Hopes of VBAC out the window?
Jill
An interesting comment left on Facebook…
E said:
Just to play “devil’s advocate” a little bit. (mind you i am a HUGE supporter of VBAC and have had an HBAC myself and will be having another one this June due to the lack of support in hospital here). We need to be monkeys on the malpractice insurance company’s backs too. Most of the time OBs hands are tied because their malpractice insurance will not cover them if they attend a VBAC. Others jack up their premiums if they attend VBAC’s and OBs are looking at their whole practice/career/education going down the toilet with one bad VBAC outcome. So not only are WE as women caught between a rock and a hard place, so are the doctors. And it all comes down to who has the money and who has to cough up the money in order to practice. And ultimately it’s the women and babies who are the last on the list to be considered and it is we that have to pay the price and fight the battles in order to birth vaginally after cesarean, which is what research clearly supports.
Jill said:
It might be part of the problem (Can you cite that it is? Now I want to go dig up articles on this again!) but it’s not all of it. Thanks for your comment. -Jill
E said:
completely agree, this issue is multifaceted for sure. I just wanted to point out that the doctors are under a LOT of pressure as well. They actually cover this particular issue in the VBAC volume of more business of being born. :)
Jill said:
Sure, they feel the pressure but sometimes fears aren’t based on evidence. I am very sensitive to the effects that a lawsuit can have on a physician after watching a friend have his life destroyed (not even being dramatic… totally destroyed). The point of the post really was to point out that it is an uphill battle but we really need docs to start fighting the system, too. If the will is there, they will find a way.
I’m not so sure the will is there. It is for a few pioneers. I would like to see it become a bigger priority and for them to see the ripple effect on women’s choices.
Not arguing or trying to split hairs. I know we’re on the same page. Just wanted to clarify and not give into an overly simplistic “answer” to a very complicated problem.
Reader Comments (16)
My family and I were recently on vacation in Florida. While grabbing lunch one day, a cafeteria worker approached to compliment the kids. When she asked about their births and I mentioned my son was a VBAC, her face temporarily lit up, then she was sad. She said she had no hope of finding a provider in Florida that would allow her to VBAC, and they were thinking of finding a provider in North Carolina. Yes, she was actually willing to leave the state altogether.
And yes, my son was born at home. I had very little hope myself.
All we're asking for is evidence-based care!
I am in this boat myself. I'm calling around for VBAC supportive hospitals/practices in NYC & finding all sorts of dandy things: Like hospitals who will just give you a RCS if you hit 41 weeks- no choice in the matter, hospitals that will INDUCE you for a VBAC. In-Hospital Midwifery groups who will use Pitocin to "move things along when labor stalls" during a VBAC. The really supportive doctors and midwives who have high success with VBAC don't take insurance. LOVELY. I truly think I will be going with a HBAC and paying out of pocket to get what I want. It's not a matter of choice. It was putting my faith in OB that landed me in an unnecesarean in the first place- I will not be trusting again.
YES. I was "forced" into an HBAC decision for the same reason. I loved my experience and it was wonderful - but would I have made a different decision IF the options were there?? Maybe. But they weren't.
I wish my VBAC provider was available EVERYWHERE. Seriously. I want to clone him and send him to all the places where women have such horrible experiences finding doctors to help them VBAC.
I wholeheartedly agree. Drs dont like hbs but will not, or with crazy regulations allow a vbac but get upset when they hear about hbs. Im expecting #5 in 2 weeks and even after my very fast, very successful vbaccc in 2010 i could only find one hospital whod "let me try" to vbirth again. And the stipulations they had were outrageous and unreasonable. Not to mention the consent form id have to sign that basically took away any rights id had before going in. Id wanted a hosp vbirth this time but with my option only being that one hospital a hospital birth wasnt plausible for me...and i slowly grew to the idea of a hb. Honestly im looking forward to laboring in a pool, having a mw trust me and my body, and not being poked and prodded 24/7. What a relaxing way to have a baby.
I knew there was *zero* chance of finding a provider to take me as a patient after having 2 c/s...one with a J incision. I planned for a HBAC. I was forced into the hospital at 30 weeks with premature labor. I think the doctors would have equated me with Satan...and treated me as such. I was obviously a HORRIBLE mother for planning a HB and refusing their c/s. Their behavior just solidified by deep seated mistrust and downright HATE for the OB profession. I know there are some good ones but damned if I ever found one. The entire profession needs a complete overhaul and self-examination.
