Your Right to Refuse a Cesarean: ICAN’s Guide to VBAC Bans
Thursday, September 17, 2009 at 7:19PMThe International Cesarean Awareness Network has a guide online for women who are wishing to give birth in one of the hundreds of hospitals in the U.S. that seeks to ban VBAC, either officially or by a de facto ban. The guide is a starting place for the many women who have been told they must “choose unnecessary surgery or forgo hospital care altogether.”
The following is a summary of Your Right to Refuse: What to Do if Your Hospital Has “Banned” VBAC Q & A:
You cannot be forced to undergo surgery.
Protect yourself by:
- Knowing your rights
- Filing a grievance with the Chief Compliance Officer at the hospital where you plan to give birth.
- Replace your birth plan with a customized form documenting your refusal to consent.
A hospital may not refuse to admit you unless if you do not consent to a cesarean thanks to the federal Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals to admit women in active labor and to abide by their treatment decisions until after the baby and placenta are delivered.
If your care provider ignores your refusal to consent and performs a cesarean anyway, you are within your legal right to file criminal assault and battery charges and, if you or your baby suffer an injury, you may also sue for negligence.
If you challenge your care provider and they drop you from care, they would be doing so in violation of professional ethical guidelines and they can be charged with patient abandonment.
The odds are very good that your care provider or hospital will not seek a court order to perform a cesarean. Both the AMA and ACOG have revised their ethical guidelines to state that court-ordered cesareans are rarely, if ever, justified.
If you want to give birth vaginally in a hospital but are concerned with the stress that this will cause for your family, here are your options:
- Fight and assert your legal rights
- Submit to surgery
- Opt for homebirth
ICAN’s guide suggests that you educate yourself as to the risks and benefits of each option and call a local ICAN chapter if you need help.
Reader Comments (14)
I would love to have a VBAC.Tried to refuse a c-section 3rd time around and got told they would sign me in as a mental patient and just section me anyway.
I also wondered whether it would be worth getting alittle legal letter written up from a lawyer to take to the initial booking in.And also a letter from a fully qualified pschologist stating your in full control of your faculties.Could they still legally refuse you a trial of labour, if the only other option is an assisted homebirth?
I would really be interested in anyones thoughts on this ?
Oh God, they said they'd involuntarily commit you?!
I would absolutely go to the news media with that information. It seems that's the only way to get change in this world.
Desalie, are you familiar with Cesarean Awareness Network in Australia-- http://www.canaustralia.net? I'm not sure about the laws in Oz but VBAC is a human rights issue and denying someone a VBAC crosses an ethical line. They might even have lawyer recommendations or templates for you to use... I don't know.
I'm with EG. Threatening to label you as mentally incompetent is ridiculous.
Desalie - I don't know where you live, but (as a licensed psychologist) I can tell you that in the US the doctors and hospital cannot not deem a person mentally incompetent - a judge has to do that, and it does not happen within minutes. One of the rotations I had to do as an intern was in a psychiatric ER - even if we had someone floridly psychotic, nothing more than the administration of Haldol (if they were violent and imminently endangering themselves or those around them) was allowed without either their consent or a signed temporary commitment order by a magistrate (and we had a direct fax line to a magistrate around the clock, and it STILL took time). I call Code Mec on that hospital and that doc.
BTW, I don't think that having a letter from a psychologist would help - the doctor (if he/she actually followed through with the threat to commit) would just claim that you may have been competent when you were evaluated by the psychologist (prior to labor) but were no longer competent.
This is why I chose the third option (homebirth). Who wants to fight against the knife when you are trying to have a baby?!? Seriously. I can't even imagine it. When I was in labor with Jacob, I was so IN THE ZONE that I was barely cognizant of anything else around me. I can't fathom having to battle with nurses, doctors, forms, and whatnot the whole time. Just let me birth my baby in peace, thank you!
I understand and wish I could 100% agree with Jill, because it's totally outrageous that a laboring woman must be forced to "fight" and fend off her body from an act of violence while trying to bring a baby in the world, but the problem with HomeBirth is that it is usually always excluded from Health Insurance policies.
In the Washington D.C. area where I live, Midwives charge at least $3,000-4,500 and this is a hard pill to swallow for even affluent women, since most of us affluent women are heavily insured and would thus pay almost nothing simply by going to a hospital. In the cases of lower-income woman, can they really be expected to cough up the thousands of dollars to hire a Midwife?
I used an independent Birth Center and paid $700 out-of-pockent for a Doula while pregnant with my first child last summer, beause I DID read all the facts and watched Business of Being Born etc., then still ended up being transferred to a hospital by my Midwife after laboring only 7hrs and of course, the hospital with the 40% C-section rate gutted me like a fish to take out my son. Now, this Birth Center in Alexandria, VA will not accept me as a client, and they are the only Birth Center that my insurance will pay for.
Currently my choice is to pay the $4,000 for a Home Birth, with no garuntee that I will not be transferred again to a hospital and be gutted again, or to submit to the hospital after laboring at home until fully dilated, then be prepared to FIGHT against the knife. Unfortunately, this is an issue that limits womens choices until Health Insurance starts reimbursing for Home Birth, and since Midwives do not refund your money should they transfer you, then it's the Woman who bears all the financial risks with sometimes no reward.
