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Consumers Question a VBAC Ban

by Mar 24, 2008VBAC, VBAC Bans1 comment

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,

___________________

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1 Comment

  1. Hi. I just wanted to compliment the letter writer for an excellent point in the handling of any non-vbac birth. I have a sad story involving my daughter and 2 grandchildren who passed after placental abruptions(separate births) at a hopital where there is no anethesiologist immediately available. The first stillbirth was at 32 weeks and we believe that the baby was dead long before we arrived at the hospital. The second stillbirth about 1year later happened at 28 wks, but the baby was alive but in distress when we got to the hospital (per the fetal monitor), and though the ob was there, we had to wait for the anethesiologist and neo-natal specialist. To make your point – I called the e.r. in route while giving my daughters complete history: Prior abruption, c-sect delivery and D.I.C which resulted in her near death after 8 transfusions and the babys stillbirth. Told them her symptoms that she was 28 weeks and that she was abrupting again, they asked if someone needed to meet us, I told them we were 5 minutes away and would be faster if I just completed the drive… It took 1 hr. after we got to the hospital for that baby to be born. 1 HOUR. Yes, he was dead and my daughter was almost gone to. Transfused 13 times and in surgery for almost 3hours with a uterus that was almost removed because it would not stop bleeding. So yes. I question the reason why the propper staff isn’t immediately available. I also question why they didn’t call for the proper staff until 30 min. after we arrived, but that’s a whole nother issue… My lesson from your expirience, is that if the hospital isn’t sanctioned for vbac, then there won’t be the proper staff on duty to ensure any complication might have a better outcome than we’ve had. The argument here needs to be why? Any hopital that has an e.r. needs to have ansethesiologist on duty, in my opinion. If they don’t provide that, people need to know before it’s to late for them. Any traumatic injury that requires you being put to sleep, may be your last, if your hospital is not equiped with the proper staff. Healthcare costs have skyrocketed, i get charged 10 dollars for a tylenol in the hospital. Why aren’t they insuring the welfare of the people they serve and charge so much? Is it because most people don’t know??? I hope we can change this, because I found out today that my daughter is pregnant again, and instead of it being a joyous time. I cried and prayed to the lord that she makes it through… I now know what to ask and what to say, if I ever need to call in an emergency again… Page the anethesiologist 911!

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Jen Kamel

As an internationally recognized consumer advocate and Founder of VBAC Facts®, Jen helps perinatal professionals, and cesarean parents, achieve clarity on vaginal birth after cesarean (VBAC) through her educational courses for parents, online membership for professionals, continuing education trainings, and consulting services. She speaks at conferences across the US, presents Grand Rounds at hospitals, advises on midwifery laws and rules that limit VBAC access, educates legislators and policy makers, and serves as an expert witness and consultant in legal proceedings. She envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and community support, so they can plan the birth of their choosing in the setting they desire.

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