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State of Florida to Ban VBAC in Birth Centers

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Guest post by Samantha McCormick, CNM

On Wednesday, March 24th, the State of Florida’s Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers. Currently, VBAC is not allowed in Birth Centers in FL, but can be done at home with a Licensed Midwife and physician consult sign-off. After a request that the language be updated to include legalized VBAC’s at birth centers with Licensed Midwives and physician consultation, the State used the opening to move to make VBAC’s illegal in state licensed birth facilities.

This is a dangerous proposition. The State has evidenced already this year its assumed position as medical surrogate, in the January case of a Tallahassee woman who was confined to a hospital bed and subsequently court-ordered to have a c-section. This sort of treatment completely negates a patient’s right to informed consent. Further, if the State feels women should have VBAC’s in hospitals, then by the same medical surrogate token, they should mandate that AHCA hospitals allow women adequate trial of labor and welcome VBAC’s. If fewer than half of Florida hospitals ‘allow’ VBAC, and fewer than 1% of obstetricians ‘allow’ VBAC candidates as patients, and Florida women are limited in their choice of birth place and care provider…well, you do the math. Our primary c-section rates aren’t getting any lower (Florida’s average is around 37%). The best way to begin to chip away at these epidemic and very dangerous numbers is to increase the VBAC percentages.

Women who attempt to VBAC are successful over 75% of the time without necessity for intervention, yet at Sarasota Memorial Hospital, for example, only 1 to 3 women have successful VBAC’s each month. Why? Because they cannot find supportive care providers. Many providers, pressured by insurance and medical malpractice concerns, scare (for lack of a better word) women into believing they are making an unsafe choice (read this thorough comparison to learn for yourself).

While it is true that a uterine rupture (the primary concern of providers hesitant to accept VBAC patients) can be a devastating obstetric event, it occurs in fewer than 1% of VBAC candidates, and is responded to by emergency c-section—a procedure our hospitals are fully equipped to execute effectively. For those undergoing repeat c-sections, rates of serious placental complications, infections and NICU admission for the babies of those sections are rising rapidly. Women should and are legally obligated to receive balanced information that includes the risks and benefits of VBAC as well as the risks and benefits of repeat surgery.

Allowing the pursuit of VBAC at home or at a state licensed birth center with a Florida Licensed Midwife will keep healthy, safe options open for Florida’s families, and will dramatically reduce taxpayers’ investment in unnecessary surgery.

There is virtually no difference in medical equipment between a birth center and the gear of a homebirth midwife. If the state considers VBAC with a Licensed Midwife at home safe, it is literally contradictory to ban VBAC’s in birth centers. Many women would feel more comfortable in a birth center than in their homes, for a variety of reasons, and should be offered this opportunity. Physician consultations for VBAC’s take into account several factors regarding the woman’s previous surgery(s) and current health risk factors. Once again, we should be striving toward a collaborative model, one in which normal, healthy woman can choose the safe, cost-effective, nurturing care of midwives, and be reassured that obstetricians are available to provide their expertise and intervention if necessary—and only if necessary.

For these reasons, I urge you to sign the following petition and make your voices heard in support of legalizing VBAC’s in Florida’s licensed birth centers:

To: Florida Agency Health Care Administration

While we recognize the need to change outdated language in the rule, it is our position that the state consider similar language to that of F.S. 467. Such language would work to insure the patient received competent care from a licensed practitioner and respects the right of the patient to make an informed decision. We ask the State of Florida to remain a regulatory body and not take on the role of medical surrogate.


Click here to sign the petition

Photo credit: Baby Love Birth Center

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Reader Comments (12)

At least Florida has birth centers...here in nanny state Illinois they are illegal. Not that it makes this VBAC ban right. I just wish we had birth centers.

March 18, 2010 | Unregistered CommenterLulu

"If the state considers VBAC with a Licensed Midwife at home safe, it is literally contradictory to ban VBAC’s in birth centers."

I'm sure homebirth bans are the next thing on their list.

March 18, 2010 | Unregistered CommenterErin

If you list near Tallahassee, I urge you to attend this month's ICAN meeting. Here's a message from Kristen Nelson Sella, left on the ICAN of Tallahassee Facebook fan page:

I want to make sure you know that we have an upcoming ICAN meeting on Thursday, March 18th from 6 to 7:30 pm in the back room of Best Beginnings (please enter in the back as the store portion closes at 6pm).
If you are looking for support after a cesarean or are planning a VBAC or if you have a birth story you would like to share, we would love to see you there.

Some other important topics I plan to discuss:

The National Institute of Health (NIH) recently hosted a conference on VBAC which generated some positive findings regarding the safety of VBAC's.