BTW....despite the doctors' efforts to the contrary (bullying, dead baby stories, lies, outdated statistics etc.)...my beautiful little girl was born via VBA2C in a hospital. I may have earned a few haters that day but I had one less scar to show for it and my daughter benefited from all the wonders of a natural birth. Doctors can bully all they want...the law was and is on our side!
On my first appt with my OB he told me straight to my and my husbands faces a VBAC was not possible....he can't do it....the hospital wont allow it.....it's not safe. I broke down crying....he handed me a box of tissues and left the room. Came back 10 minutes later and totally changed his tune. Said he would be willing to give me a 'trial of labor' but had to induce me, constant monitoring, have an anesthesiologist in house the entire time i was there, and if i failed to progress to his liking we would go straight back to the operating room. Wow, I couldnt believe it just 5 years prior in 1999, upon being discharged after my unnecesarean, my discharge nurse instructed me to wait at least 2 years to have another baby to allow my incision to fully heal so I could have a VBAC. What the heck happened? And wait a minute....what happened to...'not possible'...'hospital wont allow it' ? did my OB just lie to me? Yes, I believe he did! That was the kicker, not the things he was telling me but that he lied to me. How was I to trust this man with my life and my child's? Nope, couldnt do it....and when i called him out on it he apologized and gave me some lame, 'my hands are tied' excuse. Well sir, if you cant do what's best for your patients then goodbye to you. So I did a lot of research! I educated myself on VBACs, talked to other women and my primary care Dr, I found theunnecesarean.com! Luckily there was a licensed freestanding birth center only 45min from my home that was doing VBACs and with great results. And they were only blocks away from 2 major hospitals. I delivered my baby boy in a peaceful renovated victorian era home, surrounded by my family, my amazing CNM and her RN assistant. It was the most amazing experience of my life, I was on cloud 9....I walked out of there 4 hours later (to recover at home) saying, "I did it....I just had a VBAC!' The confidence in my abilities as a woman and mother were through the roof! And the best part of it all....my insurance paid 100% of it all, prenatal, delivery and post care for me and baby! (but I would have paid out-of-pocket, if i had to) I feel sad for all the women who walked in that OBs office with the same hopes and dreams and trusted him, only to loose what i was too stubborn to give up. My womanhood, my right to birth my babies 'My Way'....no man, woman, dr can take that away from you. Educate yourself and find a way....stand up for YOUR right to birth 'Your Way'!
Another aspect to the insurance issue is getting the health insurance providers to stop contracting with doctors that have the higher rates of interventions and cesareans. (unless a practice specializes in high risk care) Since there is no legal requirement for doctors in the U.S. to publish their c/s rates, it is the insurance companies that are in the ideal position to make a difference.
Jill, I hope that your updated comments are there just to stir the pot because obstetricians have been advocating for malpractice reform since the 1970s. E’s comments are right on track, politicians will only enact malpractice reform when women advocate for it. Until then it will be lawyers and accountants that decide what services obstetricians can afford to provide. This is similar to the way that roller rinks vanished from our neighborhoods as a direct result of the cost of liability insurance.
As for your comments on premiums, please be aware that many malpractice carriers place a “surcharge” on any obstetrician that wants to attend VBACs. This is separate from the premium increases that you mentioned. The surcharge can be in the neighborhood of forty to fifty thousand dollars each year. If an obstetrician has ten patients a year that want to attempt a VBAC then it will cost that obstetrician $4,000.00 to $5,000.00 per VBAC to pay for the surcharge. This is more money than what managed care pays the obstetrician for attending the birth. Therefore, only the busiest obstetricians will be able to afford this surcharge.
Since we are doing some math, how about the cost of one bad outcome? There was a $214,000,000.00 jury verdict in our county for a birth injury as a result of a uterine rupture during a trial of labor. Appeal brought the verdict down to $69,000,000.00. A hospital can be held responsible for this entire amount even if it exceeds their insurance coverage. Therefore, if this type of outcome occurs once in every 1,000 VBAC attempts then the cost to the hospital can be $69,000.00 per VBAC attempt. Or in other words, every woman attempting a VBAC needs to pay the hospital $69,000.00 just to cover the cost of the liability. This is the math that has made VBAC go the way of the roller rink.
It is math that has made VBACs difficult to obtain and this math can only be corrected by women demanding that their elected officials correct the math. Until then, the best way to decrease the number of women who are denied an attempt at a VBAC is to decrease the number of primary cesarean births.