Comments on: Arizona Mom Fights VBAC Rules at Local Hospital

By: "Sarah"

"Sarah" — Sat, 19 Dec 2009 12:03:04 +0000

I agree that the problem begins with our high c-section rate, but there is more to this problem. It’s true that VBAC moms have difficulty finding an OB and a hospital that will allow a VBAC. Although, when one is found, we are often required to submit to certain procedures or policies that have little or no justification. I am currently pregnant and intend to deliver my baby at a local hospital that allows women to deliver in inflatable pools of water. However, the hospital policy states that women attempting a VBAC can only labor in the water. At the actual moment of birth, the VBAC mom must stand up in the pool to deliver the baby and then she can sit back down in the water. Standing in water during delivery doesn’t sound safe and there are no medical reasons why a VBAC cannot occur in the water. In fact, many women attempting a VBAC have water births at home under the supervision of a midwife with no problems. Hospitals are not the only problem. In many communities there are no midwives available to attend a home birth, or free standing birth centers to accommodate laboring women. Due to restrictions from some insurance companies (including Medicaid in my area) home birth or birth centers are not an option for every woman. Why is it that a woman has a right to choose whether or not to abort her child, but has little choice regarding a child’s birth?

By: Sarah

Sarah — Thu, 17 Dec 2009 17:14:24 +0000

What a mirror image for my personal story. On my first delivery I had, what I now know, was a “failure to progress in labor” c-section which the doctors (off the record) told me was “celphalopelvic disproportion” ( baby is too big- was 8# 4 oz). A friend told me I could have a VBAC the next time, but doctors wouldn’t let me. I switched to the high risk delivery doctor at the largest hospital in the area and had a very successful vaginal delivery of an even larger baby. (8# 11 oz) I went on to deliver 2 more children of similar size the natural way as well. On #4 we did have to negotiate a bit as they gave me too much epidural and put me to sleep. My husband, bless his heart, made sure my body was allowed to do what it does naturally and avoided a c-section again in spite of the situation. I also found it ironic, that I never needed an episiotomy during all 3 natural deliveries. Recovering from a c-section while caring for and nursing an infant was very painful and I wish I had known from the beginning how to avoid a c-section unless it is a true emergency. I had my last child 10 years ago and can see it has only gotten worse since then. OBGYN’s are in a tough position due to their high malpractice costs and the best advice may be to educate for avoidance of unnecessary c-sections before a woman’s first delivery.

By: Christine C.

Christine C. — Tue, 20 Oct 2009 18:46:11 +0000

Here is the article Susan mentioned (thanks!) from Citizens for Midwifery:
http://cfmidwifery.org/resources/item.aspx?id=32

Childbirth Connection also has good data on incentives and costs: http://www.childbirthconnection.org/article.asp?ck=10285

Generally speaking, a vaginal birth without complications is least expensive; followed by a vaginal birth with complications; a c-section without complications; and finally, the most expensive, a c-section with complications.

An earlier post by Rachel on liability issues is also relevant:
http://www.ourbodiesourblog.org/blog/2009/09/providers-liability-concerns-limit-womens-choices

By: Stacey

Stacey — Mon, 19 Oct 2009 20:48:34 +0000

Good for her to stand up and get the public involved. I had similar issues when I wanted to have my second child. The area hospital, Everett, WA, considered me high-risk, virtually would not allow an attempt at natural labor, etc all because I had a C-Section with my first because he was breech. I fired my OB, found a mid-wife who would do homebirth VBAC, and had a beautiful, safe homebirth. I didn’t even bother going to an OB for my third, and again had a beautiful, peaceful water birth at home. We need more women in the USA to stand up for their rights to birth, the natural way!

By: Jessica A

Jessica A — Mon, 19 Oct 2009 19:41:48 +0000

In response to Susan,

Sorry, for posting this, but just sharing you how I feel on this. You got to be kidding me on this because most of them are being performed nowadays in non emergent situations. Then being performed in emergent situations which they were intended for. At the same time I’m with others (Jill–Unnecesarean, JoshuasGrandma, Pamela, my previous response here).

By: Susan

Susan — Mon, 19 Oct 2009 17:13:49 +0000

in response to JoshuasGrandma…

While economics may not be ALL of the problem, hospitals and physicians do stand to gain economically from performing more cesarean sections, and planned cesareans (as are typical when VBAC is denied) are the best economically speaking. Planned cesarean sections are very efficient and predictable for space and staffing, and there are many add-on charges that are paid for by insurance; in contrast, letting labor start and proceed on its own time frame requires unpredictable use of space and staff with fewer complications and interventions, while the hospital will usually be paid only a set “global fee” for the birth. The article “Effects of Hospital Economics on Maternity Care”on the Citizens for Midwifery website explains some of the basic economics that drives interventive maternity care. Under our current system, the more interventions and the more complications requiring treatment, the more income for physicians and hospitals, but letting labor begin and continue on its own time frame (including for VBACs) results in less income for the hospital and physician, even though the outcomes are better for mothers and babies.

By: Pamela Maurath

Pamela Maurath — Mon, 19 Oct 2009 11:32:43 +0000

If If ACOG and hospitals consider VBACs “too risky,” then they should work to reduce the primary c-section rate, which is the beginning of the VBAC cycle. If there were fewer primary c-sections (risky surgery) then the issue of VBACs would not be such an issue. Perhaps ACOG would like to comment on the increase in primary c-sections from 25% to 31% when the recommended rate from the World Health Organization is 10% to 15%. While I think Joy and her family are courageous for standing up for their health care choices, the real issue is getting the OBs to reduce the primary c-section rate. While c-sections were intended, and have in fact saved the lives, of the 10% to 15% of high risk pregnant women and their babies, the current rate goes way beyond the average for the population. In fact it is to the point where one has to wonder if OBs and hospitals are really concerned with the best health care for the mom and baby, or whether they are more concerne with their annual income.

By: JoshuasGrandma

JoshuasGrandma — Sun, 18 Oct 2009 14:11:38 +0000

Since evidence shows that safety is NOT the issue, has anyone done a cost-comparison of VBAC vs C-section? There has to be some motivation for such a policy that so interferes with a patient’s autonomy and wishes.

By: Jessica A

Jessica A — Fri, 16 Oct 2009 19:04:39 +0000

2nd what Jill–unnecesarean said in her response here. I’m so so so glad that Joy is following her gut instead of her doctors or others or hospital gut as well. Now, hope others will follow her example here in the US and other countries like US as well.

By: Jill--Unnecesarean

Jill--Unnecesarean — Fri, 16 Oct 2009 13:38:08 +0000

I’m really glad Joy decided to speak up. This has generated a national discussion about VBAC, women’s right to autonomy, ACTUAL evidence of the safety of VBAC and the rare but real threat of court-ordered cesareans.