Thursday, February 19, 2009

New TIME article on VBAC bans

There is a great new article in TIME magazine today. It's called, "The Trouble With Repeat Cesareans."

It's about the difficulty that many women with prior cesareans have in getting a chance to have a Vaginal Birth After Cesarean (VBAC). It's about countless women who are essentially being forced into unnecessary surgery that they don't want or need. As the article says:

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them.
The International Cesarean Awareness Network (ICAN, http://www.ican-online.org/) was a big part of helping this writer research her article. In fact, I helped do the phone survey she talks about in the article:

The International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them.
Read that again, folks. 28% of the hospitals with maternity services in the United States have official VBAC bans on their books. Another 21% of hospitals have de facto bans.....no official policy, but doctors basically won't attend VBACs there anyhow.

That means a whopping 49% of hospitals in the U.S. will not let you have a VBAC. Nearly HALF of all hospitals do not "permit" women to choose how they give birth if they have a history of prior cesarean.

In my state, the rate was even higher.....54% of hospitals did not "allow" VBAC. Some states are even worse.

Of course, you can choose to have an elective cesarean section in nearly all these hospitals........but if you have a history of cesarean in your background, you are not "allowed" to choose to have a vaginal birth.

Hello??? Reproductive rights anyone?? Alas, apparently only if it makes life more convenient for the doctors. Where is the outrage about this?

And the sad thing is, VBAC is generally even less accessible for fat women. Even if you can find a hospital that "permits" VBACs, many of them strongly discourage "obese" women from trying a VBAC. Some doctor practices outright ban VBAC for women over a certain weight limit.

So take everything the article says about VBAC access and multiply it for women of size. This is not "just" a birth issue or a reproductive rights issue; this is also a fat-acceptance issue.

*More on this tomorrow.

11 comments:

Jen said...

I hope a lot of people read that article and run with it in a positive way and learn more about VBAC to go with it.
I live in Canada so the bans on VBAC isnt' as bad but it's close. I had a c-section with my first after 22 hours of backlabour and being too exhausted when I was finally fully dialated to push. I worry about future pregnancies and will fight hard not to have another section.

spacedcowgirl said...

The figures on prohibition of VBAC are really astounding. We're thinking about trying to conceive sometime in the next year or so, and information like this really leads me to wonder how much "say" I'm actually going to have in my own birth process (even for me--I'm fortunate to have access to health insurance, a range of doctors/hospitals/midwives, etc.)

wellroundedtype2 said...

I'm in this boat -- unless I want to travel some distance, and since a VBAC means I already have a child you don't want to be far away from -- I'm a de-facto c-section if I want to deliver in my own home town.
I think this has special signifcance for women who are pressured into c-sections because of a fear of a too big baby the first time around.
I get where the OBs are coming from, but I really would like the opportunity to labor and see how things go. I am hoping if I do get pregnant again I'll have a chance to discuss this with my doctor. I also wonder what would happen if I miscalculated the first day of my last period and went into labor before my scheduled c-section -- would they assess the situation and see if it was a greater risk to have an emergency c-section or to allow me to deliver vaginally.

Because I have diabetes going into pregnancy, I generally feel I need to be super compliant and prove I'm a good patient and mother -- which sucks.

Lori Controversies in Childbirth Conference said...

I love how the article points out, “patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs.”

This article is very informative and highlights the Catch 22’s of birth that will be discussed at the Controversies in Childbirth Conference. www.birthconference.org.

The president of ICAN, Pam Udy, will actually be on a panel to discuss cesareans at this conference.

In the conference seminar, “Is There Any Benefit to Low C-Section Rates?” all sides of the cesarean debate will be presented. Dr. Fishbein MD FACOG, (Anti-Cesarean OB); Marra S. Francis MD (Pro-Cesarean OB); Pauline McDonagh Hull, Editor of electivecesarean.com; Pam Udy, President, ICAN

Sara said...

I'm mourning the child that I will never have because I have already been told...I will not be allowed a VBAC, even though my first child was an easy vaginal birth. Here's the reasons I've been told why I cannot have a VBAC:

#1 Age - 40 years old
#2 Weight - 290lbs
#3 Pre-hypertensive
#4 Risk of abruption

Now apparently the docs in my town feel that your risk goes up for abruption, once you hit 40 years old. I haven't yet seen stats on that one to believe it.

I mourn the child I'm not going to have because I cannot and will not endure another c section. And someone may not like these words I choose in regards to how I feel, but ever since I was "sliced and diced" I haven't felt like the same person since. And we're talking 2002. My body, my abdomen, urinary, cycles, ...the whole she-bang never felt the same again.

After the c section, I had nightmares for months. I've never regained abdominal strength and I'm facing a surgery for an umbilical hernia which developed post op.

My husband and I want another child together so badly...but it's not going to happen because I won't be given the chance to VBAC.
The only route I can take is a homebirth, and even though I'm in a legal state, the homebirth midwives in my area are too touchy touchy about it.

