You may recall that I blogged about Joy Szabo 2 months ago. At the time, she was pregnant, and was seeking media coverage because she had learned that the hospital closest to her, Page Hospital in Arizona, was denying her request to VBAC. Ms. Szabo’s case was particularly troublesome because the nearest hospital to her that would “allow” VBAC was in Phoenix, a 6 hour drive from her home, and Ms. Szabo already had 2 vaginal births, so certainly would be expected to have good odds for being able to achieve her desired VBAC. Having the cesarean would actually have put her baby and herself at a higher risk of complications than having a VBAC would.
Unfortunately, Ms. Szabo’s situation is far from unusual. A survey done in January 2009 by the International Cesarean Awareness Network found that half of all hospitals in the US ban VBAC.
Well Ms. Szabo had a vaginal birth earlier this month, and for that, I am happy. However, I don’t take it as all good news.
Many bloggers are hailing this as a “victory,” and even CNN titled their article “Mom fights, gets the delivery she wants.” I do not see the circumstances of her birth as a victory though.
Page Hospital apparently stuck to their position that it was too dangerous to “allow” a VBAC in their facility due to the risk of uterine rupture. This despite the very obvious fact that emergencies such as umbillical cord prolapse, placental abruption, and acute fetal distress–things that can happen unpredictably in any labor–occur in about 2% of labors, while uterine rupture only occurs in 0.5% of VBAC labors. If this hospital is not safe for VBAC, then it is not safe for ANY labor.
This in turn forced Ms. Page to choose between 3 options:
- Submit to an elective surgery that had higher risks to her and her baby than attempted vaginal birth
- Have an unattended home birth (midwives in Arizona may not attend out of hospital VBAC)
- Move to Phoenix approximately 3 weeks before her due date of November 21 so that she would be within a reasonable travel distrance to the hospital that would allow her to have a vaginal birth when she went into labor.
She opted for the final option. Which I’m sure, if you were to ask her, wasn’t really the “delivery she wanted.” What mother wants to be separated from her three young children for 5 weeks before the birth of her fourth baby? Even if the mother wants a bit of “down time,” most families in America aren’t really looking to double their housing payments, for however brief a time period.
Further, CNN reported that her labor was only 4-5 hours long, but the drive from her home was 6 hours. Unless her labor was induced, that means that her husband wasn’t there for the birth. In the past, I have done a “priorities” exercise with students, in which we rank the priorities for what women want in labor. Different women rank things differently–some are adamently opposed to an IV, while others really don’t care. Some want to be able to use the Jacuzzi without restriction, while some are grossed out by the idea of sitting in a tub of water that might have birth fluids in it.
But one thing is universal…in a good relationship, women place having their partner present for the birth just below “healthy mom/healthy baby.” It goes ABOVE ”avoiding a cesarean.”
But Ms Szabo was forced to reverse that, and put “avoiding a cesarean” above “having partner present.” I’m sure that was a very difficult choice for her. The only thing that makes me somewhat hopeful for how things turned out on this count is that her baby was born at exactly 42 weeks gestation…so it is possible that her stress of not having her husband present held off labor until she finally consented to an induction, which hopefully was started only when he could be there (the only reason I can imagine for why an induction would be done on a Saturday–December 5).
I’m glad she got a vaginal birth, but this was NOT a victory. In addition to her personal losses, this could easily be used by hospital administrators as “precedent.” “You want a VBAC? So sorry, we don’t offer that here. Do what Ms. Szabo did, go move to be near ‘hospital X.’”
NOTE (12/21/09, 6 p.m.): Many people seem to be misunderstanding my point with this post. I am glad that Joy got a vaginal birth, and on that level the birth was a victory. But on the larger scale level…the extreme hoops she had to go through make it less than that. The “victory” that I see missing is an acknowledgement by the Page Hospital administration that A) VBAC is safe and B) even if they disagree with “A,” they have no right to force a person to have surgery. For a woman who does not have the financial means to do what Joy did–move away from her home for over a month–surgery is still a forced situation.
As for letting Joy define her birth…in all of her comments, including what appear to be her remarks in the comments section to the article, I have not seen her use that term, nor did she contradict my brief comment in which I made similar points as I have made in this post. The title to the article are most likely not her words, or even the words of the article author. Titles to articles are written by editors who choose a title that will draw in readers.