Tuesday, October 30, 2007

VBAMC

Vaginal
Birth
After
Multiple
Cesareans

VBAMC. Virtually unheard of in a hospital environment, it's also prohibited in most "out of hospital" legislation. The following was emailed to me from a list earlier and it's given me cause for wonder and at the same time, alarm. Last evening, I spent 2 hours with two lovely women who will probably never have vaginal births without a fight. The idea of women having to fight to be able to make their own decisions in health care while pregnant, while gestating, while trying to be at peace simply offends me. Evidently, it doesn't offend the obstetricians who help force through the laws or the midwives who compromise simply to be able to offer care to anyone. Or maybe it does, I don't know. What I am having a hard time grasping right this moment is why we are fighting so hard for legislation that precludes MANY women from using it, due to a perception of risk which is not based in evidence. Those same OB's coerce women into agreeing to the second cesarean through unreasonable expectations (you have to have a 40 week baby under 8lbs? That's REASONABLE? I don't think so!) or through forcing them (I won't take you as a client unless you agree to a cesarean. Sorry, I don't do VBAC) and then have eliminated them through shared practice restraints from being able to do homebirths. So, for the sake of a 1% risk, these women are told they don't have the RIGHT or ability to choose a vaginal birth.

A woman in a hospital setting is not given a chance if she's a normal, low-risk woman having her first baby. I fail to see how mothers who have had more than one cesarean are going to receive fair or balanced treatment based on their needs and not blind protocols.

It's a conundrum. How to make midwifery accessible without making midwives be hunted.
How to make the "system" recognize that women deserve the right to birth where they choose, with whom they choose and with the responsibility of understanding the risks they choose through an informed consent process that matters. I don't see any of that in the legislation.

Oh, and by the way...if you can't have a VBAC unless you have had a VBAC...how in the hell do you get the first VBAC?

http://www.dora.state.co.us/Midwives/Rules.pdf

*RULE 4 – PRACTICE RESTRICTIONS *

The purpose of this rule is to define the practice restrictions applicable
to a direct-entry midwife.

A. The direct-entry midwife shall not provide care to any client whose
medical history exhibits the following signs or symptoms:


11. Vaginal Birth After Cesarean Section (VBAC) unless compliant with Rule
12, or


*RULE 12 – STANDARDS FOR VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC) *

The purpose of this rule is to establish parameters for VBAC patients
seeking midwifery care during pregnancy in order to safeguard the client's
welfare.

A. A direct-entry midwife shall not assume primary responsibility for
prenatal care and birth attendance for women who have had a previous
cesarean section unless all of the following conditions are met:

1. All prospective VBAC women shall sign an informed consent statement,
which shall be retained in the client's records and include the following:

14 (a) VBAC educational information including history of VBAC and client's
own personal information;

(b) Associated risks and benefits of VBAC at home;

(c) A workable hospital transport plan;

(d) Alternatives to VBAC at home; and

(e) Other information as required by the Director.

2. A workable hospital transport plan must be established for home VBAC. The
plan shall be in writing and include:

(a) Place of birth within 30 minutes of transport to the nearest hospital or
emergency medical center able to perform an emergency cesarean;

(b) Readily available emergency numbers for the nearest hospital or
emergency medical center; and

(c) Provision for phone contact with nearest hospital or emergency medical
center prior to any transport notifying the destination that transport is in
progress.

3. There has been at least 18 months from the client's cesarean delivery to
the due date of the current pregnancy.

4. The client with 2 or more cesarean deliveries has also had a prior
vaginal delivery.

B. Direct-entry midwife shall obtain prior patient cesarean records, in
writing, and shall analyze the indication for the previous cesarean, and
retain the records along with a written assessment of the physical and
emotional considerations in client's files. If the direct-entry midwife is
unable to obtain the written records, the direct-entry midwife shall not
retain the woman as a client.

C. Records that show a previous classical uterine/vertical incision or any
previous uterine surgery which required an incision into the uterine fundus
are a contraindication to VBAC at home and shall require immediate transfer
of care of the patient.

D. Direct-entry midwife shall not induce or augment labor by the use of
chemicals or herbal supplements or nipple stimulation.

E. A direct-entry midwife shall be present and manage the VBAC delivery from
the onset of active labor throughout the immediate postpartum period.

Monday, October 22, 2007

Living "at risk"

I wrote something a while back which I think needs to be reiterated. I've had a very busy month and left the blog a bit empty while I was refocusing and getting organized. So, the renewal period will begin with this:

Obstetricians do know how it feels to be a VBAC mother. They live every day, wondering when someone will give them a gut wrench and hand them a court summons to appear. Knowing that someone else controls their livelihood in the blink of a moment, that gut check controls their existence.
VBAC moms live in daily fear of that gut check. It controls their ability to birth in a safe environment with a care provider they trust. Knowing that at any moment, their "care" could become defensive and controlling, knowing that at any moment, they could be left out to dry and forced to have an unnecessary surgery because of that OB's fear.
The difference is simply meted out in dregs..it's all fear and misery.
The only real difference in the outcome is this:
An OB could lose their practice, their livelihood, their home or their car.
VBAC mothers could lose their life or their baby's life on that table.
Defensive medicine cannot excuse away the unconscionable actions being taken that endanger our women and babies. Maintaining a license is NOT equivalent to maintaining a life.