Hospital says "No VBACS" - am I out of options? - Mothering Forums

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#1 of 25 Old 08-01-2006, 11:46 AM - Thread Starter
 
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A little background:
My DS was born in a hospital 2 years ago. I had SROM and was induced, had 9 hours of drug-free labor but had an emerg c-sect due to ds's heart rate dropping to 20's. i had no complications after delivery except PPD.


I was at the doc on friday getting a yearly physical done. we just started on Kaiser Permanente insurance. the doc (a very nice lady) and i were talking about me having another baby in the next couple years. I mentioned that i was hoping for a vbac. She said, "well, I can guarantee you that if you deliver in the Kaiser hospital, you will be having a scheduled c-section. We dont do VBACs anymore due to potential for malpractice lawsuits."

I DO NOT WANT ANOTHER C-SECTION. Part of my PPD was due to the fact that i felt i was robbed of my beautiful birth experience. I really want a non-medical experience this time - midwife, no ultrasounds, homebirth. My last delivery was as medical as you can have (except for pain meds) andi think it took away my sense of power as a woman.
I have told my family that i want a homebirth VBAC. They are all very leery, saying that its better go just have the repeat c-section than risk a uterine rupture with a homebirth. we would also have to pay out of pocket for the homebirth, which will be tough.
WWYD?
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#2 of 25 Old 08-01-2006, 11:51 AM
 
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i'd start saving now for the HBAC. sure, it'll be a bit costly out of pocket but if you have time to prepare, it'll be easier. i was in the same situation except i didn't have time to save because i was already pregnant again.
good luck!
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#3 of 25 Old 08-01-2006, 11:55 AM
 
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I agree. Start saving now.

-Angela
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#4 of 25 Old 08-01-2006, 12:09 PM
 
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I would start saving for the HBAC.

Research it. Don't just do it b/c we say so.

Look into the risk of rupture. Look into the risk of rupture in an un-augmented (natural) labor. If nobody's using pitocin or cytotec on you, what is your risk of rupture?

Quite low.

Good Luck and happy pushing!
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#5 of 25 Old 08-01-2006, 12:11 PM
 
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Moved to VBAC...

anna kiss partner to jon radical mama to aleks (8/02) and bastian (5/05)
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#6 of 25 Old 08-01-2006, 12:13 PM
 
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thats what they told me. then i found a mw. i agree..research.
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#7 of 25 Old 08-01-2006, 12:25 PM
 
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Read Silent Knife and Open Season

and then enjoy your homebirth in a few years
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#8 of 25 Old 08-01-2006, 12:39 PM
 
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I'd be willing to pay just about anything to avoid another c/s and we are poor.

I agree with previous posts. Research homebirth and if it is what YOU want then you do it. If that means that you have to keep your family in the dark, then so be it-it is your birth and not theirs.

Also, a lot can change with hospitals in a few years.

See if there is an ICAN chapter near you for support and the inside scoup in your area.

Regardless, you do not have to submit yourself to unnecessary surgery just because the hospital says so. Yet, I wouldn't want to go into the hospital in labor fighting.
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#9 of 25 Old 08-01-2006, 02:24 PM
 
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I never had a C-sect but just wanted to say that I started saving for a home birth before I was pregnant (ok, just a couple of months, since I got pregnant the VERY FIRST time we TTC ). We're not poor but then again we both only make $11/hour, so we're not exactly drowning in money or anything, but we made it a priority. If you research and find that HBAC is right for you, I think you can also do it if you make it a priority.

Homeschooling mama to 6 year old DD.

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#10 of 25 Old 08-01-2006, 08:58 PM
 
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I agree...start saving now. Even a few dollars a week or a few dollars a month can make a difference if you do it every week/month!

When you do become pregnant, you can use the money for a HB or (if you decide that HB is not for you) you can use it towards a birth at a birth center or VBAC supportive hospital. And as a pp said...a lot can change in hospital policy over a few years! New guidelines by the ACOG could come out, malpractice law could change, the insurance could add coverage at a hospital that supported VBAC or could be persuaded to cover a midwife attended HB (a friend of mine actually convinced her insurance to cover a HB...she isn't pregnant yet but she's trying. It took her almost a year to convince the copmany btw, so if you want to try this start now!). You never know!

