I have an idea for the ICAN blog carnival about VBAC...
Monday, March 1, 2010 at 10:42PM 
The International Cesarean Awareness Network blog is hosting its first blog carnival ever to coordinate with the upcoming NIH VBAC Meetings, to be held in Bethesda, MD from March 8-10.
The topic of the carnival is “Why is VBAC a viable option?” If you already blog and wish to submit your entry directly to ICAN by their March 6 deadline, please visit the ICAN site.
I’ve talked to a lot of you via e-mail, comments and Facebook about your struggles to find a VBAC-friendly provider or to deal with repeated attempts to scare you into surgery. You’ve told me about your fears of having a bait-and-switch pulled on you at the hospital and, for a bunch of you, the realization that you’re probably not going to be able to find anyone to attend your VBAC and aren’t feeling like unassisted birth is a wise move for you.
I’d like to compile some of your voices as a post for the ICAN blog carnival. Whether you send me a paragraph, an essay or a novel, I hope that you won’t hold back. I’m happy to post it anonymously if you would feel more comfortable that way.
What would you tell someone who thinks it’s a sensible idea to keep risking women out of vaginal birth after a previous cesarean and doesn’t really care about how it actually affects women and their families? What would you tell someone who wants people to believe that the only reason women wouldn’t want a repeat cesarean is because they’re looking for some kind of metaphysical (yes, I keep hearing that one) vaginal birth experience? What message do you have for the obstetrician who put their personal fear of litigation before your health and gave you misleading information?
I can think of a few choice words to say on your behalf, but I’d rather hear it from you.
E-mail me your story (or blurb or essay or profanity ridden rant) at unnecesarean (at) gmail (dot) com or message me on Facebook by March 5.
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Reader Comments (13)
The Connecticut Worst to First campaign is also doing something similar. We are looking for women from all walks of life, and all areas who want to tell their story of struggling with the Hospital system regarding maternity care and birth.
From women victimized in the hospital, or subjected to court orders, CPS, or other forms of harassment, to unnecessary episiotomies, cesareans, and just overall rude comments.
If anyone would like to submit a story, or learn more, you can e-mail me at
Danielle@CTWorsttofirst.com
Well, what I would say is pretty simple: it consists of this here finger between my pointer and my wedding ring. Yup.
But I'm sure I can scrounge up something more articulate than that. ;)
Ha!
I used to be very anti- c-section and pro VBAC. I wanted a mid-wife-led delivery only, believed interventions were over-rated and I demanded a VBAC. I had a *mild* uterine rupture and nearly bled to death when my 3rd child was born after insisting on a VBAC. I almost had to have a hysterectomy and was pretty sick. That sort of changed my mind.
As to the doc who puts his fear of litigation first? I'd probably assume he's someone who pays several hundred thousands of dollars a year in malpractice insurance, cares about his patients and wishes he could just practice medicine and not worry about people suing. Women sue over bad delivery outcomes all of the time, even if it isn't the doctor's fault. They demand VBACs and then sue when something goes wrong and the baby dies. They refuse c-sections until the baby is in distress and suffers damage ... and then they sue. Some of this responsibility is ours too.
I still think c-sections are done too quickly sometimes...but I also have made sure to express my wishes with my health care providers and I try to listen to their feedback after having gone through my own experience with hemorrhaging.
Sorry to add a voice of partial disagreement here.
"Women sue over bad delivery outcomes all of the time"
Really? What's your evidence of how frequently it happens? Did you sue anyone for your uterine rupture?
"I'd probably assume he's someone who pays several hundred thousands of dollars a year in malpractice insurance, cares about his patients and wishes he could just practice medicine and not worry about people suing."
And that makes it ethically okay to refuse to attend VBAC? Even if there really were a huge malpractice crisis, it still would not be okay to coerce women into surgery, which has its own set of risks.
I'm glad to hear that you're no longer anti-cesarean. It's more important that women receive accurate information about risks associated with ERC and VBAC and make an informed decision, no?
