vbac in rural areas?

[Deleted User] · July 2013

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mysticl · July 2013

The hospital where I live has a VBAC ban. Fortunately there is a city about 45 minutes away where I can find VBAC friendly providers. After my son was born I asked my midwife what our local hospital would do if a woman refused to sign the surgical consent. She said they would have the OR on standby for an emergency c-section and pressure the mother to sign the consent. She also said they would try to transfer the mother if they felt there was enough time. She doesn't agree with the ban but has to honor it to be allowed to deliver there. She suggested laboring at home until about 8cm and then going to the hospital.

I've also heard it suggested that you contact the hospital and ask why they don't do VBACs. If they say it's because they aren't set up to do an emergency c-section if you rupture contact the local newspaper and pitch a story about how the local hospital cannot do emergency c-sections. There are other pregnancy complications that can require emergency c-sections and logically if they aren't "set up" to perform one on a woman trying to VBAC they aren't "set up" to perform them at all.

[Deleted User] · July 2013

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mysticl · July 2013

Threaten a lawsuit to require them to VBAC?

I'm only half joking.

[Deleted User] · July 2013

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nosoup4u · July 2013

Oh man, seriously sue!!! I think the legal route is the only way in most cases...

There's a woman in Arizona who went to the press about a VBAC ban, I can't remember if the hospital changed its policy.

I agree with going to the press at the very least, high CS rates bc of VBAC bans is a real public health issue. ACOG and NIH both advocate for VBAC in most cases. Good luck!

mysticl · July 2013

It would be an interesting article about the hospital is letting their liability insurance make medical decisions.

[Deleted User] · August 2013

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mysticl · August 2013

I grew up in the boonies. My mom and step dad live out in the middle of nowhere. However, according to my research their local hospital (the one I was born in) does do vbacs.

I currently live in what many would consider a small town though it is bigger than where I grew up. We have a vbac ban here but there is a city just over the state line (about 45 minutes) that has hospitals that do them. I even heard the one of the OB practices there does not set a "must give birth by" date for an RCS.

Ninabean1030 · August 2013

I live in the middle of nowhere. Luckily the closest hospital (about an hour away) does allow vbacs. However, I'm going for a vba2c and I think my ob is one of the only ones in the state who will consider it.

[Deleted User] · August 2013

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nosoup4u · August 2013

WildFlower26 said:

It is encouraging to know that vbacs are an option in most locations.

That's not true, unfortunately. Only 10% of eligible women VBAC right now (not sure of 2013 stats), even though 75% of VBACs are successful. There's been a huge drop in VBAC rates over the past 20ish years.

https://www.childbirthconnection.org/article.asp?ck=10554

[Deleted User] · August 2013

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kbeeb · August 2013

The hospitals 15 min and 45 min away have VBAC bans in place, but luckily there is another 2 hours away (their success rate last year was 92%!!!). It is incredebly frustrating to live in a rural area and not have any viable options. If this hopsital didn't allow VBACs my only other option would have been a home birth with a group of midwives who do VBACs, but they do not accept my insurance, so not really an option after all...it may be an option for you though if you really want a VBAC!!

Before i switched to the VBAC friendly hospital, my old OB said tat i can refuse to sign all the consent forms at the hospital and refuse C/S, but that there is so much red tape, that all the staff will pressure you really hard, constantly to try and change your mind. and they will use every excuse they can to make it "medically necessary" and scare you into it. She also suggested that if i was going to try it here anyway to labor at home and not come in until i was very far along, practically pushing, at which point they wouldn't have much of a choice...

Good luck!

mysticl · August 2013

kbeeb said:

The hospitals 15 min and 45 min away have VBAC bans in place, but luckily there is another 2 hours away (their success rate last year was 92%!!!). It is incredebly frustrating to live in a rural area and not have any viable options. If this hopsital didn't allow VBACs my only other option would have been a home birth with a group of midwives who do VBACs, but they do not accept my insurance, so not really an option after all...it may be an option for you though if you really want a VBAC!!