A dear friend of mine, she got her VBAC, unassisted childbirth at home with just her and her husband.
There was no other way. After a time of the placenta not delivering she had to go the hosp. The doctor needless to say was P'OD at her, even called social services on her to investigate her.

But now she laughs and says, "I still got my vbac".

OlderThanDirt said...

My son, born 17 years ago, was a VBAC. I thought at that time the tide was swinging toward more VBACS because they'd discovered that repeat cesareans weren't necessary. What happened? Was I just fortunate enough to give birth during the time when the birth industry was listening to women a bit more?

Cherie said...

I had a planned c-section with my first child just over 15 years ago due to him being in a footling breech position and a failed attempt at a horrible inversion (a hell that I would never allow to repeat, ever, even if it meant having ten c-sections). When I got pregnant with my second child about two years later VBACs were pushed by the medical community as everyone was trying to get their c-section rates down. I was given no choice by my doctor and the hospital to have a "trial of labor", fat or not.
It all worked out just fine (other than having what I'm sure was an unnecessary episiotomy) and I've now had three successful VBACs. However, it was indicated with my last delivery, my fourth, that I was only being allowed another trial of labor because I had already had two previous successful ones.
It's just interesting how the medical culture can change that much over ten years.

Well-Rounded Mama said...

Ladies, thank you for your comments. I love comments!

Jen, I hope you are already in contact with ICAN, www.ican-online.org. They have a number of Canadian chapters. Also, you might want to check out the FAQ on malpositions on my website, www.plus-size-pregnancy.org. You had all the classic signs of a malpositioned baby. And yes, there are ways to lessen your risk for a repeat of the same labor scenario. Check it out.

Spacedcowgirl, you CAN have say in your own birth (it's your body!) but it's important to be really educated about your choices. I recommend reading "Pushed" by Jennifer Block and "The Thinking Woman's Guide to a Better Birth" by Henci Goer. I also recommend starting your birth attendant search with midwives, both hospital and birth center/home. Interview several and then go with what your intuition says.

Wellroundedtype2, email me offlist. I know a VBAC with diabetes is difficult because of all the restrictions the put on you, but I know people who have done it. I have their stories on my website. Also, I may know of some vbac-friendlier providers in your area. Give me a ping by email.

Cherie, congrats on your 3 VBACs! (and yay, another mom of four!)Always wonderful to hear of VBACs in women of size. Email me your birth stories for my website some time! I'd love to have them. See the site for details about submitting stories.

Sarah, you are actually the PERFECT candidate for VBAC because you've had a prior vaginal birth. That means your risks for complications are LOWER than someone who hasn't; it also means you have a "proven pelvis."

The docs are just looking for any excuse not to allow VBACs these days. If it wasn't your age or your wt, they'd find something else. Pay no mind to them. You are actually a terrific candidate.

Some parts of our stories are very similar. I had a VBAC (after 2 cesareans no less) in my late 30s and another in my 40s. I'm near your size, and I also had an umbilical hernia repaired between #2 and #3, yet went on to have 2 VBACs after that. Those things don't mean you can't VBAC.

I too had terrible nightmares and PTSD after my first cesarean; taking time to process that was an important part of my emotional recovery and healing. There are some good resources out there now for processing birth trauma; I hope you will seek them out so you can process this. If you haven't yet been in touch with ICAN, I'd encourage you to do that also.

As for choices, there are always choices. There are traveling midwives who will come to you at your own house and attend you there if you'd like. Or some people travel to other places because they feel choice is so important and they don't want to expose their baby to the risks of repeat cesareans.

Don't give up your dream of another child if you truly want one. I almost gave up after #2 (after my second c/s) because I was convinced there was no hope for a different kind of birth and I didn't want to keep enduring surgery. Yet I took a leap of faith and went on to have 2 VBACs. Even if I hadn't, I'd still have two more beautiful, sweet children enriching my life because I didn't give up. I hope you won't either. Blessings on you, and may you find hope and healing.

Blessings on all of you and thank you so much for your comments. I'll continue to write more about VBAC in days to come, and I'm sure it will resurface periodically because it's a real passion of mine. And if VBACs aren't your thing, keep reading...there will be other stuff too.

Well-Rounded Mama said...

Cherie and Olderthandirt (love the name!), I forgot to add that yes, the climate around VBACs has totally changed since your VBACs. I have another blog entry on that in the works since it's something I've been asked about several times now. It'll explain more about why the climate has changed so much for VBACs.

Sara said...

Thank you! I will think over what you have written here, and explore my options.

You know I thought I was the only one who had nightmares after my c section. I told my mom and a couple friends about it and they all told me that I was basically silly, because c sections are nothing and that I got a healthy baby out of it.

Anonymous said...

I am so angry with not having a choice! I had a C-section 10 years ago due to an emergency situation. The baby was a l lb. Now I've had two glorious VBACs and learn that none of the hospitals around me will let me have a VBAC!!!!!! SO, I have to drive over an hour to have child number 4 and I'm not even sure if I'll make it to the hospital. Ugh.