Denied VBAC

A friend told me a story today that has had me thinking ever since I heard it. Her friend was choosing a VBAC (Vaginal Birth after Cesarean) for her second birth. She had arranged with her OB/GYN to attempt a VBAC when labor began. She went into labor and after some time (I do not have all of the details) headed to the hospital in the middle of the night. Her doctor was not on call. The doctor on call refused to allow her to continue laboring, refused to attend a VBAC, refused to stay on the hospital floor in the middle of the night, refused medical liability, etc.

Off they went to surgery. For absolutely no medical reason.

This story makes me sad and angry and disappointed. I don’t want to point blame here at all; instead I want to offer encouragement and some possible options to avoid this type of situation. It would be very easy to start pointing fingers and put all of the blame on the OB/GYN, who may have never had any experience with VBAC, or who had multiple other obstetrical patients taking up their time. I don’t know, nor do I feel the need to defend him or her.

So what other suggestions or options can we come up with for this? Well, a lot of them would be preemptive, such as having a provider who will attend your birth no matter what, supports VBAC, has only a few back-up doctors/midwives that you have met and who also fully support VBAC.  For whatever reasons, though, this didn’t happen and the plan changed due to a provider not being available.

As for arriving at the hospital with some laboring to still happen, a few suggestions immediately came to mind:

1.  Ask for a second opinion. See if there was another doctor working at the hospital who you could transfer your care to.
2. Refuse another surgery. Outright refuse to sign the papers. Hopefully the on call doctor would transfer your care — perhaps to someone more sympathetic and VBAC friendly. Be aware there could be consequences to this but legally no one can force you to have a cesarean without a court order.
3. Leave that hospital. Go to another hospital and see if a more VBAC friendly doctor is on call at the time. Go in through an emergency room and speak to whoever you need to speak to — head of OB/GYN department, on call doctors, etc.

I know some of these will sound extreme to many, particularly if the thought of birthing in a hospital seemed the safest route. It may not sound pleasant while in labor to run around and find a provider who will support you the way you want, need, and deserve. Please know I am not dispensing medical advice or advocating one particular course of action or finding fault with personal choices. Obviously the preferable choice would have been for everything to line up, ducks in a row, planets aligned, for this mother to labor the way she chose — with an OB/GYN provider, in a hospital. Unfortunately, it didn’t. Too many women are finding similar “switch and bait” actions when they are going for a VBAC — a provider who changes tune in the last trimester, a  provider on vacation who doesn’t have backup who provides similar care, a list of things that must happen exactly so in order for a “trial of labor” to happen for a woman wanting a VBAC.

Because of this, I do strongly encourage you to ask hard questions from your provider. Who will provide backup? Is your provider planning any vacations around your guess date? Can you meet the backup and ask the same questions? What other providers could you transfer to late in pregnancy or even last minute? What are the required protocols for a trial of labor for a VBAC? How does your hospital offer a second opinion or second provider in case the on call doctor cannot or will not support you in your birthing choices? If you have a midwife and are planning a home birth, ask where care would be transferred to in the event of further required intervention? Will she be able to go with you and help you navigate a change of birth plan?

Other suggestions: Hire a doula. Have a birth plan that is discussed, approved by, and signed off on by your provider. Know your rights.

This is not an exhaustive list, as this post was typed rather hurriedly. Any other suggestions?

ICAN can help you find VBAC friendly providers as well as scores of information to shape your idea of birth, including questions to ask providers.

 

 

All Rights Reserved 2011, Kimberly Sebeck, Knoxville Doula

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2 thoughts on “Denied VBAC

  1. I think what it boils down to is that each & every pregnant woman must do research and learn her options…what does she want to happen, what could happen & how will she handle that,etc. This includes making her birth plan, asking her provider the hard questions to make sure the provider supports her & her birth plan, hiring a doula to support her (or having another support system in place), changing providers if necessary, finding out if her place of choice for her birth works with her plan (for example, some hospitals don’t ‘allow’ VBACs no matter your provider says), etc. We must take responsibility for ourselves and our births. If we don’t educate ourselves so we can make the decisions that are right for us when the time comes. Not making a decision IS making a decision.

  2. Wow. What a tough spot.

    Of all your suggestions, I think “hire a doula” is the one most likely to help a woman in this scenario avoid a surgery. The problem is that a woman in labor and her partner are 1) understandably focused on the sensations the woman is experiencing and the labor that is progressing in her body (mind/soul) and 2) have probably never had to advocate with a doctor who thinks cesareans are no big deal (but VBACS) are before on the doctor’s turf.

    An experienced doula probably has faced such a doctor before and can talk with her/him compassionately and respectfully but forcefully. This is a tricky situation. The couple and her doula need to advocate for themselves without making an enemy of this doctor, who does hold a lot of power in this situation. For example, the doctor could decide that leaving the hospital constitutes endangerment of the baby and call authorities. So it is important to try to keep the peace. It is also important to find a better solution than non-medically-indicated surgery.

    A doula can help the couple make suggestions that might work in this hospital. For example, in this scenario, one of the first things I would do as a doula is try to contact the original doctor (who promised to attend a VBAC). I would go through every channel available at the hospital to call that doctor at home/page that doctor. This may be annoying to the doctor-on-call, but it is a relatively benign way of asserting that this doctor’s opinion is an opinion (not medical fact).

    If the doula has not faced this situation before, she probably at least talked about how to advocate in tricky hospital situations during doula training and has more experience with practicing this than the couple.

    I will have to turn this scenario into a new post in my blog series “Why Hire a Doula: Reasons that Don’t Usually Make the Top Ten.” (http://wp.me/p14IqD-2w)

    Thanks for posting this!

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