The Agency for Healthcare Administration (AHCA) is having a rule change workshop on March 24th at 1:30pm. The rule being changed is the one that governs birth centers in Florida, and specifically VBACs in birth centers in Florida.

Cesarean Awareness Month (CAM) is coming up in April. Help plan ways we can increase awareness of cesareans here in Tallahassee and in Florida.

I intend on going to the AHCA workshop next week in hope that they'll hear public testimonials.

March 18, 2010 | Unregistered CommenterErinn Streeter

@Erin My thoughts exactly!

Samantha, thank you so much for sharing this, I had no idea this was happening!

As a lawyer, the petition leaves me with some questions (like what exactly is the language they are replacing, what are they replacing it with, how does it ban VBAC from birth centers, etc.). I'm so super grateful for technologies that let people create petitions with minimal burden (I really think the internet is the "new frontier" for democracy), but I also hope that folks with experience lobbying can share strategies with the rest of us on how to talk so legislators can hear, what sorts of petitions work best, etc. I'd love to help create a How-To document with the birthing groups that have professional lobbyists (AABC, ACNM, surely others), because I think they can be the link helping to translate the activist voices for ears in power.

Maybe I'll run a pro-bono petition editing clinic out of the CM blog. Like the Statue of Liberty with red pen and Bluebook in hand ;)

March 18, 2010 | Unregistered CommenterCourtroom Mama

I hate Florida. Although I hate Illinois law for the reason Lulu mentioned.

@Courtroom Mama - ICAN FL is looking for an attorney who may be able to offer a legal opinion to sway the workshop committee. If you're interested in helping, please contact Kristen Nelson Sella on Facebook or contact me at erinn streeter at gmail dot com and I'll put you in touch with her directly.

March 18, 2010 | Unregistered CommenterErinn Streeter

Here in CT, there is only one freestanding birth center, and they will not "allow" VBAC's either. When I asked the MW, she said it was due to "liability issues".

It's really sad. Once you have a cesarean, no one wants to touch you.

March 18, 2010 | Unregistered Commentermichele

Courtroom Mama, both the Big Push for Midwives and the MAMA Campaign use paid lobbyists (all of which have been frantically active during healthcare reform on the Hill), those might be places to start, as well.

March 18, 2010 | Unregistered Commenteremjaybee

I have my info mixed up, so here's some clarification...

I received noticed about this through the grapevine; the message I received was written by Miriam Pearson-Martinez and can be seen on Pushing 4 VBACS FB page.

Hello Ladies
While working for the pushing 4 vbacs committee I came across this in theFlorida Administrative Weekly. AHCA has requested the risk criteria rulesgoverning birth centers be changed. After requesting the language from thedepartment, I learned that they are
1) changing the maximum gravida to 7 This is a good thing
2) removing the language concerning the NACC study for VBACs and leaving VBACsillegal in birth centers without exception.

pushing 4 vbacs is currently interviewing a lawyer and hopes to have one onretainer by next wednesday. We plan to file an objection to the rule change andsubmit language giving an exception to women who have consulted with an OB,similar to FS 467. (midwifery law)If anyone is interested in helping us out, or would like to read the language please contact me privately.

Using contact info included in the Notice of Development of Rulemaking, I called and spoke with AHCA staff members who are organizing the workshop. The process of the rule change begins with a "mostly unstructured" workshop during which the public may voice their opinions. Bill, one of the gentlemen I spoke with, confessed that this part of the process sometimes results in "people speaking over one another." So....free-for-all? I plan on being at the workshop, so I guess I'll find out.

After the workshop, there's a formal hearing, and testimony is more structured. Depending on the outcome of the hearing, there may be another workshop. It continues this way until the powers-that-be are satisfied with the rules change verbiage.

TIME AND DATE: March 24, 2010, 1:30 p.m.
PLACE: Agency for Health Care Administration, Building 3, Conference Room B, 2727 Mahan Drive, Tallahassee, FL 32308

March 18, 2010 | Unregistered CommenterErinn Streeter

I believe VBAC is safe for low risk women. By experience as well as learning what the studies are saying. I attended VBAC's in the late 70's when women had 2 to 5 previous cesarean births, with vertical incisions. They all did very well & had healthy babies. I've only had one transport for a VBAC to have a repeat cesarean in 33 years! The Five Standards for Safe Childbearing by David Stewart had information for the Cesarean Birth Alliance with a 24 hour hot line for mothers to call if they or their husbands thought a cesarean truly was unnecessary. Wow maybe we should do that again, keep the court ordered cesarean births at bay!

March 18, 2010 | Unregistered CommenterLinda Honey
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