It’s Not You, It’s the Liability
Via Well Preserved, an article in New Jersey’s Star Ledger about local treatment of pregnant women who have had previous c-sections. The opening quote echoes women’s comments in a recent ABC news piece – women indicated that they were led to believe c-section is easier than it truly is:
“They said, ‘We’ll do a ‘C’ to get the baby out.’ They made it sound so easy,” the Manville resident said. “But they didn’t tell me I would watch everyone else take care of my baby. That I couldn’t count her toes. That for weeks it would feel like my stomach was exploding.”
The Star Ledger did a review of women having a VBAC in the state, and found that rates have “plummeted.”
A decade ago, 34 percent of New Jersey women who had Caesarean sections delivered another child vaginally, the analysis shows. Last year the figure had shrunk by three-quarters to 8.5 percent. At many hospitals, just 2 percent to 4 percent of women with previous Caesarean sections deliver babies without surgery.
To supporters of VBACs, the dramatic shift signifies a sharp increase in the medical management of birth, and a lack of choices for women.
To many doctors, though, avoiding VBACs is simply safer because otherwise, on rare occasions, the mother’s uterus can rupture at the site of the previous incision — a potentially catastrophic complication for mother and child.
These doctors say the rise of VBACs in the 1990s was fueled by health insurers seeking to save money on surgeries, not by medical evidence, and that anything less than a perfect birth outcome today could result in multimillion-dollar lawsuit against the physician.
Some hospitals are simply refusing to allow women to attempt a VBAC – “Hackettstown Community Hospital tells women upfront that it no longer delivers VBAC babies.” As a result, women are now seeking care further away from home in order to have their VBAC wishes respected.
For Dana Roberts, finding a practitioner who supports VBACs meant driving an hour from home. She sought out Midwifery Care Associates in Pennington, which says it has assisted in 44 VBAC attempts, 42 of them successful, in the past 17 years. The practice’s overall Caesarean rate is just 5 percent.
New Jersey’s state representative for the American College of Obstetricians and Gynecologists was interviewed for the piece; the organization continues to say that VBAC can be an option under many circumstances.
During a Caesarean, you cut the mother’s abdominal wall and uterus. You cut through muscle. You can sew the muscle back together, but the scar is never as strong as intact muscle,” he said. During a subsequent pregnancy and labor, the scar is under tension.
“But we found in the 1980s that you could monitor patients and there was a very low risk of bad things happening,” he said.
New Jersey women are currently lobbying for legislation to make healthcare providers release their c-section and VBAC rates, because they are by no means consistent. One obstetrician interviewed for the piece says the Women’s Health Associates group (which includes OBs, a perinatologist, and midwives) has a c-section rate of 4% (compared with 37% for New Jersey overall), and has delievered 317 VBAC babies, succeeding at helping a woman have a VBAC 86% of the time.
He said inappropriate use of Pitocin, a drug to induce labor, and epidurals, or spinal anesthesia, can inhibit the natural process of labor and lead to Caesarean sections.
Well Preserved also has a homework assignment for you – ask your local hospital about VBAC and c-section rates. If you do, let us know what you find out.
