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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]

This is great info for women of those states! 

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

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.

Becoming her work
By THERESA HOGUE
Gazette-Times reporter

To better study homebirths, debunk myths, OSU anthropologist became a licensed midwife
When cultural anthropologists are looking at a group they want to study, one of the best ways to access the group is to immerse themselves in the culture, such as moving into a village to learn traditions and language. For Oregon State University assistant professor of anthropology Melissa Cheyney, the best way for her to study homebirths and the people who participate in them was to become a licensed midwife.

Now in her second year at OSU, Cheyney keeps busy, both delivering babies and lectures as she researches the serenity, safety and stigma surrounding homebirths. As a medical anthropologist, Cheyney is particularly interested in the world views of American women who chose homebirth, which is a very unusual decision in today’s world. Becoming a midwife gave her access to many women and midwives practicing homebirth.

“You’re more of an insider than if you were some detached observer up in the sky looking down,” she said. “The idea is that intimacy you get from becoming a member of the community gives you insight you wouldn’t get if you were analyzing from a distance … in order to write (about) someone’s culture, you have to live that culture on some level.”

In the OSU anthropology department, the focus is on community-impact anthropology. That means researchers seek solutions meaningful to the people whom they’re studying, rather than operating on a more theoretical level. Cheyney’s work involves studying midwives as a marginalized group that the broader medical community looks upon with suspicion.

“The most common misconception is that midwives are untrained or poorly trained,” Cheyney said. This perception stems from the trend of midwives to use low-tech medical approaches, such as massage and herbs, during labor. But they also use medical high-tech devices, such as infant heart monitors and they carry anti-hemorrhage drugs and IVs for emergencies.

“It’s this combination between the time-honored ways of being with women … combined with access to training in Western style biomedicine that you can use when you need to,” Cheyney said.
Midwives tend to focus on avoiding medical intervention — such as Cesarean sections or inductions — unless absolutely necessary, under the belief that those interventions bring with them a risk of infection and complications in otherwise healthy women. However, a majority of midwives are not averse to those interventions when there is clear risk to the child. And according to a major study by the British Medical Journal, about 12 percent of intended homebirths end in a trip to the hospital, either during labor or following birth.

Ten percent of births in the United States are attended by midwives. Of those, eight percent take place in a hospital; two percent of births happen at home. Cheyney said this small percentage of homebirths is a goldmine for medical anthropologists, because the motivation and practices surrounding homebirth are so different.

She currently is working on a major study that she hopes will include a large portion of all midwives in Oregon, both licensed and unlicensed. She plans to track their work from the first visit they have with their patients until they give birth, and beyond. About 50 of approximately 125 Oregon midwives are enrolled. Cheyney would like to involve at least 100 midwives.

The information she hopes to gather includes infant mortality rate, safety and other aspects of home birth, and whether licensing, which is optional in Oregon, has an impact on outcomes.
“If you look at all the countries that have better outcomes than we do for material child health, they have two things in common: One is universal health care, and the other is midwives as primary-care providers,” Cheyney said. “That tells us as researchers we need to be looking at midwives.”

On Wednesday, [March 12, 2008] Cheyney will moderate a panel discussion on homebirth that will take place after the screening of “The Business of Being Born,” a documentary about how American women give birth. The event is scheduled for 7 p.m. at the Odd Fellows Hall, 223 S.W. Second St.