Sunday, March 14, 2010

Why VBAC Bans are a Violation of Human Rights

The International Cesarean Awareness Network (ICAN) recently held a blog carnival about why VBAC is a vital option.  If you can, you should definitely go check out some of the different entries about why having the choice to VBAC is important.

[For those unfamiliar with the terms, VBAC stands for Vaginal Birth After Cesarean, pronounced "vee-back."  In the United States today, more than 90% of women who have a cesarean will have cesareans with future children.  Some women choose this happily, but many are forced into it because the option to have a VBAC has been taken away in nearly 50% of U.S. hospitals today.  Not because VBAC is unsafe or women don't want to have them, but because doctors and administrators -- or malpractice insurance companies -- refuse to "let" women have them.]

VBAC bans are a Human Rights Issue, plain and simple. No one should be forced to have surgery against their will. 

Doctors will argue that not offering VBACs is not "forcing" a woman into surgery, but in essence it is if there are no other options in her area for having a VBAC or if the conditions in places that do "offer" VBAC are so restrictive that almost no one will get one. 

Doctors need to stop pussyfooting around the issue and quit splitting hairs; if their hospital or practice does not offer VBAC as a choice, they are denying women the right to choose how they give birth, and in essence, FORCING women into surgery.  How does that align with the oath of "First, Do No Harm?"

Ideally, women are given true informed consent about VBAC vs. Elective Repeat Cesarean Section (ERCS), and their choices are honored. Of course, sometimes that does happen; but far too often women's decisions for VBAC are not honored, and their choices are taken from them.

Sometimes women are literally bulled into repeat cesareans with threats (like calling Child Protective Services). Sometimes they labor at home and go in pushing.....only to be put under anesthesia and forced into a repeat section when they get to the hospital.  (Yes, I know women to whom this has happened.)

More often women are seduced into repeat cesareans with distorted information about risks of VBACs vs. cesareans, inaccurately gloomy assessments of their ability to VBAC, or scare tactics about possible complications of VBAC without similar information about possible complications of repeat cesareans. 

Talking people into potentially harmful interventions without fair and balanced informed consent -- and the freedom to refuse the intervention -- is a human rights violation.

In no other situation is a person forced to undergo surgery for the benefit of another person.  Furthermore, one could argue that with VBACs, people are being forced to undergo surgery for the medico-legal security and the financial benefit of others

This is such a complete and total breach of medical ethics it's breathtaking.....and yet many doctors, hospital administrators, and insurance company officials readily advocate it.  They refuse to see the implications of their decisions and policies.

Everyone has the right to bodily integrity and to informed decision-making. No one should be able to take that right from you, not "even" during childbearing.

Violence and intimidation against women does not just occur via domestic violence or rape. Unfortunately, it also happens during childbearing, but our society does not view it as an abuse of rights....but it is.

It's time to see VBAC bans as the human rights violation that they are.

Shame on ACOG, and shame on the doctors and hospitals who are going along with these bans. 

15 comments:

Erica said...

I'd actually been reading a medical blogger who stated that the insurance co. and lawyers are forcing the hands of the med. community here. While uterine rupture is rare, the women it did happen to in vbac apparently sued-claiming they did not understand the risks. Now the rest of us bear the brunt of that misfortune and the bad decision to blame someone for it. Changing how things were dealt with-aligning more patient responsibility for treatment would probably help this and tons of other things for plus sized women in my opinion.
I actually don't know what the vbac rates are. I was lucky and did not have to have a section so far. But my friends often say their md's asked if they'd like a trial-run through labor or a repeat section. I'm hoping that is a standard question. Risk taking is all around us and should most certainly be a personal, not a mandated choice.

Pampered Mom said...

Here, here!

Maegan said...

Erica, I think you and I have been reading the same blog. ;)

And while I understand the dilemma of the few creating problems for the many by not "understanding" the risks involved...I also know that there are certain terms used to describe the behavior of the doctor. "Gross negligence" is one of them. You have to PROVE this beyond any reasonable doubt. So...if it can be proven that the doctor was grossly negligent in your care or explanation, sure you have a case. But then...THAT isn't the fault of the insurance company. I also wonder...what precautions do these doctors take when "allowing" a VBAC? Interventions can be a contributor of possible problems during labor & delivery. I don't know a single doctor that doesn't give SOME form of medication "just in case" things need to be changed quickly. When really, if you allow the body do what it's supposed to do, those increased risks drop.