I am one of those low-income women. It took me a solid year to pay off my $2,000 homebirth in bits and pieces. My midwives were more than patient, since they would rather see a woman get the birth she and her baby deserves than turn her away because she doesn't have enough money. I made cloth pads and cloth diapers and sold them, along with a lot of my possessions (who really needs a vintage My Little Pony collection worth hundreds of dollars anyway?), along with earnings from my $6.50 an hour weekend job. I was often stressed out about not having the money, but I would take that stress over the stress of a hospital birth any day of the week.
Yes, it is a lot of money and even more so to those who are not well-off. But I had to ask myself, what was my bodily and mental integrity worth? What was a real shot at a vaginal birth worth? What was not having another C-section worth? The cost of a homebirth is often less than many couples spend on their weddings (in our case, it was pretty much even), which is, as they say, "just one day" in your married life. I had to ask myself what that "one day" in my child's life was worth to me.
As a wise woman once said: there are ways within and all around. If little ol' me who doesn't often have two nickels to rub together can pay for a homebirth, anything is possible.
I love your attitude, Jill. I watched your meter on your blog go up, kept my fingers crossed for you, and sent as many people as I could to your store. There certainly are ways within and all around. Xoxox--MM.
I'm in Australia.There's currently a huge struggle to get insurance for independant midwives, so they wouldn't take me on.There's no hospital in Australia that would let you go for a VBA4C.
I don't really want to go unassisted so......!But I will come up with a plan.I've done so much reading and I know you can strengthen the uterus and achieve a vaginal birth.
The thing is if I birth at home and turn up at hospital after the birth they're just as likely to remove the baby from my care as I've endangerd it.I've seen this happen before too.You really don't get left with much choice.I am rhesus negative and need to get the bloods done after, which is where the problems come in.This was the issue with my Vba2c.
I'm looking into alternatives for the ant-D vaccine ,as I don't vaccinate at all.Something else to fight about.Sigh! I'm taking vitamin C ,E.P.O.fish oil Coq10.raspberry leaf,cal/mag.Any other ides to heal the scar.
Betwwen my first 2 I had 4 1/2 yrs,next one was 2 1/2, the last one was 3 1/2.So I've had good spaces between.I also have a horizontal scar.Had staples with the first one 12 yrs ago, and stitches with all the rest.
This is the standard info I give to any of our ICAN of DuPage moms who contact me/us about a doc trying to force them into a cesarean. Well, one of those docs dropped one of our moms at 41 wks pregnant for refusing a cesarean. She went on to have a perfectly healthy VBAC just a few days later, but in the meantime I talked to the Illinois ACLU and they said that dropping a mom at 41 wks pregnant is not technically illegal in our state. Apparently there's nothing on the books that can stop a doc from doing just that. The only case that IS on the books is a mother who won a case against a doctor who tried to get a court order to force a cesarean. So according to IL state case law now, courts CANNOT order a woman to undergo surgery. But, until a mom sues a doc for dropping her - and WINS - it may continue to happen. This mom may take the complaint up the channels. I hope she does. Her case has a good shot of making history.
Crystal, I had 2 of my 3 babies with the midwives in Alexandria, one at the birth center and one at home. I am sorry to hear that you did not have a good experience. The hospitals in this area are definitely big on unnecesareans. I obviously don't know anything about your specific case. But considering the excellent care I got from the midwives (prenatally, in labor, and postpartum), I knew that if I wound up in the hospital with a c-section, it would very likely be because I needed it. In my experience, they are knowledgeable and trusting of the birth process.
For anyone with insurance issues precluding them from a home birth, the first and best thing to do is to call the insurance company. We switched insurance in the middle of my 3rd pregnancy, and the new policy did not cover my midwife. I called (multiple times) and argued with them, and they agreed to cover the rest of the pregnancy and postpartum period. Many insurance companies, when they realize you are about to save them thousands of dollars, will manage to extend coverage to you for midwifery services. Another option, if it is available through your or your spouse's employer, is a healthcare flexible spending account (FSA). Depending on the provider, they may or may not cover midwifery care. Those that don't will often cover "nursing services," so if you have a midwife who is a CNM or certified midwife with an RN, you may be able to use FSA dollars to cover the cost if you specify it as "nursing services for childbirth." The advantage to the FSA is you save the dollars tax-free in increments with each paycheck over the course of the calendar year.
here are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.
I have a friend that is 35 weeks pregnant. She had a VBAC with her 4th baby and wants to have a VBAC with her 5th baby. However the ONLY hospital that will allow her to VBAC is stating that as soon as she walks into the hospital that she HAS to have an epidural. NO IF's AND OR BUTTS!
They have also said that if she refuses then they can drop her as a patient! (mouth dropped open). Can they really refuse to allow her to have her VBAC if she refuses an epidural? They say that it is there in case there is an emergency. You know one intervention leads to another and having her 5th baby, she knows the troubles it can lead to. IF she's had 1 VBA3c's then she should be able to chose to have an unmedicated birth. This is in KY. I can't find anything really that would give us a good answer for her to take to the hospital to shut them up and LEAVE HER ALONE!
Thanks in advance!
Hi Concerned Friend,
Well, sounds like they're assuming her uterus will rupture and want to have an epidural in place "just in case" they need to perform surgery. That is bull.
I can't believe they're pulling this crap on her this late in pregnancy.
I'll email you a reply later after I talk to some people, ok?
Jill