For Immediate Release
New Survey Shows Shrinking Options for People with Prior Cesarean
Bans on Vaginal Birth Force People into Unnecessary Surgery
Redondo Beach, CA, February 20, 2009 – The International Cesarean Awareness Network (ICAN) has released the results of a new survey showing an alarming increase in the number of hospitals banning vaginal birth after cesarean (VBAC). The survey shows a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding people from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” ban.1 Full results of the research can be seen https://ican-online.org/vbac-ban-info.
The bans essentially coerce people into surgery they do not need. In response to bans, people are either submitting to unnecessary surgery or are traveling long distances to hospitals that do support VBAC. Some are feeling forced out of hospital care altogether and are having their babies at home in order to avoid coerced surgery.
“There is an alarming disconnect between what medical research says about the safety of VBAC, and the way that hospitals and their doctors are practicing medicine” said Pam Udy, president of ICAN, an all-volunteer patient advocacy organization. “These bans are about business, not about the health and well-being of pregnant people and families.”
Research has consistently shown that VBAC is a reasonably safe choice for those with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well-respected, independent maternity focused non-profit, in the absence of a clear medical need, VBAC is safer in the current pregnancy, and far safer in future pregnancies.2 While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well. “The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.
Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs.3
Hospitals cite strict guidelines set by the American College of Obstetrics and Gynecology as the driver behind the bans. The ACOG guidelines stipulate that a full surgical team be “immediately available” during a VBAC labor, though the stipulation is a “Level C” recommendation, which means it is based on the organization’s opinion rather than medical evidence.
“If a hospital can’t handle a VBAC emergency, they can’t handle any emergency. VBAC-banning hospitals are claiming to be a safe place of birth for non-cesarean parents, but those people are just as likely to have an emergency as someone with a prior cesarean” says Udy. Placental abruption, cord prolapse, fetal distress are all common emergencies that any person can experience and require immediate attention.
For physicians, repeat cesareans are often considered more convenient, more lucrative and better insulation from lawsuits. VBACs are inconvenient and costly because they require the physician to be on-site and be available to care for the mother. “ACOG created clinical guidelines that are, in effect, good for business,” said Gretchen Humphries, ICAN’s Advocacy Director, who spearheaded the research. “If physicians think VBAC patients need more attention, then they can simply provide that attention by being in the hospital. But it’s easier to just push people into unnecessary surgery.”
“These bans mean that any mother with a prior cesarean is going to have to be aggressive about seeking out balanced information about the pros and cons of a VBAC versus an elective repeat cesarean, and unfortunately, be prepared for an uphill climb if she chooses to have a VBAC,” said Humphries. For more information about the rights of people facing VBAC bans, please visit https://www.ican-online.org/vbac/your-right-refuse-what-do-if-your-hospital-has-banned-vbac-q .
For more information about the clinical risks of VBAC and elective repeat cesarean, please visit: http://www.childbirthconnection.org/article.asp?ck=10210#bottom
About the survey: This survey was powered by an all-volunteer team of callers who called, state by state, hospitals across the country. Survey volunteers used publicly available listings of hospitals and made every effort to call every hospital in each state. Surveyors contacted each hospital’s Labor and Delivery (L&D) ward and questioned L&D nurses about the hospital’s practices. Survey questions were designed to elicit information about formal bans, de facto bans, the reasoning behind the bans, and the level of coercion mothers might face if couldn’t find an alternate hospital option. Information from calls was recorded into a central database. A total of 2,850 hospitals were called. Individual records are available for viewing at https://ican-online.org/vbac-ban-info.
About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. https://www.ican-online.org/resources/white_papers/index.html
1 A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.
2 http://www.childbirthconnection.org/article.asp?ck=10210#bottom Best Evidence: VBAC or Repeat C-Section, Childbirth Connection
3 Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1
Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL. 107, NO. 6