Hospital Policy Pains Expectant Mother
The Lake Powell Chronicle, a newspaper in Arizona, carried an article recently highlighting the plight of a woman who has had 3 previous births–the first a vaginal birth, the second a cesarean, and the 3rd a VBAC. Now, expecting her 4th child, she is being told that she must consent to a repeat cesarean because her local hospital (Page) has determined that it can not handle any possible emergencies that a VBAC might bring.
Being in PA, I can’t really verify exactly what is going on in Arizona…but since the article says that Ms. Szabo’s only options are unattended homebirth, or going to a hospital in Phoenix, I’m going to have to make the assumption that there aren’t midwives available for homebirth there (this is not uncommon–especially in such a sparsely populated area), and the closest hospital is in Phoenix (this may be the closest hospital that allows VBAC).
According to MapQuest, Phoenix is more than a 4 hour drive from Page. According to a midwife referral website, midwives are indeed hard to find in northern Arizona.
The combined risk of having a placental abruption, umbillical cord prolapse, or acute fetal distress necessitating an emergency cesarean in ANY labor is over 2%. The risk of uterine rupture in VBAC is under 0.5% If a hospital can not handle the possible emergency of rupture during VBAC, clearly the hospital can not handle ANY birth.
SOMEONE needs to stand up like this woman is doing…because the rights of birthing women are being quickly eroded. When the International Cesarean Awareness network did a survey at the start of this year, they found that half of all hospitals in the US ban VBAC.
This is my letter of response to Mary Forney (reporter@lakepowellchronicle.com, leepulaski@lakepowellchronicle.com is her editor), the reporter who wrote this article.
I thank you for having the courage to cover the story of Joy Szabo and her anticipated forced cesarean. Unfortunately, it has been my experience that some newspapers are reluctant to print stories like this, possibly because of how much advertising money they get from hospitals.
If you visit the website for the International Cesarean Awareness Network (ICAN), you will learn that Joy’s situation is far from unique. In fact, half of hospitals in America that handle birth will not allow VBAC, and those that do “allow” it often put such tight restrictions on it that it is very hard to achieve vaginal birth. But as Joy rightly points out, “if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all.” This is because complication in ANY labor–such as placental abruption, cord prolapse, or acute fetal distress–that would require an emergency cesarean are far more common than uterine rupture in a VBAC labor.
It is worth pointing out that if this hospital accepts any Medicaid money (which they likely do), then they are bound by the “EMTALA” act–Emergency Medical Treatment and Labor Act. This act requires a hospital to admit any laboring woman who comes within a certain radius of the hospital. To then force her to have a cesarean would be to violate her rights. Allowing a VBAC is not “performing a procedure.” It is allowing the natural culmination of pregnancy to play out. The cesarean is the “procedure.”
I find it oddly conflicting that Sandy Haryasz, the hospital CEO, uses ACOG guidelines as a scapegoat to hide behind in placing the VBAC ban, and yet then blatantly admits to planning to violate ACOG guidelines by pursuing a court order to force Ms. Szabo to have a cesarean. ACOG stated in a 2004 ethics policy that they do not believe that court orders should be used to force women to have cesareans except in very extreme cases, and that same document says that they really can’t come up with an example that a court order would be warranted.
Again, I thank you for writing your article!
Jenn Riedy
President and member of the Board of Directors of EmPoWeReD Birth
Tags: EmPoWeReD Birth, hospital birth, midwife, VBAC
Arizona is one of the states that forbids out-of-hospital midwives from attending VBACs.
Thank you for filling in that detail Kathy!