Before i switched to the VBAC friendly hospital, my old OB said tat i can refuse to sign all the consent forms at the hospital and refuse C/S, but that there is so much red tape, that all the staff will pressure you really hard, constantly to try and change your mind. and they will use every excuse they can to make it "medically necessary" and scare you into it. She also suggested that if i was going to try it here anyway to labor at home and not come in until i was very far along, practically pushing, at which point they wouldn't have much of a choice...

Good luck!

And lets not forget that some hospitals have been known to go to court and get a judge to order the C-section.

vanvoorhis-101 · August 2013

Yes the Hospital near me doesn't do VBACs either although my OB told me that may change soon. Our hospital doesn't do them because they do not have an anesthesiologist in house at all times, which is required in case of a true emergency. They are always on call so they can do c-sections but in the case of a uterine rupture they have to have that baby out in like 2 mins! A true emergency they put you under general sedation and get the baby out ASAP. Right now the plan is to go to the city about 45 mins away, which is not too far. Five hours is a long drive though! You may just want to get a hotel room or even find a one month rental there when you think you are getting close.

nosoup4u · August 2013

I am aware that vbac numbers are down. My original question was done anyone else live in an area where a vbac is not an option. My comment was based on the two ladies who commented about living in rural locations but being able to get to a hospital that permits vbacs. They both said that was their plan. I don't have any doable options right now. My comment was intended to be supportive of Mysticl and Ninabean1039.

Sorry if I misconstrued what you were saying. I think it's totally worth pointing out that most women don't have the option to VBAC, rural or urban. This is a national message board, might ask well not candy-coat reality.

nosoup4u · August 2013

vanvoorhis-101 said:

Yes the Hospital near me doesn't do VBACs either although my OB told me that may change soon. Our hospital doesn't do them because they do not have an anesthesiologist in house at all times, which is required in case of a true emergency. They are always on call so they can do c-sections but in the case of a uterine rupture they have to have that baby out in like 2 mins! A true emergency they put you under general sedation and get the baby out ASAP. Right now the plan is to go to the city about 45 mins away, which is not too far. Five hours is a long drive though! You may just want to get a hotel room or even find a one month rental there when you think you are getting close.

There are still non-UR obstetrical emergencies that need to be done in a short amount of time. And UR doesn't necessarily mean death for mother and/or baby after two minutes, they're justifying their ban. Glad you can go somewhere else!

Clynnpollock · August 2013

nosoup4u said:

Oh man, seriously sue!!! I think the legal route is the only way in most cases... There's a woman in Arizona who went to the press about a VBAC ban, I can't remember if the hospital changed its policy. I agree with going to the press at the very least, high CS rates bc of VBAC bans is a real public health issue. ACOG and NIH both advocate for VBAC in most cases. Good luck!

I just did a google search for the story on the AZ woman (since I live in AZ I was interested in which hospital it was... Turns out she moved to a major metro area 5 hours from her home for the last 3 weeks of her pregnancy and had a successful VBAC. The local hospital administrator told her that the hospital would get a court order to do the c-section if she tried to deliver there.

mysticl · August 2013

vanvoorhis-101 said:

Yes the Hospital near me doesn't do VBACs either although my OB told me that may change soon. Our hospital doesn't do them because they do not have an anesthesiologist in house at all times, which is required in case of a true emergency. They are always on call so they can do c-sections but in the case of a uterine rupture they have to have that baby out in like 2 mins! A true emergency they put you under general sedation and get the baby out ASAP. Right now the plan is to go to the city about 45 mins away, which is not too far. Five hours is a long drive though! You may just want to get a hotel room or even find a one month rental there when you think you are getting close.

The problem with that rational is that it is not just VBACs who rupture. Also, things like placental abruption and umbilical cord prolapse can be true emergencies requiring an immediate c-section. Another problem with that rational is that Anesthesiologists do all types of surgeries, not just Obstetrical, so if they are required to have one in house to handle true emergencies and they don't have one then that hospital cannot handle any emergencies at all.

vbac in rural areas?

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