Good luck with your future HBAC/VBAC!

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#11 of 25 Old 08-01-2006, 09:22 PM
 
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If you can actually find a midwife that will do an HBAC (in my area many are not doing this anymore for political reasons) then GO FOR IT! If you cannot, and if you truly feel that a homebirth is not a good option for you (and don't listen to the fears of your family) you can show up pushing at the hospital and refuse a c-section. They cannot force you to have surgery (although they may try, supposedly you can charge them with assault if they do). This probably won't make for a very pleasant birth experience though. Homebirth is the way to go.
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#12 of 25 Old 08-02-2006, 05:32 PM
 
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They can have "No VBAC" policies all they want. But legally, they can not FORCE you into a c/s. They may try to coerce you, but you can say NO. If they forced you, you can have them (the doctors and nurses) brought up on criminal charges! I would tell them that too!
Quote:
The legal doctrine of informed consent/refusal developed from the laws on battery. In a medical setting, battery is defined as: touching or treatment that occurs without obtaining proper informed consent; medical treatments that are substantially different from the ones a patient consented to; treatment that exceeds the scope of consent; or treatment provided by a physician other than the physician who obtained the patient's consent.

As case law on informed consent/refusal evolved, however, the courts increasingly defined lack of proper consent as a matter of negligence. Negligence requires that the lack of proper consent or failure to meet the standard of care resulted in emotional or physical harm worthy of monetary compensation. In certain circumstances in which monetary compensation is not an issue, though, the laws on battery may still apply.


Court Decisions and Case Law on the Rights of Pregnant Women

The courts have been an important ally in protecting the right to informed consent/refusal, particularly for pregnant women. Many people are under the impression that no physician has ever lost a malpractice suit performing a cesarean. However, in Meador v. Stahler and Gheridian , a jury awarded a $1.5 million settlement to a Massachusetts woman and her husband for undergoing a medically unnecessary cesarean that she made clear she didn't want.
You can go to the hospital that your insurance covers, or that you prefer, and you CAN have a VBAC. Although it may just be easier for you to NOT tell them that you have had a c/s before, if that were possible.

Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#13 of 25 Old 08-03-2006, 01:11 PM
 
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I would also check into the article "50 Ways to Protest a VBAC Denial" at http://www.midwiferytoday.com/articles/50ways_VBAC.asp

It does give you some ideas of things to try as well.
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#14 of 25 Old 08-07-2006, 09:26 PM
 
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What would happen if you walked into the ER nearly fully dilated? It takes time to set up the OR. You'd probably be ready to push by the time they were ready. Also, in the ER, they wouldn't necessarily know you'd had a c/s, unless your OB saw you.
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#15 of 25 Old 08-08-2006, 03:44 PM
 
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Quote:
Originally Posted by julie128
What would happen if you walked into the ER nearly fully dilated? It takes time to set up the OR. You'd probably be ready to push by the time they were ready. Also, in the ER, they wouldn't necessarily know you'd had a c/s, unless your OB saw you.
Despite what we might see on tv, Emergency Departments don't deliver babies. If you go to the hospital in labor you will bypass the ED and go straight to L&D.

My local hospital is probably going to ban VBACs soon. There's a big fight because ACOG apparently recommends 24/7 anesthesia on-call and the anesthesiologists at my hospital don't have the staff to do that. And more importantly they don't want to. If you went to the hospital you'd have about 30 minutes to give birth before anesthesia was in hospital and another 20 before they were ready for you. Let's say an hour.

Personally, this is driving my over the edge to a homebirth.
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#16 of 25 Old 08-08-2006, 03:55 PM
 
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Our local hospitals also have a VBAC ban--the word from one of the L&D nurses, however (in the "birthing classes"), is that if you showed up 8 cm+ dialated and refused a C-section, they'd pretty much have to deliver the baby vaginally. I think she said something about no epidural, but I wasn't paying attention, because I wouldn't have one.

And at the time, I didn't expect to ever need to care, but ended up sectioned. sigh.