Yes, It is important that women get all of the information and can make an informed choice.
I also think it is reasonable for an OB/GYN to refuse to have all of the information and choose not to assume responsibility for the risks. There are OB/GYNs who will and you can seek those out. If someone has watched a woman bleed to death and a baby die, they might be more sensitive to the issue of VBAC...and less willing to take on the risk of delivering women via VBAC. If they have been sued over a bad outcome, then they might be reluctant to take on the risk of VBAC.
Do women sue? Yes. Did I? No. Any story that I can tell you is anecdotal, but as someone with a view from the inside, I can tell you that it is not ... what you think. People can and do sue over much less.
As someone who used to be super-crunchy...who brought candles and a birthing ball to my first birth and cried for 2 weeks after needing an emergency c-section after almost 48 hours of unproductive labor and a baby who was in distress, I can tell you that the movement that you are supporting also has the power to hurt women. I felt like a failure for my c-section and could think of nothing but delivering by VBAC... I found a mid-wife who would support my choice, had an extensive birthing plan, and completely lost touch with the fact that many years ago women and babies used to die much more frequently during childbirth. I am so fortunate that the outcome for my son and I was ok...it could easily have gone another way.
You have your opinion and you aren't willing to think about my perspective or see this from the other side, so I won't comment again.
That should say that I think that it is reasonable for an OB/GYN to have all of the information and choose not to assume the responsibility for the risks.
Kris, you said earlier that you used to be "very anti-c-section." Why? I'm not (nor are any of my co-bloggers) anti-c-section. If we had to define it, I suppose we would be anti-unnecessary AND unwanted c-section.
"If someone has watched a woman bleed to death and a baby die, they might be more sensitive to the issue of VBAC...and less willing to take on the risk of delivering women via VBAC. If they have been sued over a bad outcome, then they might be reluctant to take on the risk of VBAC."
Again, does it make it ethical to do deny women vaginal birth? It doesn't. I understand the difficulty but it is not ethical or even decent on a human level to treat subsequent patients unfairly.
"People can and do sue over much less."
Sure they do. The question is... do they win? How frequently? The media and doctors have blown the supposed crisis way out of proportion and rely primarily on anecdote. I know a lot of doctors who have been sued unfairly, one amazing one who is no longer practicing OB as a result of a ridiculous settlement.
"As someone who used to be super-crunchy...who brought candles and a birthing ball to my first birth and cried for 2 weeks after needing an emergency c-section after almost 48 hours of unproductive labor and a baby who was in distress, I can tell you that the movement that you are supporting also has the power to hurt women. I felt like a failure for my c-section and could think of nothing but delivering by VBAC... I found a mid-wife who would support my choice, had an extensive birthing plan, and completely lost touch with the fact that many years ago women and babies used to die much more frequently during childbirth. I am so fortunate that the outcome for my son and I was ok...it could easily have gone another way."
I'm so sorry for the pain you went through. If by being "super-crunchy," you mean that you had an unrealistic view of birth and thought that, if you just did everything a certain way that you thought would be healthy, nothing bad would ever happen to you, then I can see why you felt like you had failed. But you didn't fail.
"You have your opinion and you aren't willing to think about my perspective or see this from the other side, so I won't comment again."
I've heard your perspective. I get what you're saying and I disagree with some of it. We're watching vaginal birth slowly being squelched out of the system, largely under the pretense that it's due to a malpractice/litigation crisis that is feared and cowered before is if it is fact. The truth is that "the crisis" that everyone talks about is understood on a very superficial and anecdotal level. Patient care should be based on evidence, not fear of litigation, insurance woes, and other factors that have nothing to do with the health of a patient.
Posted from the Facebook page:
There are physicians who put ethics and evidence before hospital/insurance policy... and some catch a lot of flak. That or their pocketbook takes a hit, which I guess they trade for being to figuratively sleep at night (by not practicing daylight obstetrics). I've also seen doctors who, knowing that they would no longer be able to practice obstetrics in a way that was ethical and fair to patients, just stopped practicing.
