I am so frustrated and angry today. Recently, my hospital has decided to stop providing VBACs. This was not provider driven. We are a small, rural community hospital and only do aroun 210 births a year. We are required to a have a perinatal agreement with a larger hospital with a NICU and other specialized services. This agreement includes all sorts of stipulations, like when we are required to consult a perinatologist and when we are required to transfer care. The powers that be in the bigger hospital don't want us to do VBACs because we don't have 24 hr in house anesthesia or OB. I have practiced here for 6 years and have attended around 20-25 VBACs, with over a 90% success rate. I am a family doc and don't do cesarean deliveries, so up until now, I would have all my VBAC clients meet my back up OB once in the third trimester. During labor, I would notify anesthesia and my OB back up that a VBAC client was laboring, and they would then keep themselves available, which in our hospital wouldn't necessarily mean sitting in house, but would mean staying ready. I stay in house during the entire labor. I've not had a problem, nor has my OB back up who has practiced here 30 years. Not every prior cesarean birth client I care for chooses to VBAC, but those that do, I've felt confident that we could assist them in making their own decision and then supporting them well. Since this policy is in effect, I'm not supposed to attend any VBACs at all. My OB back up has been making off the record exceptions for my repeat VBAC folks, but not for primary VBACs, and frankly, I'm worried that if this policy becomes more strictly enforced that I won't be able to do that even for my repeat clients. I'm supposed to tell them all they have to schedule a cesarean or deliver somewhere else.
Today, I had not 1, but 2 very excited women in my office in early pregnancy for new OB visits. Both were thrilled to be starting care with me because they had heard I'd help them VBAC. I had to tell both that I could no longer attend primary VBACs, even though they are both great candidates. After telling them where they could go to VBAC (hospitals an hour away or more, with less supportive labor environment, but no outright VBAC bans), one woman said to me "And what if I just continue my care with you and then refuse to have a c-section at the end?" I told her that was absolutely her right to make any decision she wanted to and we'd have to abide by it. To tell the truth, though, I think I'd probably lose my privileges pretty quickly if I had too many of those, and I'm not sure I wouldn't be required to turn the client in labor, even, since I don't do surgery to begin with and now have no back up to provide VBAC.
My question for both all the VBAC mamas and the birth attendants out there, is what can I do about this? Does anyone know if there is an active ICAN of IL chapter doing anything about VBAC bans? Do any birth attendants have experience with this type of situation? Where can I point these women so they get good counsel and information (besides myself)? Anyone else face a VBAC ban? I'm so upset about this I'm actually considering leaving the community over it (dh is not liking that one, we are settled and happy here) but I cannot participate in either forcing women to have a surgery they don't want, or guilting or persuading them into it by manipulation of facts. Any thoughts, ideas, or even just commiserations would be greatly appreciated!
Today, I had not 1, but 2 very excited women in my office in early pregnancy for new OB visits. Both were thrilled to be starting care with me because they had heard I'd help them VBAC. I had to tell both that I could no longer attend primary VBACs, even though they are both great candidates. After telling them where they could go to VBAC (hospitals an hour away or more, with less supportive labor environment, but no outright VBAC bans), one woman said to me "And what if I just continue my care with you and then refuse to have a c-section at the end?" I told her that was absolutely her right to make any decision she wanted to and we'd have to abide by it. To tell the truth, though, I think I'd probably lose my privileges pretty quickly if I had too many of those, and I'm not sure I wouldn't be required to turn the client in labor, even, since I don't do surgery to begin with and now have no back up to provide VBAC.
My question for both all the VBAC mamas and the birth attendants out there, is what can I do about this? Does anyone know if there is an active ICAN of IL chapter doing anything about VBAC bans? Do any birth attendants have experience with this type of situation? Where can I point these women so they get good counsel and information (besides myself)? Anyone else face a VBAC ban? I'm so upset about this I'm actually considering leaving the community over it (dh is not liking that one, we are settled and happy here) but I cannot participate in either forcing women to have a surgery they don't want, or guilting or persuading them into it by manipulation of facts. Any thoughts, ideas, or even just commiserations would be greatly appreciated!