We're considering ttc #2; we've already talked about homebirth. I need to do some more research--that and, like, get pregnant.

Mom of two girls.
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#17 of 25 Old 08-08-2006, 11:21 PM
 
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Quote:
Originally Posted by claras_mom
Our local hospitals also have a VBAC ban--the word from one of the L&D nurses, however (in the "birthing classes"), is that if you showed up 8 cm+ dialated and refused a C-section, they'd pretty much have to deliver the baby vaginally.
Unlike what they want you to believe, if you walk in with ANY dialation, in labor at all, and you refuse a c/s, they will have to deliver the baby vaginally. They can not refuse a laboring woman admittance to any public hospital that takes any form of government funding (medicare, medicaid or any other type). AND they can not force you into accepting a surgical procedure.

So, if you WANT to go to the hospital to deliever your baby, you can and they can not force you into a c/s. Although they WILL try and coerce you, scare you, or trick you in any way they can to get you to comply.

Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#18 of 25 Old 08-09-2006, 12:40 PM
 
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Quote:
Originally Posted by Kidzaplenty
Unlike what they want you to believe, if you walk in with ANY dialation, in labor at all, and you refuse a c/s, they will have to deliver the baby vaginally. They can not refuse a laboring woman admittance to any public hospital that takes any form of government funding (medicare, medicaid or any other type). AND they can not force you into accepting a surgical procedure.

So, if you WANT to go to the hospital to deliever your baby, you can and they can not force you into a c/s. Although they WILL try and coerce you, scare you, or trick you in any way they can to get you to comply.
This SHOULD be true, yet we've had more than one mama in this community who have been given C-sect without their consent. I recall one who said she was wheeled to the OR yelling "I DO NOT CONSENT!" the whole time.

Lawyers aren't going to touch that since this culture believes that C-sections are the safest way to go. A jury will listen to a case, think the mama was nuts and say "she should be thankful the baby is ok" and that's that.

Homeschooling mama to 6 year old DD.

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#19 of 25 Old 08-09-2006, 05:21 PM
 
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Perhaps they may be able to get out of civil charges, but to cut a person without consent is a criminal charge. And if they ever touched me, believe me, I would be filing a criminal charge at the police department.

At that point, they would have to PROVE that I consented or that I was incapable of consenting. And since my DH had POA and he would not consent, they would be held criminally guilty.

Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#20 of 25 Old 08-09-2006, 06:15 PM
 
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Quote:
Originally Posted by Kidzaplenty
Perhaps they may be able to get out of civil charges, but to cut a person without consent is a criminal charge. And if they ever touched me, believe me, I would be filing a criminal charge at the police department.

At that point, they would have to PROVE that I consented or that I was incapable of consenting. And since my DH had POA and he would not consent, they would be held criminally guilty.
I really hope you're right, but I wonder. The two times I had to deal with the local police department (neither incident a big deal thankfully) I was just amazed at how disinterested they are in helping to protect citizens. I feel quite, quite, quite certain that they would do an eye roll at me - and nothing more - if I ever tried to file criminal charges against a doctor who c-sectioned me.

Probably the best way to go would be the medical board, but unfortunately even if they decided in your favor it would just be a slap on the wrist for the doctor, most likely. Yet I don't say this to say that wouldn't be worth it. If enough complaints were filed, doctors would start paying attention, and even the board themselves would probably take it a little more seriously (especially with multiple complaints against one doctor).

Anyway this is all speculation, I have never tried to file any sort of complaint against any sort of doctor, nor do I know anyone who has. So I could be wrong. I hope so.

Homeschooling mama to 6 year old DD.

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#21 of 25 Old 08-09-2006, 06:21 PM
 
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Home births are NOT anywhere Near the cost of a hosp or c/s. Many midwives will work out payment options as well. I would put a little back each month into a money market or standard savings account. My the time you're ready you should have most of the cost covered then you could work out payments for the rest.