I totally disagree that doctors are merely powerless cogs caught up in a broken machine. They have a lot more power to police themselves, control their actions, advocate for systemic change and define the standard of practice that they and the media would lead us to believe. Remember this? http://www.theunnecesarean.com/blog/2009/9/11/acog-releases-survey-results-ob-gyns-ultimately-hurt-patient.html
What if your employer asked you to do something totally unethical and lie to someone? Would you do it to keep your job? Or would you just say "I am powerless to change anything and have no choice but to do as my boss says?"
So if a general contractor tells his subs to cut corners or do shoddy work that could potentially harm the family living in the home (structural damage, fire hazard, unsafe materials), do we pat them on the shoulder and say, “I understand that you were just doing as you were told and could have lost your job?”
I expect that when a woman’s or her baby’s health and autonomy is on the line, that the person in a position of power and trust who will influence her decisions and perform medical treatments on her body should have the backbone to blow the whistle on unethical and harmful policies. So where are all of the whistleblowers WITHIN the system?
Obviously, the outrageous cesarean rate and routine corralling of women into unnecessary procedures is serving the doctors and “the system” well and there’s no philosophical or ethical incentive to change anything.
By anti-c-section, I guess what I mean is that I was anti-intervention. I had an extensive birthing plan with my first child that included ... no pubic shave, no enema, natural birth, etc. Yes, I was unrealistic in my expectations of myself, others around me and my body. This was helped along by the midwife who attended me up until my birth, but I certainly don't blame her. She provided me with what I wanted. So, that is also what I mean by super-crunchy. LOL
As to physicians...my disclaimer is that my husband is a physician. Just as we are all justified in our feelings about unnecessary interventions (and I really still have some strong feelings about interventions during delivery when they are unnecessary), I know now from being on the other side that yes, people are demanding, they sue and often hospitals settle even if a lawsuit is without merit because it costs the hospital too much to litigate everything.
I know that there are some doctors who do indeed jump to c-sections or think about their wallets. I believe that they are the minority. I can honestly tell you that most of the doctors that I know here see patients whether they are insured or not (and comp visits when someone is uninsured) and want the best possible outcome for their patients. They feel emotionally invested in the care of their patients.
It can be hard to tease out the risks of VBAC and because it is such a high stakes game, there is a push back to c-section after VBAC. A doctor should have the right to say that he isn't comfortable with the procedure and refer you to someone who is. Unless the patient is willing to sign papers that in the event of complications that they will not litigate, why should they be forced to perform a procedure that does carry these risks. I read the statistics myself when I was pushing for a VBAC but certainly felt that they wouldn't apply to ME. But they did.
This is not just a problem of OB/GYN though. If you go to the ER nowadays with abdominal pain you are likely to be whisked off for a CT scan...not because it is necessary, but on the 1 in 500,000 chance that it is something more serious even though you are presenting with symptoms of gas...because if any little thing is missed, patients have a tendency now to sue.
Defensive medicine is the norm now and most doctors are not fans of it. They feel used by patients and the system, are overworked and are often underappreciated or even vilified....
Kris, on what are you basing your many assertions about patients' tendency to sue, defensive medicine as the norm, doctors attitudes toward defensive medicine and feeling under-appreciated? I'm asking because there really isn't a lot of data out there on the whole malpractice crisis. Ask any physician for data and numbers and you get anecdote and an amorphous blob of fears and beliefs posing as fact that aren't actually substantiated by anything other than a claim that it's just something we all know to be true.
As for the conscience clause type stuff and refusing to attend VBAC (it's attending a birth, not performing a procedure), that right is being exercised all over the US with hundred of hospitals banning VBAC. OBs have exercised their right to not deal with certain patients or to misinform them so they "choose" a cesarean (primary or repeat). OB-GYNs already have plenty of advocates including a huge lobbying organization that looks out for their interests. If you're here to advocate for making doctors sue-proof (essentially depriving patients of legal rights) by having patients sign waivers, then you're wasting your time. Pregnant women are entitled to the same rights as other patients.
