I want to plan for a VBAC I am not pregnant as of yet but will be ttc in 2 months. I am from La Crosse WI area and they have two hospitals Gunderson Lutheran and Franciscan Skemp..when I called them to get there statistics about VBACs they told me they didn’t have any. So how should I choose which hospital to go to for the better chance of succeeding with my VBAC. I also do not have any doulas in the area is it necessary to have a doula for a successful VBAC? Any thoughts or suggestions would be great. Thank you.

Hi Jeri!

It’s ironic that the person you spoke with at the hospital said that they didn’t have any VBAC statistics, because when I googled “Gundersen Lutheran VBAC,” I found a page entitled "Births by Cesarean and Vaginal Births After Cesarean” on Gundersen Lutheran’s very own website where they state:

A vaginal delivery is the preferred, naturally-designed way to have a baby but when needed, delivery by Cesarean section is a second option. At Gundersen Lutheran, efforts are made to choose a vaginal birth, even after a previous C-section unless there are reasons that would put mother or baby at risk.

“Generally, successful VBAC is associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, fewer infections, and fewer thromboembolic events than cesarean delivery.” [ACOG Practice Bulletin #54 2004)

AIMS
1. To have a cesarean section rate below the national rate
2. To have a VBAC rate higher than the national rate

They have succeeded in their goals as Gundersen Lutheran boasted a 27.3% VBAC rate in 2006.  That is exceptional considering that the national average is 9.2% (CDC 2006) and the Wisconsin state average is 12% (Wisconsin: Infant Births and Deaths 2006).

Ted Peck, M.D. is named “activity leader” on that page so I would contact him and ask for the top three VBAC doctors at Gunderson Lutheran.  I would also check out the resources here for additional referrals and to see if any of the names overlap.  Keep in mind that just because the hospital has a great VBAC rate doesn’t mean that all the OBs are supportive of VBAC.  You will still want to ask the same questions and interview a couple different doctors, just like you would get more than one quote if you wanted work done on your house.  You are the consumer, you have the power to chose who you will hire!  It’s important for you to understand the risks and benefits of VBAC vs. repeat cesarean to you, your baby, as well as your future children and health, but be on the look out for scare tactics masquerading as informed consent.

I also googled “Franciscan Skemp VBAC” and was directed to ICAN’s VBAC Hospital Policy Information where Franciscan Skemp is listed as a de facto VBAC ban hospital.  This means that while there is no formal ban in place, the hospital does not attend VBACs.  They could give you a whole list of reasons like, “Our OBs don’t want to do them” or “Our anesthesiologists don’t want to sit in the hospital during a VBAC labor,” but Dr. Stuart Fischbein gives us another perspective:

[Hospitals] ban VBACs under the guise of patient safety. But patient safety is a euphemism for “we don’t have a good evidence-based reason to do it, other than we don’t want to get sued, it’s more expedient, and we make more money from c-sections—the hospital does, not necessarily the physician, but the hospital does—so we’re going to ban it because it’s easier for us, and we’re going to say it’s for patient safety because of the risk of rupturing the uterus.” But you know what? That risk should be something that the patient decides. Patients have a right to be given informed consent, free from misinformation or coercion, free from skewing information that benefits the practitioner or the hospital. And they have the right to consent or refuse to accept the treatment that’s offered. That right is frequently being denied.

(To read more of this interview with Dr. Fischbein, please go to: An Inside Look at Hospitals & VBAC Bans.)

If I was unable to easily find this information by googling, I would have gone to Wisconsin’s Department of Health Services and just start searching for VBAC, birth, cesarean, and hospital statistics to see what I could find.  Sometimes this data is so deep within a website, it can be tricky to locate.  You could also call the Department of Health Services and ask them if they maintain hospital birth statistics.  The state of California maintains this data, but I don’t know if all states do and if they make that information available to the public.

In terms of a doula, yes, I think it’s very important for any woman laboring in a hospital, especially women seeking a VBAC, to have a doula.  (Here is more information on what a doula is and the many benefits of having one: DONA’s Birth Doula FAQs.)  Some practices are not supportive of doulas, even going so far as to post a sign in the waiting room detailing their anti-doula policy.  Switch providers immediately if you read a similar sign or if you discover that your provider is not doula friendly.  A great way to find out is to ask your OB or midwife if they have any doulas they can recommend.  Their response will quickly tell you if this care provider and you have the same vision for your birth.

I went to findadoula.com, and found there was one doula listed for La Cross, WI:

Renee Plunkett

Telephone: 608-786-4466

Location: West Salem Wisconsin United States

I also cover the following geographic areas:
La Crosse, WI

Hopefully you two will be a good fit and if not, the list of resources I provide for finding a supportive OB or midwife can also be used for finding a doula.  I would add DONA and toLabor (formally ALACE) which are Doula credentialing organizations as additional resources.  DONA lists 64 birth doulas and toLabor lists 10 birth doulas in Wisconsin.

You can find more VBAC statistics by going to the The Birth Survey’s State Resources page which provides links to each state’s birth statistics.