As far as HBAC I know it can be done I have many friends that have done it.
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#22 of 25 Old 08-09-2006, 06:28 PM
 
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The legal framework for court-ordered cesareans is messy. It was much more prevelant 5-10 years ago, but does still occur. Recently a few appeal court rulings have gone in favor of the assaulted mother (including financial recompense for suffering/trauma as a result of the c/s).

However, it has happened that the court will grant a hospital the right to perform a c/s if it is considered "medically necessary", despite the mama's refusal. For example, if the hospital staff state that to procede with a vaginal delivery would result in fetal and maternal death, then the court can grant temporary custody of the child to the hospital, and force the woman to have a c/s.

You can find a few papers in pubmed that discuss court-ordered c/s (go to pubmed at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed then search for court ordered cesarean) and a google search would probably turn up more from te popular press. Although a woman can leave the hospital before the order is handed down, if she does so she can be arrested and charged (in some cases mother's have been charged with attempted murder!) and even if the baby is delivered safely there is still a chance that the mama will face prosecution.

As I said, it was much more common ten years ago, and there have been a few successful challenges to these orders in recent years (though of course those are all after the fact) so the courts are becoming more careful about granting hospitals this sort of power.

But it can happen.

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#23 of 25 Old 08-09-2006, 06:51 PM
 
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I got this info straight from ICAN. There is so much info available, but thought I would just post this. It is a lot.
Quote:
Your Right to Refuse
What to Do if Your Hospital Has “Banned” VBAC

The International Cesarean Awareness Network has tracked over 300 hospitals across the U.S. that have instituted policies seeking to ban vaginal birth after cesarean (VBAC), misleading women to believe they must undergo cesarean surgery whether there is a medical need for it or not. Clinical research shows the risks of VBAC are small and that repeat cesarean surgery carries its own risks. In spite of this, many hospitals have attempted to ban VBAC in order to limit their exposure to liability. As a result, many women around the U.S. have been told they must choose unnecessary surgery or forgo hospital care altogether. Below is a guide for women in this situation. Women who are seeking to avoid other medical ifind this information useful.

Q. Does my doctor or hospital have the right to force me to undergo surgery?
A.
No. You have the legal right to refuse any medical treatment, including cesarean surgery. VBAC “bans” exist only because they have not been challenged by patients. The doctrine of informed refusal is upheld by common law, case law, Constitutional law, federal law, state law, state mandated medical ethics and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). Any facility or care provider claiming that you must undergo a cesarean you wish to refuse is violating the governing principles of their respective institutions and professions, as well as the rule of law.

Q: What can I do to protect myself from being forced into surgery?
A:
There are multiple steps you can take to protect yourself:

• Know your rights. Visit www.birthpolicy.org to learn more about the illegal and unethical status VBAC “bans.”

• File a grievance with the Chief Compliance Officer at the hospital where you plan to give birth. Hospitals that attempt to ban VBAC are in violation of the Center for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP), which require all federally funded hospitals (approximately 80%) to honor the rights of patients to be informed of the risks, benefits, and alternatives of all procedures, to refuse any proposed treatment, including cesarean surgery, and to participate in all treatment decisions. To hold your hospital accountable under these regulations, you must first file a complaint with the hospital’s Chief Compliance Officer, who is required to issue a ruling within 60 days. If the CCO rules against you, then you have the right, first, to appeal to the your state CMS office and then to Office of the Inspector General’s Office at the Department of Health and Human Services. If HHS rules against you, then your appeal goes to the Department of Justice, which is authorized to bring litigation against the hospital on your behalf. You can read the CoP regulations by going to the Code of Federal Regulation’s main page at http://www.gpoaccess.gov/cfr/index.html Enter “42CFR482.13” into the search engine, which will bring up all of the CoP regulations on patient rights and filing grievances. To find contact information for your state CMS office, go to http://www.medlaw.com/healthlaw/EMTA...iolation.shtml

• Replace your birth plan with a customized form documenting your refusal to consent. By law, you are not required to sign the hospital’s consent form. You can either customize the hospital’s form or write down your refusal to consent to treatment on any piece of paper and sign it. Put a line through any listed procedure you want to decline and then add the list of routine procedures, including cesarean surgery, you want to refuse, initial each change or addition and make sure you have all the required signatures. Doing so will legally document your refusal to consent and alert staff that you understand and are prepared to protect your rights. In addition, such a document will require staff to obtain direct, verbal consent from you each time they want to do a procedure you've already declined in writing. If possible, pre-register at the hospital no sooner than thirty days before your due date and take the forms home with you to review, add to, and sign. Be sure to keep personal copies of any forms you sign and ask your partner or doula to record any changes that were made during the course of your labor.

