It would seem perfectly natural that a woman could give birth naturally if she wants to. Guess what? She can't.
An increasing number of hospitals in this country are refusing to offer women the option of delivering the way nature intended, if she had a cesarean section the first time around (and guess what -- chances are she has because the 31% of all births are now C-sections -- up 50% in 10 years).
I wrote an article in this week's issue of Time magazine called "The Trouble With Repeat Cesareans" on the subject of women's diminishing patient's rights. I won't repeat the story here, since you can link to it here, but will give some of the back story for those who want more:
This was a story I've been wanting to write for a long time. The short version is, doctors and hospitals are no longer allowing many women to have a vaginal birth after cesarean (or VBAC, pronounced "vee-back") because the "medicolegal" costs are too high. Or, as one ob-gyn put it when I asked why she and other doctors no longer allow VBACs, ""It's a numbers thing. It is financially unsustainable for doctors, hospitals and insurers to engage in a practice when the cost of doing business way exceeds the payback. You don't get sued for doing a C-section; you get sued for not doing a C-section."
Now, I think most of us realize that many hospitals are for-profit institutions and that doctors need to make money too, increasingly hard in this era of managed care. It is nonetheless tough to hear a physician talk about medical care in such bare-bones financial terms. So, um, we can't get the most appropriate care because it costs too much? What's especially galling is that VBACs are actually a much less expensive "procedure" (if childbirth can be termed that way) than cesarean sections, which are major abdominal surgery and require days more in the hospital. The costs the doctor is referring to are the malpractice insurance costs passed on to doctors. And those costs aren't even reasonable, but are largely in response to a few high-profile cases of VBACs gone awry dating back 10 years, many of which involved a labor-induction drug called Cytotec, which is no longer used during vaginal births after cesarean.
Meanwhile, according to the International Cesarean Awareness Network (ICAN), out of 2,849 hospitals with labor and delivery wards nationwide, 28% have total outright bans on VBAC and an additional 21% have de facto bans in that they say they'll do it but none of the doctors on staff will do it. That's half of American hospitals, but the numbers are probably much worse. Many of the rest will allow what's often termed "Cinderella VBACs" (a term coined by Henci Goer ) -- "yes, you can have a VBAC as long as you have it Monday - Friday, between 8 am and 5pm and you aren't over 40 weeks and we don't think your baby is too big".
Moreover, even if the hospital allows VBACs, it doesn't mean that all the doctors there are willing or eager to perform them. Take my own case. After I had a cesarean with my first child, I made a point to find a new practice that was VBAC-friendly. (I would have stayed with my first doctor, but my insurance switched, a whole other story). The practice I eventually signed up was very encouraging, telling me that VBACS had a 60-80% success rate and that their particular practiced boasted a 75% success rate. All good. Right?
Except, when I hit the 6 month point, my doctor said to me casually, "OK, let's schedule your C-section now."
"Excuse me?"
"Oh," he said, "You know, you only have a 13% chance of success with your VBAC." He went on to explain that since I had reached the "pushing" phase of my first labor, my chances of a successful VBAC were dismally low and therefore it made no sense to attempt one.
Furious at the bait-and-switch (doctors love, love, love C-sections -- in and out in an hour! No messy labor! No pesky doulas or family members hanging around!), I asked him to produce the study that said so. It turns out that the study, which dated back to 1999, was contradicted by several later studies, all of which showed a significantly higher rate of success -- between 40-60%. One study showed no difference in success rates at all, no matter where the first labor ran into trouble.
The doctor on call when I ended up giving birth on Thanksgiving weekend, was, needless to say, very much put out by my inconveniencing him. His revenge? He refused to talk to me while I was in labor, and didn't answer his pager when I was ready to push. So that's an example of a hospital that allows VBAC and supposedly pro-VBAC doctors for you. The truth is, doctors who are truly VBAC-friendly are few and far between. The good news is, I gave birth, via VBAC, to a perfectly healthy little boy and had a much quicker, easier recovery than I did with my C-section (which was hell, but another story).
I'll end with this story, much more dramatic than mine: After giving birth to her first child via cesarean, Alexandra Orchard, a CPA in Colorado Springs, was told her second baby measured too large to be delivered vaginally. "My doctor said, 'You're not only risking her life, you're going to break her collarbone when you push her out,'" Orchard recalls. Through tears, she scheduled a second cesarean. "I was in so much pain after each surgery that I don't even remember when I met my children." With her third child, Orchard was determined to get a VBAC, but her doctor refused. Orchard researched the risks and with the help of a midwife, labored for 30 hours and gave birth at home to a daughter, now almost two years old. Orchard is apprenticing to become a midwife because, she says, "I don't want my daughter to have to fight like I did."
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I'm glad to see articles such as this drawing attention to the plight of women in this country who aren't so lucky to have access to a supportive OB/hospita
There are still many risks in giving birth, both to baby and to mother. People are taking a big chance doing this at home, IMO.
In the end the safest place to give birth is the place where you feel safest. If someone is in the small group of the truly high risk, then yes, they should definitely be in a hospital. Any homebirth midwife who saw such a situation would tell that person to go to a hospital.