So if you can come up with some citations on the prevalence of frivolous lawsuits in OB, please share them. From what I've researched, the highest payouts are being awarded to women who were actually victims of malpractice and not just greedy, difficult patients looking to exploit the system. That would mean that the legal system is actually working at least somewhat effectively and benefiting the proper parties. So if doctors are not indeed being sued left and right for birth injuries that are beyond their control, then of what are they actually afraid? The courts do a good job of throwing out so-called frivolous cases and many victims of malpractice are never compensated at all.
But let me know what you've found to support your claims. Thanks.
I won't write a thesis on this. You can do the research as well as I can...but...
here are some tidbits from medicine.net (2000)
*An August 1999 report by the Risk Management Foundation of the Harvard Medical Institutions found that although ob-gyns made up only 5% of physicians covered under their insurance plan, they generated 14% of all claims and accounted for 23% of the plan's losses.
*In addition to being sued more frequently, ob-gyns pay the highest claims. In a 1998 report summarizing 13 years of data, the Physician Insurers Association of America, a Rockville, Md., trade association, found that 26% of claims resulted in judgments of $250,000 or more. Such high payouts inevitably drive up the cost of medical malpractice insurance. The national average for ob-gyns' annual premiums, according to Strunk, is $30,000, although in some areas it can reach a staggering $140,000. In comparison, premiums for internal medicine physicians can range from $3,782 in Arkansas to $28,548 in New York's Nassau and Suffolk counties, according to the monthly newsletter Medical Liability Monitor.
*The combined pressures surrounding obstetrical care continue to take their toll. The ACOG survey shows that as a result of the risk of malpractice, 17.1% of ob-gyns have decreased the amount of high-risk obstetric care they give, 8.9% are no longer practicing obstetrics at all, and 6.2% are decreasing the number of deliveries they perform.
I was able to find several stories by practicing physicians in states like Florida, Massachusetts and Nevada detailing their need to pull back and not perform VBACs, triplet births or attend to high risk pregnancies due to fear of litigation and increased costs of malpractice insurance. I also was able to find many stories about doctors doing GYN only now or leaving medicine altogether. In other words, for every anecdotal "I couldn't find a doctor willing to do my VBAC" we could probably post a story about a doctor who has chosen to no longer do OB, has quit medicine or has scaled back their practice.
The truth is in the eye of the beholder...and there are stories on both sides.
Those reports are more than 10 years old. Plus the argument "Such high payouts inevitably drive up the cost of medical malpractice insurance" isn't necessarily true. The U.S. Government Accountability Office maintains that losses on medical malpractice claims is just one of the factors that causes premium rate hikes. Insurers invest premiums in the market. When investment income is high, insurance can be offered at a lower price than the expected cost of paying claims. Good market conditions—lower rates. Bad market conditions—higher rates.
A long lag between collecting premiums and paying claims affects rates as well. Insurers hold their premium rates down even while underlying losses are increasing. As a result, large rate hikes are required when the trend in losses is recognized. The point being that a picture is often painted of horrible sue-happy women and ruthless lawyers inflicting unjustified grief on innocent, hard-working obstetricians who are fighting off lawsuits left and right and that these lawsuits are responsible for huge insurance premiums.
Strunk is actually ACOG’s deputy executive vice president. I’m leery about any statements/research from OB-GYN’s political lobbying group, aren’t you?
You seem intent on showing me what doctors are experiencing, that there’s another side to every story. I get it. I have acknowledged that doctors are really afraid of being sued. We know that 76% of obstetricians have been sued at least once.
VBAC bans are still unethical. The 45 percent cesarean rates that many hospitals have are unethical. Coercing a woman into unnecessary surgery for reasons that have nothing to do with her health are unethical. Even if one understands the reasons WHY these things happen so often, it doesn’t make them okay, does it?