By Katy Rank Lev and Lauren McAnallen

In late 2012, ICAN of Southwestern PA started getting calls and emails from women living in Mercer County, PA, about an hour northwest of Pittsburgh. Apparently, one of the hospitals there was instituting a VBAC ban! Some of the women contacting our chapter had already had successful VBACs in the city of Pittsburgh and had been looking forward to birthing closer to home, supported in the local hospital by a CNM, for their next babies. For them, the VBAC ban was upsetting. How could they choose between coerced surgery or driving an hour into the city for each prenatal appointment (with young kids in tow) and driving while in labor?

But then, our chapter learned that this particular hospital served the local Amish population and that they were transferred to this hospital for cesareans. Many of them felt safer birthing in the hospital for subsequent babies. This became an important factor for many reasons: these women felt called to have many children, however it simply isn’t a safe plan for a woman to have 8 or more cesareans. These women also did not carry health insurance. They would have to pay out of pocket for hospital procedures. Coerced cesarean delivery would mean tens of thousands of dollars per Amish family per child. Some Amish do not drive automobiles, so even though the tertiary hospital in Pittsburgh, where VBAC was supported, was only an hour away by car, this was not a practical option for families whose primary means of transportation is a horse and buggy.

We immediately reached out to the ICAN board of directors for advice. While we waited to hear back, we started a letter writing campaign, addressing our letters of concern to the patient advocate at the hospital as well as the head of obstetrics. We found some letter templates in the chapter leader guidebook and tweaked them to fit our situation.

Soon after, ICAN’s legal counsel got back to us. She felt that since Amish women in particular were being affected, this meant we had solid legal ground to approach the hospital administration persuasively. She began to draft a legal letter to the administrators, outlining how and why a VBAC ban was discriminatory against this religious group.

Meanwhile, we needed to find mothers who were willing to speak up against the VBAC ban. We found a few women who spoke with legal counsel, gave their stories and talked about how the VBAC ban affected their family planning and their own autonomy. A big challenge for us was to find Amish women who would speak to ICAN’s lawyer since our chapter leaders were located in the city, over an hour away, and many of these women could not access Facebook.

Thankfully, a CNM working in the hospital was willing to risk her job to help the cause. She created surveys and asked for community support and gave patients ICAN’s contact information so they could reach out to us for help. And, by winter, some Amish families did! Pregnant Amish women walked miles in the freezing cold to use a payphone and tell their story. One Amish woman pleaded with legal counsel, “My sister had a cesarean, and I saw [everything]. Please don’t let them cut me open like my sister!”

ICAN’s legal counsel developed the letter to be sent to the hospital administrators, which was about ten pages long, and called for an immediate lift of the ban. We were dismayed when they failed to respond.

At this point, ICAN’s legal counsel urged us to begin looking for an attorney who would take the case probono (we certainly didn’t have the funds to pay for a lawyer) to sue the hospital system. Our chapter decided it was important to get an ICAN person on the ground, closer to the women being affected, and so one of the mothers who originally contacted us agreed to start a new chapter: ICAN of Western PA.

Lauren McAnallen found out the day after her daughter’s first birthday that the hospital where she was delivered had instituted a VBAC ban. She says, “I was devastated. I didn’t really know where to start. At this point I was not an ICAN member; I had only attended one in person meeting and a handful of online webinar meetings, but this ban was hitting really close to home. Reaching out to ICAN was the first thought that came to mind.

“I got in contact with Katy and she soon put out a call to action for any mothers affected by the ban to write letters, spread the word, and to speak with ICAN’s legal counsel. Katy supplied some fantastic guidelines for writing my letter to the hospital’s patient advocate – simple but important things – keep it short, share how this directly affects you, quote current medical stance on the safety of trial of labor after cesarean, and encourage the hospital to reverse the decision. I quickly drafted my letter, dropped it in the mail and began to encourage my friends and family to do the same. I signed a petition in one of the local care provider’s office and kept in contact with Katy and ICAN’s legal counsel as we waited to hear if our efforts were making any waves or if they were being heard by the hospital administration.

“It took a while for my letter to receive a response, and when it came I was shocked by their reply. It seemed to be a copy/paste letter that neither covered any of my concerns nor was any bit empathetic to my personal experience or the impact of the ban on my family planning – they basically told me that there are other hospitals in the area that offer the services I want and that I can just go there. This was not the answer I had expected from a respected hospital and especially not the answer I expected after I put my heart and major concerns into writing a letter – I was furious to have not received a letter with even just the smallest bit of compassion. It was then I recognized how important it was for me to bring ICAN to my community and in March of 2013, I joined ICAN and took the steps to start a local chapter, ICAN of Western Pennsylvania.”

Over the next few months we continued to reach out to friends and family to write letters and did as much networking via social media as we could. The new chapter started holding monthly meetings and hoped to get some local interest in ICAN and fighting the ban. Also during these months news came that a different hospital would be closing their maternity department entirely. Since this time, three other hospitals have closed their maternity departments, funneling birthing mothers to the tertiary hospital an hour away. Options seemed to be diminishing for families in the area – until August 2013 when the almost miraculous news came in that the VBAC ban had been lifted.

There was little word about the ban before it was reversed. Things were really quiet for months before the news came through. It seems that the Amish community did most of the fighting. Two women came to the hospital in labor and quietly but powerfully declined repeat cesareans. They were treated respectfully by all staff, and both had successful VBACs attended by their midwife with the support of an attending physician. Soon after those births, the ban was lifted. Providers, anesthesia and nursing finally worked together to ensure the safest coverage for those desiring VBAC, advocating the lift of the ban at every staff meeting.

Our local ICAN chapters took all the steps we could to bring attention to the ban and did our best to get the community involved, and in the end it worked.

Keeping the ball rolling was the difficult part and ICAN’s board of directors and legal counsel provided the Amish mothers a voice and informed them of their options, because it really appears that they were the ones who fought the hardest.

Because of that fight the women in Western Pennsylvania have their option to birth their babies safely in a supported hospital environment. Although some women were caught unfairly in that painful period, and there’s no good excuse for that, finally common sense and autonomy prevailed!