Arizona Mom Fights VBAC Rules at Local Hospital

October 15, 2009

An Arizona woman’s dispute with her local hospital over its refusal to allow a VBAC (vaginal birth after cesarean), even though she has already undergone a VBAC at the same hospital, has caught the attention of CNN, which featured the story on its homepage today.

Joy Szabo, 32, told CNN she is grateful for the c-section performed during her second delivery, when doctors feared the baby wasn’t getting enough oxygen, but her third son was a vaginal birth and she thought this delivery would be, too (assuming there were no complications). Page Hospital has since changed its policy and no longer allows VBACs.

VBACs carry a less-than-1-percent increased risk of a uterine rupture, which could cause brain damage in the baby or even death, according to the American College of Obstetrics and Gynecologists. Childbirth Connection, a nonprofit organization that advocates for evidenced-based maternity care, notes that research “suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries.”

C-section risks to the baby include breathing problems around the time of birth and asthma later in life. The mother is at greater risk for more severe pain and infection. The bottom line, based on the latest research, is that if you “do not have a clear and compelling need for a cesarean in the present pregnancy, having a VBAC rather than a repeat c-section is likely to be safer for you in this pregnancy (and) far safer for you and your babies in any future pregnancies,” according to Childbirth Connection.

“I know there’s a risk with a VBAC, but we think the risks of surgery are worse,” said Joy Szabo. “And I don’t want to have to recover from surgery when I’ll have four children at home, at least not voluntarily.”

From CNN:

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital’s CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

“I was a bit flabbergasted, because that seemed rather extreme,” Joy says. “I’d already had a VBAC at Page and it went fine. And if something happened, I know they can do an emergency C-section, because they did one for Michael.”

At issue are ACOG’s recommended guidelines concerning physician and anesthesiologist staffing for VBACs. Banner Health, which owns Page Hospital, released a statement that said ACOG guidelines recommend “24/7 coverage of both physician and anesthesiologist,” and that “two physicians be immediately available during the entire period of labor.” But an ACOG spokesperson disputed that interpretation, noting that physician and anesthesia availability are only two criteria to consider.

Still, ACOG’s guidelines have scared many hospitals away from allowing VBACs (which in turn has inspired suggestions on how to protest a VBAC denial). International Cesarean Awareness Network conducted a survey earlier this year of 3,000 hospitals and found that 821 ban VBACs outright, and and 612 have “de facto” bans, meaning surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.

The information gathered led to the creation of a VBAC Policy Database, which can be searched by VBAC policy, or browsed by state.

Another report, Hospitalizations Related to Childbirth, which examined data on childbirths occurring in U.S. community hospitals in 2006, found that childbirths by c-section increased from 21 percent  in 1997 to 31.6 percent in 2006, a jump of 51 percent. Meanwhile, there was a 73 percent decline in VBACs, from 35 percent of childbirth-related hospitalizations in women with a previous c-section in 1997 to almost 10 percent in 2006. (Rachel discusses the report here.)

As for the Szabos, rather than agree to a surgical delivery regardless of medical need, Joy Szabo plans on driving 350 miles a week or so before her Nov. 21 due date to be near a hospital in Phoenix that will allow a VBAC. It is unlikely her husband, Jeff, who is staying behind with their three sons, will be able to make it to the hospital for the delivery.

The Szabos’ story was first covered by a local newspaper, the Lake Powell Chronicle (via The Unnecessrean), and has caused an uproar. It’s unlikely we’ve heard the last of this …

For more reading:

In addition to visiting Childbirth Connection, “Our Bodies, Ourselves: Pregnancy and Birth” has a section on VBACs and repeat c-sections. Lamaze International also offers articles on healthy birth practices supported by research studies examining the benefits and risks of maternity care practices.

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