My husband got a crash course in emergency deliveries...he's a combat medic. :) So...Um, next time, we might just stay home & be "surprised" that the baby came before we could get to the hospital.

Katy said...

Amen, madam! Erica, you should check out some of the research or watch some of the video from the NIH conference on VBAC: http://consensus.nih.gov/2010/vbac.htm.

Anonymous said...

I just want to say thank you for your Plus-Size Pregnancy website. I have GD and was being pressuered into taking insulin, but knew that there had to be other options to try first, so I started experimenting on my own and discovered that a glass of milk around 3:30 balances out my breakfast numbers...of course it means that I have no "fasting" number to test, but my day is now balanced...I only hope that my dr. will now hear me and let me sort this out without the dietician that wasn't willing to help and just wanted to take the easy route (she was too busy for me, as she was heading off on holidays, and by putting me on insulin she was able to easily pass me off to someone else)

I plan to try a later snack time, and a bedtime walk...Thank you so much again :)

Jennifer said...

I was in labor (with preeclampsia) with my third (all 3 csections) and had planned to make this my attempt at a HBAC with my midwife, however because of the complication of the preeclampsia my midwife felt it best for me to go to the hospital. When I asked the dr if I could refuse a csection and signing the consent form - she said I would have to leave, and wouldn't be allowed to labor there. Thank you for your information.

Erica said...

http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf

one of the hardest things to read, but it appears as though our maternal death rate is unspeakable. Idk if it has to do with c-sections as much as it does social structure, but since they carry higher risks, I'd bet so. I'm not sure where anyone could even START correcting these problems, and I'll bet they are worse for large women.

Lucinda said...

I went to the High Risk docs at University of Michigan, for a consult about a VBA2C and left frustrated if not a bit devastated. I was told that the risk of scar hemmorhage made it impossible for them to "allow" me to procede with a VBAC. When I asked about the risk of a third C-Section, and mentioned some of the complications that I am aware of - I got shut down. Told that it's too great a risk and then told details of hemmorhage and how we will both likely die as a result of my decision to deliver vaginally. When I asked if I could simply not schedule anything and go past 37 weeks (never made it that far before intervention before)and see how labor goes while being monitored. Again I was told of the risk and consequences of this choice. I then cried of course feeling defeated - they have told me I have to schedule a repeat section by my 38th week and if I should (God forbid) go into labor naturally I need to rush in there so they can intervene before it's too late.
I left with the last word - you can't tie me down and make me have major abdominal surgery... so we'll see - I am due on July 5th. My husband is being supportive and I am praying a whole lot too making this decision has been heart-wrenching and as a mother I feel that being selfish (which choosing a vaginal delivery has been made out to be) is not an option. I have to be prepared that by going to the hospital they will make threats and force intervention or treat me like a 'hostile patient'...
I appreciate this information very much!

Well-Rounded Mama said...

Lucinda, if having a VBAC after 2 c-sections was a death sentence, why am I still alive? I've had 2 VBACs after 2 Cesareans (VBA2C) and yet somehow my children and I are still here. And I know sooo many other women who have had VBACs after more than 1 c-section.

You can read the research on VBA2C on my website, www.plus-size-pregnancy.org, as well as stories of women who have had VBACs after more than 1 c/s.

Choosing VBA2C means you have to consider which is the lesser of 2 evils medically. Repeat c-sections, especially if you plan more children, carry quite a bit of risk. VBAC is not risk-free either. Either choice presents some risks; it's a matter of knowing those risks and choosing which set you are more comfortable with.

I would suggest that you seek out providers who are actively supportive of VBAC in your area. The high-risk docs at U of M are not, as they have proven with their unbalanced presentation of risks and their attempt to bully you into scheduling a cesarean (which by the way should NOT be routinely scheduled before 39 weeks anyhow because of the risk of respiratory complications with the baby).

There is a chapter of ICAN, the International Cesarean Awareness Network, available in the Ann Arbor Area. You can check the ICAN website (www.ican-online.org) for contact info for it, or email me directly (kmom at plus-size-pregnancy dot org) and I will put you in contact with someone in your area. There you will find out about provider alternatives in your area if you want them, and support for you as you make your decision (either way) about how to proceed.

ICAN also has online support forums and and national email support group. Many local chapters also have local yahoo support groups as well. Please consider getting some support from ICAN.

Best wishes to you, whatever you decide to do.....kmom

Lucinda said...

