Hot Topic (10/19): Forced c-section . . . is it legal?

[Cafe GroupAdmin]

PAGE - A pregnant woman's pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital's general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.

Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

"Page Hospital is, as many small communities are, challenged with resources," said Chief Executive Officer Sandy Haryasz. "Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week.

"Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist."

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women's care clinic in Phoenix or have unassisted home delivery.

While the hospital's new policy not to do VBACs is unwritten, Haryasz said the decision is not based on money, but on there not being enough "volume" to warrant hiring another physician or emergency anesthesiologist.

"This is about providing quality safe care to all our patients," Haryasz said. "The hospital would have to cancel surgeries or any other procedure because that doctor or anesthesiologist would have to be available to her while she's in labor, which could take hours or days."

Joy's husband, Jeff, 44, is supporting what he thinks is his wife's right to choose.

"I have talked with Banner Health officials who have said it's just their policy," Jeff said. "It's a legal decision - not a medical decision. My wife's plight is indicative of the health-care system in the U.S. They make money off of people's suffering.

"Consequently, medical care is dictated by cost and insurance companies and not by what's best for the patient."

Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.

"I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order," Joy said. "They don't want to allow VBACs because she said they aren't equipped for emergency c-sections, but if they can't do emergency c-sections, they shouldn't be having labor and delivery at all. That's why women go to the hospital to have their babies - in case there is an emergency.

"I wish her luck explaining to a judge that she is insisting I have a medically unnecessary surgery."

ACOG currently supports VBAC deliveries, citing on their Web site at www.acog.org, that the benefits include the avoidance of abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss, and less need for blood transfusions.

The risks include a rupture of the previous cesarean scar during delivery, or in rare circumstances, rupture of the uterus.

Haryasz said that despite ACOG's recommendations and the favorability of success with VBACs, Page Hospital is sticking by its decision to no longer perform natural deliveries after cesareans.

"We respect our patient's wishes should they choose VBAC, however the medical staff and administration have determined that deviating from national standards and performing this procedure here is a risk that is unwarranted and too great for our mothers and babies," Haryasz said.

The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

"My doctor doesn't have a problem with me having natural delivery, but said that the hospital does," Joy said. "The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn't matter since the hospital has decided that all VBACs have to have an ‘elective c-section.' I think my definition of ‘elective' differs from theirs because I don't want this."

 

* * *

 

Does a woman have a right to choose a vaginal  birth after a c-section (VBAC)? 

 

What do you think this woman should do?   What would you do if you were in her situation?

[Biancas_mommy]

I think it depends on the dr's confidence on the mothers physical ability...with my personal experience (I had a v-birth on oz and c-section in 08) I would never never never have a v-birth again...ever..ever.ever...lol...I had a horrible v-birth and was in so much pain afterwards.  My c-section was a breeze, I was in some pain afterwards but nothing compared to my v-birth.  I had my DD on a thursday and my staples were out on monday and once the staples were out I wsas fine.  It took me forever to recover from my v-birth and I couldn't go to the bathroom...

[Mergath]

Why couldn't she have a home birth with a traditional midwife?  From what I've heard, there are many midwives that feel comfortable attending a VBAC.  Or would her medical history prevent that?

I do think the hospital has the right to decide its own policies.  She isn't actually being "forced" to have a c-section.  It's a crappy situation, but it's not as if her rights are being violated because of the hospital's policy.  She has other options; she's just unhappy because they're inconvenient.

[hsteele]

I agree. If she is not happy with the hospitals policies then she will have to find another hospital or have a home birth. It sucks, but she cannot change hospital policy. She is not being forced to have a c section. She is making the choice to have one if she stays on with that hospital. There are always other options.

[home-sweet-home]

Does a woman have a right to choose a vaginal  birth after a c-section (VBAC)? 

 

Yes she does.

 

What do you think this woman should do?   What would you do if you were in her situation?

 

She should find another hospital or have a homebirth. I would have a homebirth, unassisted if I could not find a midwife. She has successfully had a VBAC, her risk for rupture is now the same as any other pregnant woman. This hospital it ridiculous. I mean if they are not within ACOG guidelines, I hope they are not doing any other high risk clients.

[Corrina1976]

Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week. "Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist."

 

VBAC or NOT,  what if a first time mother comes in with or is laboring and an emergency arises, what would they do ??????  This hospital is not SAFE and is UNPREPARED, for ANY emergency it sounds.

 

Facts have proven that aVBAC does not present any specific emergencies that a regular laboring non VBAC woman could encounter.  Any woman can rupture her uterus..technically speaking..ya know... Emergencies arise all the time, VBAC or not. I had an emergency c section with my son, what could of happened to me if I was in this Page hospital and they were not staffed and equipped for emergencies?  I would sure hate to find out.  I guess I could be dead and so would my baby.

 

This story has an update- Joy is moving to Phoenix temporarily for the duration of her pregnancy and she will be able to VBAC there.

[Gretchen2876]

Quoting hsteele:

I agree. If she is not happy with the hospitals policies then she will have to find another hospital or have a home birth. It sucks, but she cannot change hospital policy. She is not being forced to have a c section. She is making the choice to have one if she stays on with that hospital. There are always other options.

Unless she really likes her doctor, and he only delivers at one hospital. I had that problem.

[Mommy_of_Riley]

Go to a different hospital.

[lbranta]

I think first you might have to understand how things are in that town and the surrounding area, this town is really primitive in alot of ways they don't even offer Internet besides the old dial up.  I know this because I have a very good friend who lives in that town and is at constant war with alot of things about it.  I don't on the other hand think that anyone should be forced to have an unnecessary C section.  That s a major surgery and very invasive.  But where she lives you might not have time to get to another place in an emergency so really although home birth is an option what in the case of an emergency she would still have to go to that hospital.  That's really a tough choice she is facing and I don't really see much choice here but to move or just deal with things as it is.

[stormcris]

I think a woman has a right to give birth how she wants to. I think she should also have the best medical care available to her.

Obviously this hospital has been hit by the economics of the times. I fear it may get worse as more hosptials will go to lower staff availability. I do not think they have a case to force a c-section since she has already had a successful VBAC.

[la_bella_vita]

 I don't think anybody should be forced to have a c-section UNLESS her medical history says eitherwise.

I think she should look into getting a midwife. That is probably what I would do. I don't know though, I don't know her medical history.