuscitation. There were other details but all I could hear was my baby stopped breathing. He WAS fine when he was with me. He left me there, by myself. I called down to the nurse, that I needed her NOW. No one came for the 15 minutes that I was on the phone with my mother and my husband telling them what had happened and to come down. I had to call the nurses station again, this time, demanding that a nurse come and release me from everything or I would do it myself.  For God Sake my baby nearly died. One came, and an hour later I was being wheeled down to see my baby… nothing urgent to them. Not enough staff to meet the needs of the patients. My son is wonderful, thank GOD, he is 16 months old! But if I could not get nursing support, and I was calling for it, who is to say that this was not part of the problems in these Underwood cases?

Tiffani, RN

http://icanofcapeatlantic.blogspot.com/