Thanks so much for all of the information, I will email you to get in touch with the ICAN people.
It is nice to know that I am not being selfish to consider laboring for a natural birth. Thanks again for all you do!

bookwoman said...

The C-section rate at my facility is 35%, 24% for primary C-sections. (3700 deliveries last year) I'm a nurse working as a lactation consultant at my hospital. The new L&D manager - who wishes things were different - says that there would be more VBACs if the insurance companies would insure physicians who would like to offer them. It is a factor in the mix - the fact that insurance companies are refusing to insure OBs who want to offer VBACs.

Well-Rounded Mama said...

Thanks for your comment, Bookwoman. I agree up to a point. I have tremendous sympathy for the medico-legal worries doctors go through, and I know there are many docs who would like to offer VBAC but feel their hands are tied because of insurance.

But that said, I don't buy that they are THAT powerless against insurance policy. If enough docs protested and really rallied against the anti-VBAC policies of insurance companies, things would change.

Docs employed as consultants at insurance company help set these policies and they are subject to peer pressure too. More goes into these decisions than that, I know; but lack of strong advocacy for VBAC from fellow docs is part of what's keeping those insurance policies in place.

If enough docs raised a REAL stink about this, things would change. Part of the problem is that not enough of them are willing to stand up and say, this is not right, this is not ethical, women are being forced into unnecessary surgery and it HAS to stop.

I understand how docs' hands are tied in some places but I believe the real change will come not only from consumer pressure but also from DOC pressure.....and this is what I'm just not seeing at this point.

Docs have to be willing to get out there and really lobby for VBAC too, and as far as I can see, most of them are simply not willing to do it. I feel they are really abandoning their ethical mandate of "First Do No Harm" by letting these VBAC ban policies go unfought.

Anonymous said...

I had a VBAC for my second child--what an amazing experience! I felt like wonderwoman :)

I worked with a midwife and consulted with a physician who also attended the birth. Quite honestly I believe one of the keys to our success was the midwife's suggestion to stay home as long as possible. She said if you get to the hospital early, they will start to intervene--because you are there. When I got to the hospital (where we were required to birth our daughter) I was ready to go and had my daughter in only a few hours. Like many women, my first child came into this world through an incision due to "safe" advice based on my high-risk profile that resulted in surgical intervention. As a public health professional, I didn't think that type of outcome would happen to our family--I thought I was "informed" and safe.

VBAC's are essential to ensuring that we have a choice. And being able to have choices in how our children enter this world is a blessing that is truly empowering. Thanks for blogging about this topic! I love your site!!

Heather said...

Lucinda. DO NOT GO BACK TO THOSE DOCTORS, even for prenatal care! If you have family somewhere else, move in with them if you can. The pressure will continue, and you'll be unhappy your whole pregnancy, and beyond. Just get away from those doctors. In fact, don't go to a doctor at all, unless you are experiencing other complications that a midwife can't handle. Or if you're not comfortable with a midwife, find a family doctor (not an ob) who integrates some natural medicine (even if it has nothing to do with pregnancy, those doctors are less likely to jump to meds and surgery first thing). I'm sorry you're having such a hard time finding support. It's an atrocity that this kind of abuse happens to women every day. You are strong, and perfectly capable of delivering a baby after 2 cs on your own.

Personally, I've had 2 cs. I'm not yet pregnant, but now knowing the consequences of giving in (as I did with my first two), I will never do it again! If I can't find a supportive provider, I will "provide" for myself. I won't be bullied again. Of course, I'm saying this without any pregnancy hormones in my veins now. I'm sure it'll be harder to stick to my guns later. I'm terrified of the possibility that I may have to give birth alone, and I hope it doesn't come to that. But I don't want to go through the hell of guilt that followed my last birth again.

Good luck. I really hope you can find the support every pregnant woman deserves.

Val said...

I am actually looking to have a VBA2C. I stay in Raleigh and wake med faculty physicans is my care provider. I GD but its well controlled. I have never in my life felt so taken. Its as if women do not have a say in the way we bring our children into this world. I had a female doctor who was pregnant tell me that is I was to attempt this it would be foolish because it held to much of a risk, but in recent studies it is not safe to go through a c-section more than three times. The third section provides a higher risk especially if the placent is in the front near a previous scar. You can bleed out because of that. I am determined not to go through another c-section and I think we women realy need to make some noise and stop letting fearful doctor micro manage how we should be cared for. We need more evidence based doctors