A mother from North Carolina wrote to ask what she can do to get hospitals in her community to provide care for VBAC.
” I just found your site, and I know you must be really busy, but I wanted to drop a line to tell you why your site will be very important to me. I live in a small town, and the local hospital will not allow VBAC’s. I just had my first baby 6 months ago, and after laboring 26 hours (13.5 of which were at the hospital) they then realized that my baby was breech and ushered me into a cesarean. The only options they gave me at that time were to undergo general anesthesia and be put to sleep, or have a spinal block and my husband could be in the OR with me.
I was mortified at the lack of information I had received and the fact that it took so long for them to realize that my baby was breech. When I was getting ready to leave the hospital the nurse proceeded to tell me that next time it will be easier since I will be able to schedule my cesarean because the hospital will not support VBAC.
I was shocked! I do not plan to have any more children for a couple years, but I do not want to wait until I am pregnant to try to fight this system. I do not want a repeat cesarean and I want other women to have the option to VBAC at this hospital. Every other hospital is over an hour away from this town and of the 3 hospitals that are within that approximate hour drive, there is only 1 that will allow a VBAC. That would mean that I would likely have to have all my prenatal care with a provider that is that far from me.
While it would be worth it for me to drive that far, it is not fair that a group of providers and the hospital will not give women a fighting chance. Nor do they educate them on the dangers of repeat cesareans. Instead they scare them into thinking that they can only have cesareans. Thank you for creating a web page to help educate women.”
It is not unusual for hospital staff to discover in labor that a woman is carrying a breech. Had the breech been diagnosed during the last weeks of pregnancy, Crystal would have had the option of having an external version or finding a careprovider skilled in breech vaginal birth.
When it comes to hospitals refusing care for women who want to plan a VBAC, current ACOG guidelines for VBAC state that facilities must at least inform women of the availability of emergency care in case of complications from a VBAC and refer women to hospitals and providers that do support VBAC. ACOG also recommends that hospitals do change their policies and find ways to safely support healthy women who want to avoid a medically unnecessary cesarean.
Having said that, sometimes the only way a hospital will change its VBAC policy is in response to pressure from birth advocates in the community. Women with a previous cesarean who plan to become pregnant should canvas the hospitals in their community to find out about available care for VBAC and birth centers will often support women who want a VBAC.
Although ACOG supports VBAC, often physicians and hospitals don’t provide care for VBAC because their malpractice insurance coverage is increased by thousands of dollars for liability insurance coverage for VBAC . Information about lack of VBAC liability coverage is not usually provided to the public. Many physicians who support VBAC loose business because the hospital at which they have privileges has a no-VBAC policy.
In Northwest Arkansas a grassroots birth advocacy group was successful in getting the hospital in their community to change policy and accept to provide care for women who want a VBAC.
Beth Day and Genet Jones of BirthNetwork of Northwest Arkansas describe how birth advocates made it possible for women to avoid an unnecessary repeat cesarean section. Beth Day writes,
“Last month in Rogers, Arkansas three local hospitals overturned their ban on VBAC. Our work with one hospital in particular has been a beautiful blend of work, relationship building, and timing. I have lived in the area and have attended births at this one hospital as a doula for the past 5 years. As a result of my work there, I developed a good working relationship with one of the physicians who was not only the only doctor who would allow women to labor and birth in water, but was among the few who championed VBAC.
Then, two years ago, Genet and I were working with our local chapter of ICAN, staging protests at each of the area hospitals that banned VBAC. The protests themselves were not directly successful. In fact the hospitals really dug in their heels and stood in solidarity defending the bans. But perhaps we planted the seed for a swift reversal of the bans once the new ACOG guidelines were published.
This summer, I was contacted by one hospital They asked me to outline the benefits of supporting mothers who wanted to plan a VBAC. I jumped on the opportunity and wrote a long email which basically outlined the reasons why they not only should allow VBAC, but why they should seize this moment to attract a niche market of natural birthers by becoming the only “mother-friendly” hospital in the area.
This email was circulated and they invited us to come and present our case for “mother-friendly” maternity care to the CEO, the head of obstetrics, the chief nursing officer of the hospital. Genet and I prepared a power-point presentation which explained why it made good business-sense to become “mother-friendly” and went together to make the presentation. We received excellent feedback after the presentation.
The hospital did indeed reverse the ban (along with two other hospitals who simply made the move without our input) and I believe that they are in the process of getting approval to retrofit one of the LDR (labor-delivery-recovery) rooms with a permanent labor tub. We also hope to work with their nursing staff to encourage them to receive “mother-friendly nurse” recognition.
We are so thankful for the help we received from CIMS and BirthNetwork National in giving us the framework for the information we presented to this hospital. Without the institutional support of both, I’m afraid we would have looked just like a couple of home birth nuts. But because we had the CIMS and BirthNetwork connections and information, we were able to put forth a convincing argument for changing the way hospitals do business.”
For additional information about changing VBAC bans in your community see ICAN’s Advocacy webpage.