Recently, Bartlett Regional Hospital sent out their House Calls newsletter. In this newsletter, the hospital’s policy on Vaginal Birth After Cesarean (VBAC) states that Bartlett is “not offering” VBACs, although they cannot turn away anyone who presents for care. Perhaps one reason Bartlett is publicizing their policy is because of the advocacy work of a local group, International Cesarean Awareness Network (ICAN). ICAN of Juneau began in April 2011 with the goal of improving maternal child health by preventing unnecessary cesareans through education, providing support to women recovering from cesareans, and promoting VBACs. In the last year, BRH has given no community notice or opportunity to discuss this policy. As a community supported and funded hospital, Bartlett has a responsibility to involve the community.
Bartlett justifies not offering VBACs based on the 2010 American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin, which states that a hospital should have a surgical team immediately available when a woman is attempting VBAC. However, the full intent of ACOG’s guidelines on VBACs is not reflected in Bartlett’s VBAC policy or practice. ACOG states that VBAC has fewer complications than elective repeat cesarean delivery and therefore advocates VBACs in many cases. The bulletin also encourages medical facilities without immediate surgical services to provide the safest possible environment for VBACs. If Bartlett holds patient safety as their primary goal, as stated in their newsletter, then the safest type of birth should be an option for Juneau’s mothers. To do this, Bartlett should establish a long term goal of offering immediate surgical services to mothers electing to have a VBAC in Juneau. If Bartlett is not equipped to handle a sudden need for surgical facilities for a VBAC how can it be safe for any birthing mother as emergencies arise in non-VBAC mothers?
A second main point of ACOG is that health care providers need to have “respect for patient autonomy”. “Patients should be allowed to accept increased levels of risk” in regards to attempting VBAC; coercion should not be used. In the past year, a few women have decided to refuse repeat cesarean section surgery and have had successful VBACs at Bartlett. Some in the medical community treated them as if they were making bad decisions aimed at harming their baby. As ACOG states, the role of the medical professional is to assist the patient in making informed decisions based on her specific situation, but not coerce the patient into making a particular decision.
According to ACOG guidelines and Bartlett’s goal of patient safety, Bartlett Regional Hospital should implement the following:
1. Take sincere and credible steps through an open, community-involved process to study the possibility of offering emergency surgical services to mothers who choose to have a VBAC.
2. Revise policy and practice to include the objective of “Respect for Patient Autonomy” in choosing options for birth.
ICAN’s goal is the health, safety, and welfare of birthing mothers and babies. We hope Bartlett can start working together with ICAN, the Juneau community, and medical profession toward achieving that goal.
For more information in regards to ICAN please contact Janlaine Brady & Paige McGuan, ICAN of Juneau leader & co-leader, at 907)-957-6418 or email icanofjuneau@yahoo.com.
• Brady and McGuan, of Juneau, are the leader and co-leader of the local chapter of ICAN.
Comments (10)
Add commentMaybe the parents could sign
Maybe the parents could sign a waiver as they enter the facility to have their VBAC, that states they understand the high risk situation and there is NO surgical team available and if or when she ruptures her uterus, she will die and take her baby with her. Hmmm sounds silly to me. Have to agree with Bartlett on this one. Too risky for the baby. Let the parents take risks elsewhere in their lives. Let your baby be born alive.
Apparently mom's already to
Apparently mom's already to have that waiver. But apparently some women have had a VBAC here in town-maybe they were just lucky. But you know-one day-luck runs out. Ask people in Las Vegas. The ones who lost
sorry-already posted
sorry-already posted
People should
do a little research before making ignorant comments on articles about things they know little about.
Next time think before you comment Tikitime.
misinformed
Its this sort of misinformation that keeps women from having healthy, positive births. A woman undergoing her 1st cesarean is more likely to die than woman delivering vaginally. A vbac is by far the safer alternative to a repeat cesarean and the risks drop with each vbac there after. The risks only INCREASE with each c-section! It's not luck - its the body's natural ability to give birth, combined with getting out of the way and allowing women to do it that makes them successful. If BRH can have a surgical team ready for emergency c-sections for non vbac's, then they should be able to handle vbacs!
Mrs e-I was not offended by
Mrs e-I was not offended by Tikitime's post. I am new to this-but I thought this board was to listen to everyone's opinion, discuss the issues and maybe learn something along the way. Telling the poster that he/she is making ignorant statements belittles the reason for this comment board. Maybe she is a VBAC and has her exeperiences she may want to share or could be the father of a baby whose mom did VBAC. I won't be offended by your opinion because you own that opinion-not me.
women will do whatever it takes to get what they want
What they want are scheduled births and the abiity to financially blame anyone but themselves when things go wrong.
I've watched women refuse to travel to see a perinatologist unless "someone" (other than the babydaddy) pays for her and babydaddy's travel. Some refuse to go to Anchorage to wait for delivery even if they are likely to require a NICU, which isn't available at BRH....unless they get welfare to pay for babydaddy to go vacationing with them until
Taxpayers already pay for over half the births in AK. If you want something not available in Juneau, open up your wallet and pay for what you want.
as for doctors being gentle in offering options
It's nice for someone who hasn't paid over $120k and spent years getting an education to instruct doctors on how we need to behave and what risks we need to take.
Now if only they could also instruct lawyers not to attack doctors in the hopes of a windfall. The first question is always "did you let the patient know the risks?" The answer is yes.
The second question is "did the patient understand what you were saying?" Answer is yes.
The the lawyer asks "If you really explained the risks so the patient could understand them; she wouldn't have chosen something that was dangerous...after all you're not saying this poor woman is an idiot are you?"
If society couldn't blame doctors for patient choices we could be a lot more gentle in some discussions.
We've been here before...
I had an emergency c-section for my first kiddo down south after more than 24 hours of drug-free labor. Not what I wanted for a birth experience but you know what? I ended up with a beautiful, healthy baby. How she got out no longer mattered to me. After we moved here, I was about 6 months pregnant and considered low risk when Bartlett started this no vbac policy. I was pretty disappointed, but it remained my choice. I could stay here in Juneau and get a scheduled c-section or fly down south for a vbac where the hospitals are staffed & equipped (by the way, they need a *much* faster team for a ruptured uterus than an emergency c-section). I can see both sides of this I REALLY can. But I think the authors of the above article are aiming their efforts in the wrong direction. Bartlett can't act contrary to best practices set up by their peers and their insurers or they WILL get sued and people can lose their licenses. Get the insurance companies on board and you'll get more hospital support. And I'm *not* talking about your personal health insurance carrier. I'm talking about the insurers who cover the doctors and hospital. Maybe with an ironclad waiver women can get the chance to do a vbac here if they want. And while you should always have an expectation of respectful discussions with your doctor, don't expect them to agree with your decision if they really feel you or your baby are at risk.
Mrs. E
I have done homework and I know many doctors that cannot get malpractice insurance for VBACs, or it is very cost prohibitive and juneau_mom is right, and emergency VBAC requires a much quicker response with many more hands on deck. If you want your baby to survive than go down south were there is a team available in case of the worst.