Cottage, VBAC support
First, allow me to express my gratitude to Cottage supporting birth as a normal process and an integral part of the human journey, and for providing a safety net of excellent care in emergencies and when specialized medical care is necessary.
However, I am disappointed that Cottage Hospital does not allow Vaginal Birth After Cesarean (VBAC) as this comes down to requiring surgical birth without consideration for individual patient concerns and for patient rights to informed consent (and refusal) of treatment. I don’t think this is a judicious use of intervention. I have researched VBAC and found much support for the safety of VBAC and for the right of patients to make the choice not to undergo surgery. I would like Cottage to support access to VBAC.
I had my baby at Cottage by cesarean as she was breech and Cottage requires cesarean for breech babies. Although my OB has much experience in vaginal breech deliveries, and considered me a great candidate for it, there would have been no support in the hospital. The ban on vaginal breech deliveries (and twins, and the rush to c section for other non-emergency situations) combined with a ban on VBAC, puts women like myself in a terrible predicament.
There are health risks to cesarean surgery for mother and baby – including greater risk of maternal death, respiratory distress in the baby, as well as separation between mother and baby that interferes with bonding and breastfeeding. The risks of accumulating cesarean sections are great enough that doctors recommend women to stop having children after 3 c-sections because of the increased risk of problems due to scar tissue with how the placenta forms that can be extremely harmful for both baby and mother.
In regards to VBAC, I understand the risks are associated with the potential for uterine rupture, which would necessitate an emergency cesarean. Yet, ACOG has said that “A trial of labor after cesarean seems to be as safe for the mother and infant as planned cesarean delivery.” I understand that many hospitals say that they have banned VBAC based on an ACOG statement made in 2004 advising that emergency cesarean should be “immediately available” for VBAC labors, and that many hospitals took this to mean that only facilities with 24/7 full surgical teams including anesthesiology could meet that standard. Yet the American Academy of Family Physicians suggests that “TOLAC should not be restricted only to facilities with available surgical teams present throughout labor since there is no evidence that these additional resources result in improved outcomes.” In addition, I noticed that ACOG put out research in May 2008 suggesting that no additional resources are needed for VBAC labors. I also noticed that Cottage began banning VBAC in 2003, before the “immediately available” statement. I am not sure what the reasoning is for Cottage’s ban on VBAC’s – yet I believe that it is due for a reassessment considering that major medical organizations support VBAC as a patient choice with informed consent.
In considering my experience with cesarean (painful and long recovery, respiratory distress for my baby, long separation from my newborn baby) and understanding the risks of VBAC, I do not want to have a planned cesarean for a future baby. I want the opportunity to VBAC, with support from Cottage.
I want Cottage to honor that the decisions that impact my own and my family’s long term health are ones that I need to make with advice and support from my doctor, rather than have a generic protocol imposed by the hospital that does not take into account my health concerns and values. I’ve found that the body of law and medical ethics on every level supports patient rights and autonomy in making decisions about treatment.
In summary, I want Cottage Hospital to honor and support the right to informed consent (and refusal) procedures and remove the ban on VBAC. I, and all the birthing women and families in our community, deserve accurate and complete information about VBAC from our community hospital, and respect and support for our decisions.
Please let me know in writing what you will do to address my request to support access to VBAC. And thank you again for your excellent services and care for our community overall.
Best,
KM (full name left out for web posting) Parent