Was Joy Szabo’s birth a “victory?”
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.
Tags: hospital birth, ICAN, VBAC/Cesarean
The thought of a hospital that doesn’t allow VBACs still sounds so foreign to me.
I’m glad Joy had a VBAC, but for me, I would rather be with my family for the birth and weeks leading up to it. I’m not sure a VBAC would have been worth the separation for me. I hope her original hospital re-evaluates their policies on VBACs.
Morgan, I agree, it does seem “foriegn” that a hospital would ban VBAC. So many do though.
If I were in Szabo’s shoes, I’m not sure I would have gone to Phoenix so soon–I don’t have a history of preterm labor, so I likely would have waited until a few days past 38 weeks. But I would not have had the elective cesarean–the lifetime of future risks would weigh heavier than the few weeks of separation.
When women rank having their partner present for the birth over mode of birth, they are often thinking “well if something is looking like a c-section might be NECESSARY, I’m going to get a proactive epidural rather than waiting for an emergency where there is only time for general anesthesia.”
I dont blame joy for wanting to have it her way. these drs now a days do what they want to do.. they dont care about what the mother wants. drs think pregnancy is a disease. and i dont go for that. i had my daughter at the hospital and the dr wasnt even in the room to catch her.. he was to busy flirting with the nurses.. and when i yelled shes coming.. he came in and lifted the sheet and said yep, there she is.. so who needs a dr? so when i had my last child.. i was so against everything they do.. drops in their eyes. and shots right away.. so i had my son at home and it was such a joy to have. some say i was stupid for doing that.. but i learned all i can for this to happen. i asked.. i read info.. and plus this was my 6th child. i knew when it was time to push. i knew and everything was fine. so i dont blame Joy for wanting to have it her way.. its her body its happening to. not yours or the drs. she knew the risks it was gonna bring,
so everyone needs to back off of the mother and let her do what she feels is right.. just cause it worked for some dont mean its the right choice for others.. would you give penicillin to a person that has an allergic reaction to it and may cause them to die??? NO>> you wouldnt.. so just cause its good for you dont mean its good for others…
you go JOY!! and congrats to you and your baby…
Jenn, I am in agreement with you as this is not the delivery she wanted. While I certainly respect her wish to VBAC, after going great lengths myself, this is far from a victory.
Tammy,
I think you may have misunderstood the point of my post.
I completely think that Joy should have been able to get the “birth that she wanted.”
The thing is, I don’t think she got it–what with having to travel so far just to be able to birth vaginally.
I also travelled 6 hours (350 miles) to have the birth I wanted with my daughter. I wasn’t confident in the care providers in my area and so I decided to go to a larger area with more experienced MWs and have my VBAC. I left to stay with my family at 39w4d/39w6d (depending on which date you use) and took my older son with me. My husband came for the weekend and then went back to our home to work. He came the following weekend and she was born that Sunday at 40w6d/41w1d in a glorious out of hospital birth. My husband was able to be there but it was a worry we had before the birth. I truely believe that I held off having my daughter until he was able to be there. The enitre weekend the week before she was born I had regular contractions and as soon as my husband left to go home they stopped. I had no more contractions until he was back with me. In fact when I picked him up at the airport my contractions started and the next day they were regular and she was born the day after that.
I’m happy that Joy had her VBAC! It is a victory for VBACers to have these stories of VBACs and VBAC bans out there in the mainstream media. Getting information out there is important and I thank Joy for that. People are finally starting to really talk about the state of our birthing system in this country and I’m very hopeful that the ball has started rolling for change.
I am sitting here practically in tears. You are obviously not a cesarean scarred mother. This IS a victorious birth after cesarean. To have you belittle that is insulting. To have you criticize the relationship this woman has with her husband is even more belittling. How do you know this couple didn’t find strength and love in this decision? This couple loved each other and their baby enough to do what was best for the baby, especially knowing that a vaginal birth (given her history of VBACs) was quite likely. I think her husband’s potential sacrifice of missing his child’s birth to save his wife from the pain of a cesarean recovery is commendable, especially knowing how many husbands push their wives into repeat c-sections because they believe them to be safer in the hands of doctors. Of course this VBAC was far from the ideal situation but there are too many scarred moms out there in pain who don’t think they have options and Joy showed them that where there is a will, there is a way. Every birth and the spirit and strength of every birthing mother should be celebrated as a victory; not criticized by the members of the birth community.
