Members of the local organization Birth Action Coalition gathered on June 23, outside Cottage Hospital in Santa Barbara, carrying signs in one hand and babies in the other, to protest what they called the hospital’s “ban on Vaginal Birth After Cesarean (VBAC).”
The coalition’s goal is to “help create supportive natural birth environments in the Ventura and Santa Barbara counties,” protest organizer Jessica Barton said.
“A lot of women in this area would like access to VBAC, but don’t have it,” Barton said.
Barton, who became interested in the subject after being denied a VBAC about two years ago, said research done by the International Cesarean Awareness Network shows that allowing women to give birth vaginally after they’ve had cesarean sections is a “safe and desirable option for many women.”
“Giving birth is an emotionally satisfying experience that most women want to be able to do,” Barton said.
At Cottage Hospital, she said, women who have had c-sections, but want to give birth naturally, have not been able to do so since 2003.
She said the hospital created a ban on VBAC because of fears of liability and the “slim chance” of medical complications, namely a uterine rupture, when the scar from a c-section tears under strain from giving birth.
Janet O’Neill, Director of Public Affairs at Cottage Hospital, said that the word “ban” doesn’t properly describe the hospital’s stance on VBAC.
“The hospital doesn’t have a ban on VBAC,” O’Neill said. “We haven’t done VBAC since 2003. The staff decided it was the best decision, based on patient safety, not to perform them.”
“If women say they want to do them, then we wouldn’t stand in their way,” she said.
In order to perform a VBAC, the patient’s obstetrician is required to present her case to the hospital’s Department of Obstetrics and Gynecology. The department then decides whether or not to allow the operation.
Still, Barton and her fellow Birth Action Coalition members don’t think this policy is straight forward enough.
Referring to the policy as “inconsistent” and “confusing,” Barton said the coalition wants to ensure that pregnant women and their families are completely aware of their options.
“Our main point is that VBAC is a safe option, and our goal is to educate and empower women who are giving birth,” she said.
According to a 2006 study, published by the American College of Obstetricians and Gynecologists, entitled, Results of a Well-Defined Protocol for a Trial of Labor After Prior Cesarean Delivery: “A trial of labor after cesarean seems to be as safe for the mother and infant as planned cesarean delivery.”
Barton also cited additional health risks involved with having multiple c-sections, including weakening of the uterine wall and scar tissue.
However, Cottage Hospital’s O’Neill said that the Department of Obstetrics and Gynecology bases its decision not to perform VBAC on the American College of Obstetricians and Gynecologists’ 2004 clinical management guidelines on VBACs.
According to the guidelines, approximately 60 percent of VBAC deliveries in the United States are considered successful. The most common health risk associated with the procedure is uterine rupture, and is most frequent in women who have never given birth vaginally.
The guidelines recommend “most women with one previous cesarean delivery” and a low transverse, or slanting, incision “should be counseled about VBAC and offered a trial of labor.”
The guidelines state that because of the complex nature of the procedure, VBACs should be attempted in facilities that are properly equipped to respond to emergencies, with physicians and anesthesiologists readily available.
Also, the guideline recommendations state: “The ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her doctor. This discussion should be documented in the medical record.”
On top of possible medical risks, O’Neill said VBACs have also increased financial obligations. Since it is required that specific medical specialists, such as an anesthesiologist, are onsite during the birth, the cost for the delivery increases exponentially.
Here in Santa Maria, Marian Medical Center has a similar stance on VBACs. When asked about the procedure, hospital representatives said there is no official ban on performing VBACs, but like Cottage, hospital staff at Marian have opted not to perform VBAC deliveries to ensure the safety of patients and their babies.
According to Cottage Hospital’s Web site, www.sbch.org, medical services, including anesthesiology, maternity, and neonatal intensive care, are available at the facility.
“Any woman who is really considering VBAC needs to talk to her physician,” Cottage Hospital’s O’Neill said.
For more information about the Birth Action Coalition or the American College of Obstetricians and Gynecologists, visit www.birthactioncoalition.com or www.acog.org.
Contact Staff Writer Amy Asman at aasman@santamariasun.com.
This article appears in Jul 3-10, 2008.