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Thursday, March 11, 2010

VBAC Mamas, Unite!

I'm a proud VBAC mom. My first birth was a cesarean. Luckily, my next birth took place during the VBAC renaissance, and even though they were whispering in the corner about a repeat cesarean, it didn't happen. I had my first vaginal birth accompanied by a giant episiotomy. That didn't stop me, though. My next VBAC had no episiotomy. The VBAC after that, the doctor almost didn't make it in the room to catch in time. By that time, I'd had enough. My next four VBACs were at home with midwives. Seven successful VBACs.

Women today rarely get the opportunity to even try a VBAC. Hospitals ban them. Doctors trick women into thinking they can have one and then pull the rug out from under them late in their pregnancies. Yet the evidence shows that VBAC is still a safer route to go than repeat cesareans.

This week, the National Institute of Health (NIH) has had a panel meeting to discuss this very issue. I haven't had the opportunity to listen for myself yet, but I've been reading the comments posted by others, outlining the "Hurray!" moments and the "I can't believe they still ignore us" moments.

On the WebMD site, David DeNoon reports, "Hospitals and professional societies should end bans that that keep many women who've had a C-section from opting for a natural birth in later pregnancies, an NIH advisory panel today urged." This is definitely a welcome beginning.

Kenneth Lin, a family practice physician from Washington DC, writes about the obstetrical tendency to see zebras instead of horses. He writes, "If an Ob/Gyn is feeling uncertain about how well a patient's labor is progressing and has an inflated estimate of the probability that something might go wrong (the zebra), it's very hard to resist the temptation to eliminate the uncertainty by delivering the baby surgically, then and there." He ends his article positively with "a trial of VBAC is successful more than 75 percent of the time. It's a real shame that women in the U.S. are discouraged from attempting them more often."

All this sounds great. Maybe women will get more opportunities to have their own VBACs. Maybe the cesarean rate will go down. Maybe... but then we see the extra caution thrown in. "Only qualified candidates" and "eligible patients" are the phrases that begin to crop up. Isn't that part of the problem now? Obstetricians are removing almost every woman from being qualified or eligible. Let's just schedule that cesarean... what do you say? You can pick a convenient time (for the doctor!) and we'll have your baby out in no time!

Kind of defeats the whole purpose, doesn't it? The real result is shown clearly by Courtroom Mama on Jill's Unnecesarean blog. Apparently, on day one, two members of the panel, Dr. Anne Lyerly and Dr. Howard Minkoff stated without hesitation that a woman could not be operated on against her will. The next day, when Susan Jenkins, the attorney for the Big Push for Midwives campaign, asked questions about this, the panelists ended up skirting the issue.

Here is a portion of Courtroom Mama's transcript from her post. Read the full article at the link above to the Unnecesarean blog. SJ is Susan Jenkins. LM is Larry McCullough, the ethicist on the panel.

"SJ: Dr. McCullough, just one quick follow up question, if I may, on that. The conclusions that are reached in the draft, at least the draft opinion that we saw this morning, indicate that the position of the committee is that only where it is considered “medically reasonable”—whatever that means—would the woman have a right to refuse. And the definition of medically reasonable…well, there is no definition of medically reasonable.

LM: Well, actually, there is, and the concept is when the alternatives are roughly medically equivalent. What we said is that shared decision-making should be followed, where the physician refrains from making a recommendation and really helps the woman make a decision that reflects her values and preferences, which is the goal of the informed consent—

SJ: Right, and what if her values and preference is to say “no” at the end of all this?"

Ms. Jenkins was then reminded of the long queue of people wanting to ask questions. Just what is "medically reasonable"? According to who? Apparently not according to the mom in question. Informed consent seems to have just been dumped into the trash. Pregnant women obviously don't have the same rights to equality as other medical patients. 

While we all joke about "pregnancy brain" it isn't something that should remove our rights to bodily integrity and decision making once we check into the hospital or accept a doctor's care. All the talk the panel made earlier of "the doctor and woman should be making these decisions together" seems to have been to placate the masses of women hoping to have a vaginal birth. "Making decisions together" is just another euphemism for the doctor saying "Don't worry your pretty little head about it... we'll just cut that baby right out. You won't need to even break a sweat."

I think this panel brought up some great points. It has gotten articles about VBAC in major papers like the LA Times. But we can't stand idly by and let it turn into the same old line. VBAC mamas, unite! Let your voices ring out. Demand the right to birth your babies the way nature intended. Every baby deserves the best birth possible. Every mom deserves to give birth.

4 comments:

Diana said...

Thank you for this article. As a woman with a classical incision on her uterus, I get very frustrated with the tag line "for women with low transverse incisions." What about me?

Well, I did my research and I made my choice but no one cared about my choice because I wasn't on the approved list. No one but my family, friends, and my lovely homebirth midwife, that is.

It turns out my uterus healed, my body birthed, and I'm happy to report that I am typing with one hand while nursing my 3 month old baby!

Toni said...

Oh Diana, congratulations! Your comment brought tears to my eyes. What a marvelous thing to share. :) Thank you!

See, everyone? There is hope for a VBAC for EVERY woman who has had a cesarean. :)

Cat Ellis said...

I'm due to give birth in a couple of weeks. We're planning a VBAC. We are travelling an hour to go to a hospital that not only permits, but promotes VBACs. However, an hour's drive is a long way to go, especially when there are three other hospitals nearby that have a ban on VBACs.

Here are a few things that we learned when choosing the midwife practice and hospital facility.

Hospital bans on VBACs are legally unenforceable. When medical professionals (ob-gyns, nurses, hospital staff) and hospital policy makers talk about such bans, the language they use imply that by chosing their facility, you have already given up the right to a VBAC. This is untrue.

You, the patient, have the right to refuse any medical treatment/procedure you do not want to have. You do not need their permission for a VBAC. It is the other way around. They need your permission to perform surgery on you!

If you go to a hospital in active labor, they are bound by law to treat you. You cannot be turned away. The law was put into place to prevent hospitals from turning women away who could not pay their bill. But the way it is written, it is not limited to women without insurance and covers all laboring women- including those refusing repeat c-sections.

If you are not in full-blown labor, they may try to transfer you to another hospital. That is considered "providing treatment". However, transportation is almost always by ambulance. Providing that you are conscious, no hospital can put you in an ambulance without your written consent. You are not obligated to give it.

What may happen, however, if you choose to push the issue (and sometimes there are reasons to do so) is that the hospital staff may make your stay very miserable. You may be labelled a "difficult" patient. You may have people in your face trying to coerce you into going along with their policy. That stress may slow labor. However, if you are set on having a particular midwife deliver your child and that's the hospital they have priveleges, or it you feel the need to protest, it may be worth it to you to fight the system.

We chose not to deal with that kind of stress and go to a different facility. As far as I'm concerned, it's no different than being a responsible shopper. I vote with my dollars. I'd much rather see a hospital that promotes VBACs get paid than one that does not.

Midwife International said...

Yes! We wholeheartedly agree that the mother's voice must be restored in her birth experiences! Women across the globe deserve the respect of their birth professional to make her own choices in childbirth- choosing a VBAC is one of those critical choices!

At Midwife International we work to improve the culture of birth by offering midwife training programs around the world. Midwife International partners with established clinics and professional midwives to provide leadership and midwifery training opportunities abroad.

For more information, please visit: http://midwifeinternational.org/midwife-training.

Thanks for posting and for all that you do!

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