I think the best model of care is midwives for almost everyone (in the hospital or at home) and OBs stick with the folks who really need that level of expertise. You don’t go to a neurosurge
Staying home can help avoid many complicati
Of course you can't predict WHAT will happen in childbirth
Women are so terribly afraid of birth and pain that they are completely sold on having epidurals and C-sections
Go to midwiferyt
One big problem is that women do not know how to move their bodies in order to facilitate the descent and rotation of the baby. Middle Eastern Dance was originally designed to teach women to do just that. Unfortunat
I recently had a colleague who lost a case in which a woman who was VBAC-ing ruptured her uterus and lost her baby. The doctor was sued because she was at another hospital attending to another patient. A staff doctor attended to the patient who was VBAC-ing, was able to get her to the OR and the baby out in under 7 minutes, but the baby died anyway. No better care could have been provided to this woman. My colleague settled for millions, and the hospital now requires doctors who have patients who are VBAC-ing to be in-house. This is impossible for most ob/gyns, who practice at several hospitals.
The malpractic
This is a much more complicate
Another issue I see prevailing is something you mentioned here: your colleague being busy with another patient at another facility while they had another patient in labor elsewhere. OBs work long, hard hours- I respect the amount of time that goes into the job. But many OBs have themselves stretched too thin. I understand that even with only a few patients, some are inevitably going to go into labor at the same time. . . but when it gets to the point where an OB is constantly needing to cancel appointmen
Those who want what's best for their patients should not have so many patients to care for at once in order to give the patients that they do have the time & care they need & deserve. This is something that is in line with the midwifery model of care, & you'll see midwives getting sued less than OBs because they don't guarantee perfect outcomes. They don't take on so many clients that they don't have the time to explain the risks & benefits to them
I am an emergency physician in an inner-city ER that serves mostly uninsured and MediCal patients, 60% Spanish-on
That said, I must take issue with several of your assertions in a number of your posts. First of all, how can you just assert that "OB's take on too many patients"? I think you are living in a dream world. Where are these inner city patients to go? What midwife is available to them? For that matter, what OB? If I have a 17 weeker come in with bleeding, an empty uterus with a beta if 220,000 and an adnexal mass, much less an 8 weeker with no problems who just needs an outpatient prenatal care referral, I have to move several mountains to even find an available OB. OB's see the volume they do because they HAVE TO.
What are YOU doing to affect policy, to change insurance coverages to include midwifery, to get midwifery on hospital referral panels, to actually provide on-call coverage of ER's like mine, so I can refer my uninsured/
(Continued
Believe me, if I could get a lactation consult or prenatal consult on all these women dumping cow protein into their babies and ticking along in week 11 without a single prenatal check, I'd do it in a heartbeat, and I'd surely recommend a midwife if I had one to recommend.
Dr. Russo works in a clinic for underserve
Try to get off your midwifery high horse. Not all physicians are opposed to holistic healthcare
One final comment, there was a discussion back a bit about sexism, and weather or not people delivering babies should only be "Those who have the ability to do so themselves
I had a great VBAC at home. Recovery was a breeze. Pain from childbirth was nothing like recovering from a cesarean. It was totally manageable
Why I VBACed: http://vba
Why I had a homebirth: http://vba
My birth story: http://vba
Home birth vs hospital birth for the number cruncher: http://vba
For women seeking VBAC, this article is a good start: http://vba
Ladies, you can do it! You can birth that baby! :)
Best,
Jen from vbacfacts.
I too had a safe successful homebirth VBAC. I had two previous cesareans. I agree that the hospital *should* be the safest place to have a baby, but it's not. I learned that the hard way when I had my second child- a traumatic, unnecessar
Jill-- www.unnece
Fortunatel
Our family is a large one, many of the women are nurses. Not a one ever used epidurals or had a C-section and everyone breastfed.
I wish more women had faith in their bodies and the process of birth. For me, it was the most important thing I've ever gone through. I feel that I gained a confidence and power. I wish that for more women.
Women aren't broken. The system is. It's costing some families the lives of their babies &/or mothers, & the rest of the consumers countless dollars.
If OBs didn't take on too many patients, there wouldn't be as many issues & they wouldn't feel so rushed or bothered. They'd be able to spend more time with women prenatally
Yes, it's not a 9 to 5 job. Nor should it be made into one with the over-sched
Back to the VBAC discussion
If you're endorsing the midwives model of care, that's a separate issue.
http://www
Thank you for telling my story so well.
Alexandra Orchard
A few years ago, I started offering a workshop for women who have had traumatic births. I am passionate
Thank you again for writing these pieces. May it begin a tidal wave of true change!
If it is truly about too much risk then why do hospitals allow a completely elective procedure that carries small but potentiall
Ultimately
It’s interestin
More than 7000 elective repeat Cesareans would need to be performed to prevent ONE perinatal death caused by uterine rupture. Many women are being denied the reasonable choice to not be one of those that takes a cut for the team and, as featured in Pamela Paul’s Time Magazine article, are finding themselves having to drive hours in labor to give birth vaginally in a hospital. Others just stay home.
It's ridiculous that the excuses we're given for not being able to access evidence-b
If it was truly about needing to save money, there wouldn't be such restricted access to midwives. The midwifery model of care has better outcomes for mom & baby than the typical OB/hospita