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January 18, 2012

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Imagine that you are hours into labor, pacing the floors, counting the seconds between contractions, or trying, with all your might, to focus on the little person you have known only by kick for the past nine months. All of a sudden, you are rushed into an operating room, worrying about the first breaths that little person will hopefully take, bewildered at the thought that all those childbirth classes didn’t really prepare you for this.

At least a third of women can relate to the bewilderment part. In the US last year, 34% of births happened by Cesarean section (C-section). Not all of them were emergency situations; a lot of them occur because of things like a breech baby staying put upside down on the inside or failure to progress in labor.

Fast forward a few months or years to the next labor and impending birth. The 34% that previously found themselves being wheeled into the operating room after hours of laboring now have a choice—attempt a vaginal birth after cesarean (VBAC) or schedule another C-section.

Unfortunately this isn’t the case for women in our community, because Memorial Hospital at Easton, part of the Shore Health System, does not allow women to attempt VBACs, and there are quite a few expectant parents who are unhappy about this.

Last December the American Congress of Obstetricians and Gynecologists (ACOG) declared VBACs to be “a safe and appropriate choice for most women,” defining ‘most women’ as the low-risk, basically healthy variety with few factors that would impede their chances of a perfectly healthy, normal delivery. While the greatest risk to women attempting a VBAC is a uterine rupture, a potentially fatal situation for both mother and child, that happens less than 1% of the time. So why can’t Eastern Shore moms attempt VBACs here in Easton?

Kristi Shaw is just one of the moms wondering. Shaw, expecting to deliver her second child in June, had an emergency C-section two years ago when daughter Ruby showed signs of fetal distress during labor but was born healthy despite a true knot in her umbilical cord. “I knew as soon as I had a C-section with my daughter that I would want to try for a VBAC during any subsequent births. Women's bodies were designed to have babies, and it seems excessive to immediately resort to a surgical intervention without a true medical necessity,” says Shaw.

Lauren Dutton Harton, a midwife at Easton’s Planned Parenthood and co-author of "A Pocket Guide to Clinical Midwifery: The Efficient Midwife," agrees that a safe VBAC should be an option for all women, because moms and babies are healthier after a vaginal birth rather than after major abdominal surgery (Cesarean section).  “While I think that some extra safety precautions are necessary for a VBAC, I think that our current requirements are too stringent and only limit availability rather than focusing on creating a safe environment.”

One of ACOG’s recommendations about VBACs is that medical centers have immediately available staff to handle situations where a VBAC attempt suddenly requires a Cesarean, or in the case of uterine rupture. Currently Memorial Hospital at Easton does not have either an in-house obstetrician (OB) or an in-house anesthesiologist. “Our obstetricians and anesthesiologists are on call to respond to patient needs within 30 minutes. However, for VBAC, this does not represent the 'immediate availability' that is required for a woman who may experience a VBAC complication,” says  Michael Tooke, MD, Chief Medical Officer for Shore Health System. “Therefore, our policy is not to offer VBAC so that we never put a mother or child at avoidable risk from this process.”

Dr. Tooke explains that Memorial Hospital physicians help women who wish to proceed with a VBAC make arrangements with another medical center. This usually leads expectant mothers across the bridge to Annapolis, Baltimore, or Washington, DC.

Shaw is one of the pregnant women traveling to Anne Arundal Medical Center to give birth. But beyond the normal nerves associated with the unknown of any “birth” day, Shaw laments, “I have to hope to get to Annapolis in time to have a VBAC. I come from a history of fast-laboring women and I also have to hope that summer traffic is not working against me.”

Knowing that the ability to try for a VBAC means traveling at least 40 minutes is not a comfort for most Eastonians. “I think the policy against VBACs is outdated and ill-informed. It does not serve the community well as a rural community health service. I have friends who will be traveling to Annapolis from as far as the outer reaches of Talbot and Dorchester Counties to deliver via VBAC. We deserve to be able to deliver in our community, both for our safety and for our convenience,” says Shaw.

This is the first in a two part series on birth choices in the local Easton area. Click here to read "Born at Home—Part II of Birth Choices."

by

January 18, 2012

Comments (6)

Comment Feed

ACOG guidelines

I agree with Stephanie that patients should be well informed, healthy and stay away from as many interventions as possible. I was one of those patients and I still ended up with a c-section. Does that mean I should automatically go through another major surgery? The chance of uterine rupture is low (0.5-1%) and the risks associated with c-section are considerable. I had a newborn that stopped breathing several times due to not being "squeezed" during the delivery process to expel the liquid and mucus from her lungs. I would encourage anyone interested in this subject to read the American Congress of Obstetricians and Gynecologists' latest guidelines on VBACs (http://www.acog.org/~/media/ACOG%20Today/acogToday0810.ashx?dmc=1&ts=20120217T1549512743), especially the section regarding the recent trend of increasing maternal mortality following the same trend of increasing c-section rates. Unfortunately, I'm no stranger in the OR, but I won't be hopping onto the operating table unless it is truly medically necessary.

Kristi more than 2 years ago

Interesting!

Very interesting! I didn't have a c-section but my 2nd labor was so short (my first was 12 hrs) there is no way I would have made it across the bridge! I barely made it to Memorial and it's only 10 minutes away. I'm sorry that other moms have to be face this frustrating decision! Have a backup plan, though!

Heather more than 2 years ago

risks vs option

Sometimes the risks outweigh the option. The money is not there to pay for in house anesthesia or ob. Being one that has seen the devastation that uterine rupture can cause I don't support the necessity of our small wonderful community hospital to provide them. It was not long ago that only a very small handful of providers performed them at Anne Arundel. I believe that our local providers are working very hard to prevent primary c sections by limiting social inductions. It is the communities job to educate themselves and enter pregnancy healthy and use little to no intervention.

Stephanie more than 2 years ago

here's one...

I've often times wondered why VBAC was never an option here or even really mentioned--this has clarified so many questions. Mothers should have the option or at least be informed of availble birthing options.
Our son was delievered via emergency c-section almost four years ago. While I too have friends who have longed to have a VBAC, I'm welcoming my scheduled C-section on March 5 this year for our second son and it never really crossed my mind to have it any other way. This could be "pregnancy amnesia", but I don't remember it being so terrible afterwards, and I'm glad to be able to look forward to our newest son's birthday.
Great article, Patty!

Michele Tota more than 2 years ago

Thank you!

What a great article. We had our little one via unscheduled c-section and now are faced with the options of scheduling a c-section or traveling for a vbac when we have another child. This does a nice job of outlining the why's and what's of the situation. Well done!

Abby West Cureton more than 2 years ago

VBAC

I love that this article addresses this frustrating situation. After having two C-sections (one unplanned and one scheduled) I researched my options and chose VBAC. I went on to deliver three healthy babies (including a set a twins) via VBAC, all at Memorial Hospital at a time when they were still 'allowed". Honestly, if Shore Health System really wants to live up to its slogan of "Exceptional Care Every Day" they need to give women on the Mid Shore the VBAC option.... anything else is a compromise. It appears SHS has identified the roadblock to providing VBAC at Memorial (lack of in-house anesthesiologists/obstetricians) so what are they doing to tackle it?

Thanks for publicly addressing the issue.

ctymouse more than 2 years ago

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