I loved to read this wonderful VBAC story from the eyes of the Doctor.  It demonstrates the changes in attitude regarding VBAC’s and how women have to fight for the right to have the birth they want. 

When I started my intern year, our hospital had a very high successful VBAC rate and a relatively low C-section rate in the low twenty percent range.  Women with prior C-sections came in, labored, and VBACed every day of the week.  It was a great time to be learning at the hospital and I could see a lot of women were empowered to have a chance at a vaginal birth after a C-section.

Super, moms getting the support they need to have the births they want. 

Then the malpractice carrier changed their policy.  A large settlement in a case completely unrelated to our hospital resulted in a blanket refusal to cover ToLAC unless the hospital provided 24-hour dedicated OB anesthesia

Uh oh, I can see what is coming here.  It was interesting though, how they slowly phased out VBACs, in steps.  Finally arriving at this…

I understood we were to inform all pregnant women with a prior C-section that the hospital no longer permitted ToLAC.  We were supposed to review the <1% risk of uterine rupture and explain we were now managing subsequent deliveries via repeat C-section.  However, it was clear that no woman could be forced to undergo a major abdominal surgery if she did not want to do so.  In those cases, we were supposed to refer her to an obstetrician to discuss the policy and the risks in more detail and, if the woman still wanted to avoid a repeat C-section, she was instructed to sign a declination form, which is like a consent form to refuse recommended treatment.  In other words, there was a way around a repeat C-section but it was time-consuming, confusing and required a lot of talking.

Ok, that sounds ok to me.  Moms are made aware of risks, but still have the option.  Yes, it is a pain to jump through hoops, but it was out there as an option.  BUT,

What happens when a process is time-consuming and confusing is that doctors will only participate in the process to the extent they feel strongly about the outcome.  Because human nature tends to follow the path of least resistance, doctors end up abandoning the troublesome process and go with the accepted policy.  In the community there were a number of doctors encouraging their patients to sign declination forms and were therefore continuing to have good VBAC results, but the story was different among the residents’ patients.

You need to go read the post to see what happens, but it is nice to see that one person can make a difference!  Just letting a mom know she has options can change so much! 

This is one of my most passionate birth issues.  VBAC moms should have choices and support for whatever they choose to do!