Q. What if the hospital refuses to admit me unless I consent to a cesarean?
A:
The federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to admit women in active labor and to abide by their treatment decisions until after the baby and placenta are delivered. The act was originally designed to prevent hospitals from “dumping” patients who couldn’t pay but has since been widely used to hold hospitals accountable for violating other patient rights, including the right to refuse treatment. If your hospital threatens to perform a cesarean despite your refusal, notify them that they are in violation of your rights under EMTALA and that you plan to file a complaint. To find out where to report an EMTALA violation, go to http://www.medlaw.com/healthlaw/EMTA...iolation.shtml

Q: What happens if my care provider ignores my refusal to consent and performs a cesarean anyway?
A:
Many women have been threatened by their care providers that they would be put under general anesthesia and sectioned if they sought care in the hospital, even if they were close to delivering the baby naturally. While these threats are intimidating, they are not supported in either legal or ethical guidelines. If your care provider performs surgery in spite of your refusal, you are within your legal right to file criminal assault and battery charges and, if you or your baby suffer an injury, you may also sue for negligence.

Q: What if I challenge my care provider and he or she decides to drop me from care?
A:
Professional ethical guidelines state that a physician may only drop you from his care after giving you 30 days notice. This means that if you are within 30 days of your likely delivery date, your care provider cannot terminate your care. In addition, if you are pregnant and are outside of that 30 day time frame, your provider must give you a referral and ensure you are transferred to a specific provider. Physicians who fail to meet these guidelines may be charged with patient abandonment, which is grounds for malpractice and constitutes a violation of ethical conduct that could result in loss of licensure.

Q: What if my care provider or hospital seeks a court order to perform a cesarean?
A:
While there is always the possibility that the local court could grant an order forcing you to undergo a cesarean, these cases have become very rare in the aftermath of several court rulings declaring that such orders violate the rights of pregnant women. As a result of these rulings, both the AMA and ACOG have revised their ethical guidelines to state that court-ordered cesareans are rarely, if ever, justified, and are most definitely not justified in instances where the proposed treatment poses any risks to the mother.

Q: I want to give birth in a hospital, but I am afraid that this is too much stress on my pregnancy and my family.
A:
Unfortunately, the options for women whose hospitals have attempted to ban VBAC are limited. Your choices are to fight and assert your legal rights, submit to surgery, or opt for homebirth, either unassisted or attended by a midwife. Educate yourself about the benefits and risks of each option, and make the decision that is best for you and your baby. Call your local ICAN chapter (www.ican-online.org) for more information on your options and on the resources available to facilitate your decision.

Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#24 of 25 Old 08-09-2006, 07:21 PM
 
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Thanks for posting that information kidzaplenty! I think it's really important for VBAC mamas (and their support people) to be very VERY aware of their rights and to know that the hospital staff may try to pressure/intimidate them into consenting to this surgery against their better judgement.

As I mentioned, court ordered cesareans used to be more common...it's interesting to see that the ICAN faq mentions them as still a possibility however! You can read about the case I mentioned (in which the mama appealed and was awarded damages, which went a HUGE way to influencing the willingness of other courts to award this power) at the Advocates for Pregnant Women site (http://www.advocatesforpregnantwomen...c-section.htm).

It's so important for women to have all the information...ICAN is an awsome resource for all women...not just VBAC mamas and their supporters!

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#25 of 25 Old 08-09-2006, 08:30 PM
 
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That makes me so mad!! go to www.birthpolicy.org to learn about your rights! Hospitals must admit women in active labor and abide by their treatment decisions until after the baby and the placenta are delivered! So, go in when you are ready to push and only then. There is alot more info about your right to refuse a c-section at www.ican-online.org

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