Hospital Vbac Bans: Know The Facts
Back in 2010, the American Congress of Obstetricians and Gynecologists (ACOG) established that VBACs (vaginal births after cesarean) are safe and appropriate choices for most women who underwent a single prior c-section and free of major risks for a smaller percent of women who underwent two prior c-sections.
According to ACOG’s facts, vaginal birth is safe after a c-section even in women who are in their 40s, are expecting twins, have low vertical scars or carry a really big baby. In other words, the American Congress of Obstetricians and Gynecologists says none of these situations should prevent women from planning a natural birth.
Then how come in so many hospitals women are almost forced to opt for c-sections if they underwent this procedure before? Is a RCS (repeated cesarean section) safer than a VBAC or perhaps it’s just the misinformation about vaginal birth after c-section that makes health care providers and doctors recommend women to opt for surgery?
VBAC vs. RCS
According to research studies, VBACs have a success rate of around 75%, so it’s obvious that it’s not the potential side effects of this process that makes obstetricians support c-sections over natural births. In fact, vaginal births are proven to have fewer complications compared to repeated cesareans.
The real cause for concern is uterine rupture, which can theoretically appear in women who underwent c-section and opt for natural birth in their second or third pregnancy. While this effect can indeed be catastrophic, the incidence of uterine rupture during a VBAC is very low – 0.4% according to a study published in 2004 by Landon. This rate is also close to the ones associated with post partum hemorrhage, placental abruption and cord prolapse, all of them considered medical emergencies.
As for repeated C-sections, risks include the need of blood transfusion due to hemorrhage, placenta accreta – condition in which the placenta grows through the uterus – and hysterectomy. All these risks increase with every C-section, while the risk of uterine rupture decreases after several VBACs.
We can therefore see vaginal births after C-section are not that threatening for expecting moms, but the real problem and one of the most important reasons for which VBACs are banned in so many hospitals is there are not enough doctors and anesthesiologist prepared and readily available to perform a cesarean at a moment notice.
Moreover, those who could assist women in giving birth naturally after a cesarean simply don’t want the risk. As a result, hospitals develop their own policies and protocols for VBAC, their requirements being partially or completely incompatible with ACOG’s facts!
Hospital VBAC bans
A growing number of hospitals refuse giving women the chance of attempting VBACs, mainly because they fear potential complications, lawsuits and lack of properly prepared professionals or immediately available anesthesia.
Women attempting VBACs require hospitals to have 24 hour in-house anesthesia, which is not covered by most health policies. Plans including obstetric and gynecologic coverage are usually very expensive and health care providers simply don’t want to expose themselves to the risk of lawsuits in case anything goes wrong during a VBAC birth.
If a hospital adopts the ACOG standards yet it denies a woman the right to attempt a vaginal birth after cesarean, the woman can bring a lawsuit whether the c-section resulted in harm to her or the baby or went perfectly.
Hospitals banning VBACs cite the strict guidelines of ACOG as the reason they ban these interventions: ACOGs guidelines stipulate that a full surgical team needs to be immediately available for assisting a women in giving birth naturally after a c-section. So if a hospital doesn’t have the needed technique or staff, it simply denies moms the right of delivering naturally.
But basic logic says if a hospital can’t handle a VBAC emergency, it shouldn’t handle emergencies at all! How can a hospital be safe for non-cesarean moms delivering their first baby, when the risks are so similar to those involved by VBACs?
In 2009 there were 612 hospitals banning VBACs and another 821 hospitals coercing women into c-section through their restrictive conditions, lies or threats. While doctors argue they don’t force women to undergo cesarean, they offer no alternative and this is against women’s rights.
So is there anything that can be done against this policy? There is, as long as you talk to your doctor before the due date and find out what his position is with regards to VBACs. If you’re denied this option because of physician or hospital policy, you can:
- Contact ICAN (International Cesarean Awareness Network) and ask for their support. They can help you hold a rally at the hospital, with good chances for the ban to be reversed.
- File complaints with your health insurance carrier, with the medical board against the physician or with your state agency that regulates the hospital banning VBACs.
- Contact ACOG and ask for their support.
- File a complaint through the Medicaid system.
- Find a lawyer that is well prepared to support you and help you in suing the hospital.