March 3, 2009

ICAN Releases VBAC Policy Database

The International Cesarean Awareness Network has conducted a survey of hospitals across the U.S., in which they asked labor and delivery nurses at each facility whether a VBAC (vaginal birth after cesarean) could be had and whether there were any doctors at each who supported VBACs. Respondents were also asked how far an individual might have to travel to find a hospital that does offer VBACs, whether they knew the name of a doctor who does VBACs, and what would happen if a person showed up at that hospital and refused a c-section.

This information has been used to create a VBAC Policy Database, which can be searched by VBAC policy, or browsed by state. Each hospital surveyed has been categorized as allowing, banning, or having a de facto ban on VBACs (according to ICAN, a “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support). For each facility, clicking on the name will lead to a hospital-specific page with additional details, such as the date they were surveyed and their actual answers to the survey questions.

One limitation of the data is in which L&D nurses were allowed to answer the questions authoritatively – callers asked to speak to the charge nurse, but if unavailable callers might have spoken to another nurse who may have had limited knowledge of hospital policies. However, the database seems like an excellent starting point for women, families and advocates concerned about this issue. ICAN also frames the database as a starting point, explaining:

“As always, you need to call any hospital you are considering and ask the hard questions yourself. Policies change, people who answer the phone can be uninformed and we don’t guarantee any of the information collected here. We are a community of women seeking out the most informed birth choices possible. We welcome your contributions to this pool of information.”

In order to allow those contributions to the information, the database has a very cool feature – for each hospital, comments can be left just like on blogs – so if you have a different experience than what the VBAC Ban Database would suggest, or have other personal comments on a facility, you can add a comment to the page for that hospital.

Finally, ICAN suggests that there has been an increase in VBAC bans since they last conducted a similar survey:

“The survey shows a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with ‘de facto’ ban.”

For additional discussion of this topic, see our excerpt from Our Bodies, Ourselves: Pregnancy and Birth, Vaginal Birth After Cesarean (VBAC) or Repeat Cesarean Section?


6 Responses to “ICAN Releases VBAC Policy Database”

  1. labornurse@nursingjobs.org Says:

    Thank you, Rachel, for elaborating on this. I didn’t do any investigative research on who was providing ICAN the VBAC info for each hospital and made the assumption it may have been some admins who may not even have been familiar with VBACs overall. Knowing the info came from the L&D nurses is interesting; you are right in pointing out that ICAN may have come across some nurses who were not familiar with the actual VBAC policies. On the other hand, hospitals that say they can do VBACs may not in reality, which nursing can identify to ICAN as the “de facto”places.

  2. Angela Says:

    What I liked about the way ICAN did this was that we called as a regular “Jane Doe” kind of mom, never identifying ourselves as associated with ICAN. It replicated, as closely as anyone could, what any regular Mom would find out in calling a hospital for vbac info. Some of the calls were startling–hearing from L&D nurses that vbac is illegal (it’s not), that you and your baby are safer having a rcs (they’re not), and that a rcs is so much better than vbac (most times it’s not).

    Sad, sad day when women who “support” 99% of the birthing women in the US don’t really support normal birth.

  3. Rachel Says:

    Angela, that’s fascinating. I noticed ICAN did point out that “When you read the comments, please understand that we recorded them as they were given to us and they often contain statements that are contradicted by the medical evidence about VBAC. Sometimes the reasons given for a VBAC ban (“it’s illegal”) are simply untrue.” I’m going to have to dig around in the comments for what kinds of bizarre things people were told!

  4. Jamie Says:

    It’d be interesting to get a similar study done regarding breech vaginal deliveries. I gave birth to my second daughter via breech vaginal delivery in May. I did find a practice of doctors who were willing to do it; out of 15 doctors in the practice, 12 were open to it as long as the conditions were right (baby’s estimated weight and exact position etc). As luck would have it, I went into active labor and to the hospital when one of the 3 doctors who was not ok with it was working. I refused and though I was met with the “waiver of warning of death” and pretty much forced into various interventions, she was born vaginally. I discharged us 12 hours after giving birth, against medical advice too. Birth should not be treated as an illness.

  5. Rachel Says:

    Ooh, Jamie, that would be interesting. I was once told by a nurse that breech babies can “never” be delivered vaginally, and I’d bet there would be a lot of responses along the same lines as that and what you experienced.

  6. Jamie Says:

    I just got copies in the mail of my records from when I gave birth. The reason my doctor listed on paper for my episiotomy was that tearing was likely. The reason he gave me in the heat of the moment despite my begging him not to; to use massage and counter-pressure? “Baby’s heartrate is falling!”.

    I switched hospitals earlier in the day of the night my labor started because my hospital was refusing to even consider a vaginal birth. The doc at the new hospital said that even if I wound up in labor with a doctor who didn’t want to do a breech birth, that I was safe by refusing because all doctors in the practice were more than capable of doing it. The docs at my original hospital were all about “OMG ur baby iz gunna DIE!!!”. I was with the midwives there and they were all behind my decision but it was out of their hands.

    I wish I could remember all of the reasons behind why I “couldn’t” deliver vaginally. Looking back, it makes me laugh. At the time, though, I was livid.

Leave a Reply

*
To prove you're a person (not a spam script), type the security word shown in the picture. Click on the picture to hear an audio file of the word.
Click to hear an audio file of the anti-spam word