Jenn, you said: “The thing is, I don’t think she got it-what with having to travel so far just to be able to birth vaginally.”
Um. Don’t you think that’s up to her to decide? I personally find that with struggle there is growth… but I’m going to let her be the judge of her own experience.
I like Joy would rank “avoiding a c section” ahead of having my partner present for my child’s birth. Yes, she SHOULD have been allowed BOTH without an induction. But, if I had been in her shoes, and homebirth was not an option (which would have been what I would have done EVEN in Arizona), then I would have moved 6 hours too. Not because it wasn’t important to me to have my husband present, but because my goal would be a healthy mom and baby for the rest of their lives! Which, to me, avoiding multiple cesareans is crucial. To me, the safest way for my baby to be birthed is vaginally, not by an unnecessary surgery. I could have NEVER consented to that. So many people question Joy, and it saddens me. She was doing what was best for HER baby. Why fault her for that and question her? Let her be in peace. So, I do find HER victorious. She shouldn’t have had to do what she did. But, she refused to bend over and take it and I applaud her for that! So many others are not strong enough to stand up to their doctors and I find that incredibly sad. The state of our american obstetrics practices is the failure here. Joy stood victorious despite what our country sets women up for. Congratulations Joy!
I appreciate that the overall point you are trying to make is that as birth advocates we have a lot of work to. Women shouldn’t have to go to such means to find a legal care provider to attend their births. I think the hope is that the more the public becomes aware of such cases, the more hospitals might be pressured to reverse their bans. Joy’s case is a personal victory for her and she is a tremendous role model for others. However, we have to become better organized to take the next step in our local communities to keep the pressure on and to educate women in our communities. The ICAN survey showed that a huge number of hospitals are banning VBACs. The untold picture is that there are many more care providers who are not doing them or educating their patients that it is a option. In some states there is also a rural vs urban disparities. The choices one makes in childbirth are very personal ones. However, the debate over childbirth policies that impact cesarean rates, VBAC bans, overall induction rates are ones that will have a long term impact on public health. While this mother’s VBAC is a personal victory, there is a lot we all can do before we declare that we have won mother-baby friendly childbirth for all.
The thing is, Jenn, it doesn’t matter what Joy does or doesn’t say. We can’t decide for her whether her birth is a victory or not, whether now or in the future (feelings change as we process). That is up to her.
If you want to make a point about a messed-up system that is forcing women to go to extremes to give birth the way they’re entitled to, fine. Take Joy’s example and then apply it to the system as a whole… but the minute you say “so and so’s birth wasn’t ,” you’re overstepping your bounds.
Sigh. HBACmommy, I still don’t think you are “getting” it. Please go back and re-read the “NOTE” I added to the end of my post.
For Joy personally, the birth may or may not be a victory, I don’t know. I’ve not seen her use that term in any of the written comments I’ve seen from her. It has actually been other people commenting on her birth that have used it. Which does beg the question, if other people are allowed to decide that this is a victory, why can’t I hold the opposite opinion?
For sure, Joy fought hard against “the establishment” and a large host of circumstances to get a vaginal birth. And she certainly has opened a national debate that I *hope* will be helpful. But putting myself into her shoes…I can’t imagine that she really got the birth she “wanted” just because she got a vaginal birth, any more than I, as a mother who already had 2 homebirths, would have gotten the birth that I wanted if I’d ended up needing to transfer to the hospital for my most recent birth due to high blood pressure. If she “wanted” to go to Phoenix and give birth–why would she have stirred up the media attention in the first place?
But I am talking about the bigger picture of it, Page Hospital “won,” they got to continue on with an unethical VBAC ban. They stood up under national pressure. MANY people are siding with them. This will give other hospital administrators moral support to adopt similar bans if they were considering them.
Jenn, I left this comment on the blog entry where Crunchy Domestic Goddess linked to this post, but I wanted to put the question out here, too, because I really don’t understand how a hospitals are getting away with banning VBACs:
This is SUCH a frustrating issue. I had to really fight for my VBAC, although not with the hospital directly.
I have to confess, though, I do not understand how a hospital could *force* anyone to have surgery. Isn’t it illegal to perform surgery on someone in a non-life-threatening situation without their consent? Couldn’t she have just waited until she went into labor, showed up at the ER (where EMTALA would require that she be admitted) and refused surgery? Not a perfect solution, but it seems like it would work.
