My Turn: Examining Bartlett Regional's after-cesarean birth policies

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.

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