Does your local hospital ban vaginal birth after cesarean?

Does your local hospital ban vaginal birth after cesarean VBAC or VBAC after more than one cesarean?
By Amber Craig

It is illegal for a doctor or hospital to perform invasive surgery on you against your will. However, until more consumers begin challenging VBAC bans and demanding the right to labor and the right to attempt vaginal delivery, many of these draconian policies will remain in place. Research the studies available on both VBACs and repeat cesarean sections and consider your personal circumstances to determine which birth choice is most appropriate for you.

If you have concluded that a VBAC is the most appropriate birth choice for you and your local hospital bans them, consider writing a letter and asking for a meeting. Key people at the hospital to contact include: chief of staff, chief compliance officer, risk manager, head ob-gyn, and the head nurse for labor and delivery. Inform the hospital that you have done the research and concluded that the risks of a scheduled repeat cesarean section outweigh the risks of a VBAC (or VBAMC) for you, so you have decided against a scheduled repeat cesarean section. Ask them to meet with you and draft a special informed consent form for you to sign so that everyone understands that you do not agree to a repeat cesarean section.

Sample letter:

I am planning a vaginal birth at (hospital) sometime in (month). I have had (#) previous C-section(s), and have decided, after reviewing all of the medical literature, that a VBAC route is a safer choice for me than scheduling a C-section. I sincerely hope that you will support and assist me in having the best vaginal birth possible. I am writing to request a meeting to review the following:

1. I want to ensure that the VBAC policy at (hospital) is supportive of VBAC births and the rights of pregnant women to make their own birth choices.

2. I want to request that (hospital) draft a formal policy statement that under no circumstances would staff pressure or coerce a woman to undergo a cesarean if she has made an informed refusal for surgery--in other words, it is important that there is no policy stating that women with a prior cesarean or more than one C-section are restricted from having a vaginal birth.

3. I want my medical records at (hospital) to be clearly marked that I have already made a fully informed choice to refuse a scheduled cesarean, and that I do not intend to argue or fight with staff about a cesarean when I arrive in labor to vaginally deliver my baby.

4. I want the enclosed medical literature showing that a VBAC after (multiple) cesarean section(s) is safe (my risk of uterine rupture is less than 1 percent if I am not induced), and that my risks from a repeat cesarean are significant, to be placed in my chart so that all hospital personnel assisting with my VBAC know that I have been fully informed of my risks. I am truly concerned about the risks of a repeat cesarean, and I cannot undertake this risk unless some emergency warrants it (e.g., cord prolapsed or placental abruption). It is my hope that if the staff understands my concerns, everyone will work with me to ensure I have the best vaginal birth possible.

I thank you very much for your time in reviewing the enclosed literature and for considering my concerns. I hope that once we meet, I can rest assured that policies are in place that support a woman's right to a VBAC, and that no woman will have to face pressure to have a cesarean after they have made an informed refusal for surgery. After knowing that (hospital) will be supportive of my VBAC, I will be able to just focus on having a healthy pregnancy and preparing for my upcoming vaginal birth at (hospital). I appreciate your making time in your busy schedule to discuss my concerns, and working with me to ensure I have the best birth possible at (hospital).

Sincerely,

Please also send a letter to the American College of Obstetricians and Gynecologists, asking them to take action to put an end to VBAC bans. Please make sure they hear from you:

Douglas H. Kirkpatrick, MD, President
American College of Obstetricians and Gynecologists
PO Box 96920
Washington, DC 20090-2188