Thursday, May 15, 2008

What to do about VBAC bans

Birthfriend reposted a list of 11 suggestions of how to protest a VBAC denial, originally published in Midwifery Today. It's a good starting place for what to do if your local hospital tells you you "have" to have a repeat cesarean because of a prior surgical birth, rather than leaving the choice up to you.

I have a few other suggestions:
  • Opt out entirely! Give birth at home with a midwife, give birth at home unassisted, or give birth in a freestanding birth center. Of course this does nothing to change the situation for women who don't feel comfortable abandoning a hospital environment, but you'll probably have a fantastic birth.
  • Fight the Man (a highly courageous but also highly risky undertaking): Flat out refuse a repeat cesarean and inform everyone of your intent to give birth vaginally no matter what the hospital's policy is. Call in the media crews, call in your lawyer, make a big stink. Very dramatic. Somewhat likely to induce stress and coercion. Slight risk that your hospital will seek a court-ordered cesarean.
Any others--serious or tongue-in-cheek?

16 comments:

  1. A court-ordered Cesarean? I cannot even begin to comprehend how that would hold up. Couldn't you counter-sue?

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  2. Not necessarily about how to protest, but in that situation, if I really felt adamant about giving birth in a hospital:
    either renting an RV to park outside the hospital and walking in at 10 cm and pushing
    or getting a hotel room nearby to do the same. Of course, this would involve NOT telling the OB of your plans.

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  3. Emily, you'd have to be careful about that RV thing. If they think you're just parking your vehicle there overnight- you might get booted (depending on how long the labor is).

    :)

    I think it'd be more fun to pitch a tent at a nearby park. Giving birth outside would be great.

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  4. My only suggestion is to do any of the suggestions on the list collectively as an organized and coordinated group of all VBAC moms at the same hospital? Like having a phone banking party to simultaneously flood the phone lines of those insurance companies and hospital administrators and JCAHO offices.

    I love Emily's RV suggestion for an RVBAC!!! :D

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  5. I local couple called the media to follow their planned VBAC... turned into a C and bad newspaper exposure.

    http://www.tcpalm.com/news/2008/apr/22/by-james-kirleyltbgtltigt/

    I don't know the couple or the details of the birth except what is shared in this article.

    On another note...

    Parking your RV near the hospital sounds like giving in to "fear" to me. Why not just stay home?

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  6. I think that US birth centers have agreed to give up doing VBACs -- can someone back that up? It seems like I've read it just recently; but maybe it was just a recommendation from some association or other to stop it.

    But, for what to do -- EMTALA -- http://www.emtala.com/ -- requires that hospitals admit you and abide by your wishes until the placenta delivers. Of course, that may require more *(@! than you want to put up with.... :-)

    Kathy

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  7. This comment has been removed by the author.

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  8. Here I hope is a link that should work to that earlier article. That is what I was trying to do with the above comment, just if you're curious.

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  9. While recognizing that vbac bans totally suck, for lack of a better term, my ICAN group has come up with a positive way of dealing with this. To preserve the vbac "friendly" providers here in town, we started a thank you letter campaign. We're writing thank you notes to the people who have been instrumental in helping our Mamas achieve the vbac they desired. Our hope is that these providers (OB's, midwives, nurses, doulas, etc) will understand the depth of many cesarean mom's ache, and not cave in to the pressure to stop allowing their clients autonomous choice in their childbirth options.

    Also, the mom depicted in the article that Permission to Mother gave is an ICAN mom. While I cannot speak for her, I can say that the poor thing has been through the ringer, the article was *not* supposed to take the tone that it did, and as a group we bombarded the editor with letters stating our disgust for the tone and misinformation presented.

    The only way things are going to change is one day at a time, one person at a time. Until our collective voices make a MUCH larger noise, we need to focus on getting more voices. And hopefully we can do it in a way that is not going to alienate ourselves even more than we already are from the mainstream crowd.

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  10. You asked for tongue-in-cheek:

    A steel belly jacket! One just big enough that you will be able to slip out of it postpartum; they can't do a c-section in labor if they can't get at the tummy. Paint some pithy slogan on the front of it. ;)

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  11. How timely! I just returned home from a 36-hour VBAC. One that involved 24 hours at 7cm (epidural at 2cm since contractions were 3min apart for five hours and she was having the undeniable urge to push.). 12 hours of this labor was spent with her fighting with staff, refusing to sign consent forms, refusing to sign refusal to sign consent forms forms, etc. But she trusted her body and her body did it - even with transition contractions only 10 minutes apart. Her labor went backwards and she still birthed a 9lb10oz baby (in the stranded beetle position, no less).

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  12. How about a tattoo on your abdomen that reads, "I do not consent"?

    ;)

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  13. "Parking your RV near the hospital sounds like giving in to "fear" to me. Why not just stay home?"

    Because if your uterus does rupture, you will need medical treatment.

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  14. "abide by your wishes " No where have I read that I need to abide by your wishes because of EMtala. You can refuse treatment. If I put a hand on you and you ask me not to. That is assault. However, it is not very clear cut in an emergency setting.

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  15. I would write the hospital too. The hospital is who decides if they will keep 24 hour anesthesia on and if they will keep 24 hour Ob on too. IF they have both those things the insurance should cover the Doctor to do a VBAC.

    I think the RV is not a bad idea. Much better than staying home. I have seen my Doctors do breech delivery on fully and pushing woman. When they have come in fully and pushing. I don't think it is a great idea to deliver a breech baby vaginally. But I would perfer you know all your options and op for the safest delivery for you and baby.

    But find out who is inside the hospital. All Hospitals are not created equal. If you are parking an RV in front of a Hospital that does not have an OR staff inside, you are not in a good spot.

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  16. "I think the RV is not a bad idea.
    Much better than staying home. I have seen my Doctors do breech delivery on fully and pushing woman. When they have come in fully and pushing. I don't think it is a great idea to deliver a breech baby vaginally. But I would perfer you know all your options and op for the safest delivery for you and baby."


    I would agree with you Pinky I don't think it's a great idea to have a medically managed breech either. In fact it's very problematic. It is important to be fully informed and have choice.

    It does seem that after making enquires if you are blanked staying at home is the best option.

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