In any case, I appreciate that the point was raised that financial privilege is an issue here. I am due in July with my third baby, and while there are several excellent midwives in our area who happily attend homebirth VBACs (my ideal), my insurance will only cover a portion of the expenses, and we do not have the money to pay the out of pocket portion of the costs. I have found a midwife practice that takes my insurance, but they only attend at hospital. Still, at least I have access to midwife care; many women, particularly low-income women, do not. It’s such a shame.
Somehow there has to be a way in all of this for birth activists to shed light on the fact that their VBAC ban was pointless and useless in this case, as the woman had a safe, healthy vaginal birth. Page Hospital SHOULD come out of this looking ridiculous if this event is positioned correctly. And this mommy is the one who sought media attention for this birth and the circumstances surrounding it, as I understand, so perhaps now she has an obligation to follow through (after a suitable babymoon, of course) and show the world that Page Hospital discriminates against vaginal birth………..
SKE, Yes, technically speaking it would have been illegal for Page Hospital to do the surgery without consent. But they were threatening to get a court order to force it if she showed up in labor. In my knowledge, the only time one of these court orders has been declared “illegal” was AFTER the mother and baby had died of complications of the forced surgery.
I’d also be willing to guess that pressure was put on her OB, telling him that if he allowed her to refuse a planned cesarean, they would drop his admitting priviledges. So she would have had to show up in labor, and get whatever on-call Dr. was forced to handle her care…and she’d have most likely had a huge fight on her hands while in labor. For example, they may have refused to provide an epidural unless she was having a cesarean, and maybe she wanted one.
Unfortunately I’ve heard too many stories of women screaming that they refused to consent–as the anesthesia mask is strapped on them and their partner is physically restrained. In at least one case I know the mother demanded the next day to know who had given consent, and the Dr. said “your husband did.” Well a husband can’t give consent unless the woman is unable to–and she WAS able to according to her account…just no one would talk to her as she was being wheeled into the OR and sedated. And further….
She wasn’t married.
She pointed this out to the OB. When she got a copy of her hospital records later the consent form her boyfriend had signed was not there, and there was a note in the margin that said she’d had all her questions answered, and gave verbal consent in the OR. Funny…no one but herself and the hospital staff were present when this supposedly happened.
My very best friend had a VBAC 20 months ago. This was her 8th child. Her first 2 deliveries were c-sections, followed by 5 normal vaginal births.
TRAGICALLY, her 6th VBAC ended with a uterine ruptre and emergency C-Section. She and the baby both almost died and the baby has had long term difficulties.
It has been almost 2 years now. She is convinced that the killer she expeirienced was NOT the VBAC which is always the blamed source. She blames the pitocin dripp she received 10 days before her due date to induce the delivery. The hospital’s idea of managing her risk.
We should consider the cost of such interventions - and not blame mothers for persuing a delivery their body has proven itself capable of .
I think everyone on here is missing the point. Page Hospital didn’t refuse to accommodate Joy Szabo’s VBAC simply because they wanted to, or because it was their unwritten policy. It’s an ACOG standard. They are-per standard-adequately staffed to provide emergency C-sections and labor/delivery care. But VBAC? No. So she should have forced her way into the ER and not signed her consent? What if Page Hospital complied and there were complications to the extent a huge law suit ensued and Page Hospital - A NON PROFIT FACILITY- had to shut it’s doors? Where does that leave the small community of Page? I think the hospital administrators were very prudent in their enforcement of this standard. It’s set in place for the safety and well being of mother and baby, anyway. I am thankful she did have a safe delivery, but hospitals have to look at the what ifs and follow standards, rules, regulations set on them by larger entities.
And before you start in on me, myy daughter delivered my first grandchild at home with a midwife. It was a good delivery with all healthy, though at one point baby got hung up on the pelvic bone and the midwife was a little worried. I am all for normal vaginal births. But to tear down a small rural hospital and medical staff which has given so much to this community and inhabitants without knowing the full extent of the story is irresponsible. Incidentally, Phoenix is NOT over 6 hours away…at most one travels 260-275 miles from Page to Phoenix, which AT MOST is 5 hours. I cannot fathom how CNN, Rachel Ray and all those involved in this media hoopla do not check their “facts”.