For Wisconsin, we have Wisconsin: Infant Births and Deaths, 2006 where we are given the following statistics on page 30:

Delivery Method	Number	Percentage
Vaginal (no previous C-section)	52,713	72.9%
Primary C-Section	10,342	14.3%
Repeat C-Section	7,418	10.3%
VBAC	1,017	1.4%
Forceps	812	1.1%
Other	0	0.0%
Total Births	72,302	100%

We can determine the VBAC rate by adding the number of Repeat C-Sections (7,418) and VBACs (1,017) together to get a total number of births after cesarean in 2006 (8,435).

By dividing the total number of VBACs (1,017) by the number of births after cesarean (8,435), and multiplying that number by 100, we get the VBAC rate of 12.06%.  This means that 87.9% of women in Wisconsin have repeat cesareans.

Here’s hoping you are in that 12%!

Warmly,

Jen from vbacfacts.com

Baby born on I-43 during the morning rush

By Erica Perez and Sharif Durhams of the Journal Sentinel

Posted: July 27, 2009

The baby’s name was supposed to be Cecilia Violet Marie Schulte.

But "supposed to be" doesn’t work for a child born in the front passenger seat of a 1998 Toyota Corolla driving through rush hour on I-43.

Her mother, Annmarie Schulte, delivered the baby herself at 7:28 a.m. Monday, moments after she reached down and felt the little head in her hands.

One contraction later, the baby slid out into her mother’s arms: pink, still sleeping and – her mother knew instinctively – healthy.

"She’s here!" Annmarie exclaimed to her husband, Matthew, who still sat behind the wheel.

By the time they got to the hospital, they would christen their daughter with a new middle name befitting her special birth.

But the story of how the newborn got her name began months ago.

Annmarie, 34, a stay-at-home mom, and Matthew, 39, a teacher who is looking for work, have three older daughters – Megan, almost 7; Millie, 5; and Libby, 2.

For each of her three previous childbirths, Annmarie had gone to the hospital too early and had to have a Caesarean section because of failure to progress. This time, Annmarie wanted a natural childbirth. Some doctors told her it shouldn’t be done. Vaginal births after two C-sections are considered risky because they can cause uterine rupture. She was due Aug. 4. Two doulas – Wendy Kogler and LaNette McQuitty – worked with her during pregnancy, and a physician and a midwife worked with her at Aurora Sinai Medical Center, where she planned to give birth.

Wait until you know for sure the baby is coming before you go to the hospital, Annmarie was told.

At about 1 a.m. Monday at the Schultes’ Muskego home, Annmarie woke up Matthew. Her labor pains had become more intense.

By 3:30 a.m., contractions came about two minutes apart. She and Matthew called the doulas.

They came over and monitored Annmarie’s progress. She got in the bathtub. She changed positions. Around 7 a.m., she was fully dilated. They called the midwife. It was time to go to the hospital – now.

Leaving their other girls with neighbors, Annmarie and Matthew rushed to the car. In their hurry, they grabbed towels but forgot everything else at home – a change of clothes for them, the baby’s clothes, the car seat.

They drove toward Aurora Sinai, Annmarie still in her black-and-white striped nightgown and Kogler and McQuitty following behind in separate cars.

Matthew remained calm, driving below the speed limit and soothing his wife when she felt a contraction.

Kneeling on the passenger seat, Annmarie felt between her legs and cupped her baby’s head.

"She’s coming!" Annmarie screamed.

"Do you want me to stop?" Matthew asked.

"No! Keep going!"

With the very next push, the baby entered the world. She didn’t cry; she slept peacefully.

"She’s here!" Annmarie said.

Annmarie looked at the baby and experienced a deep feeling that everything was all right. Unconventional, but all right.

Matthew was not so sure. He looked at the baby and felt the deepest sense of terror he has ever known. He let out a primal scream. He pulled over into the distress lane at the Plainfield Curve on I-94/43. The doulas pulled over after him.

He ran from the car, still screaming. Words finally came. He frantically waved and yelled for the doulas to come out of their cars.

Kogler called 911. McQuitty checked on the infant. The baby turned a bit purple.

McQuitty gave her a breath and rubbed her back. The newborn turned pink again, letting out a tiny mewl.

Everyone cried. Annmarie wrapped her daughter in a towel and held the 7-pound, 4.8-ounce baby to her chest.

Emergency responders arrived, giving the baby a clean bill of health. Matthew clamped the umbilical cord and cut it.

People driving by on their morning commute, having heard about the freeway birth on news radio, rolled down their windows and yelled: "Happy Birthday!"

The emergency medical technicians joked: "You should name the baby ‘Plainfield’ or ‘Freeway’ or ‘Shoulder.’ "

"Her name is Cecilia," Annmarie said.

Matthew and the doulas followed behind Annmarie and the baby in the ambulance to the hospital.

"We freakin’ did it!" Matthew yelled when they got to Aurora Sinai.

"I think we really should make her middle name ‘Freeway,’ " he said.

Well, Annmarie thought, this child has a free spirit. And the name certainly fit the occasion.

So it was agreed. Cecilia Violet Marie Schulte would be Cecilia Freeway Schulte.

"Each one of my kids is an amazing blessing, but this baby, I delivered – not only vaginally but on my own," Annmarie said. "With the help of my husband and the doulas, I did it. I feel awesome."

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]

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