I knew c-sections were still on the rise, but since I've never had one, I haven't looked into the numbers on VBACs in a while. I mean, I knew there were some hospitals and some doctors that prohibit it, but I didn't know how widespread that was! I think there are going to need to be some major reforms in all areas of patient choice related to childbirth if America wants to keep up with the rest of the world as the best place to have a baby.
What do you all think?
Posts: 21182 | Registered: Sep 2004
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quote:• In Oklahoma, most OB/GYNs won't allow patients to attempt a VBAC because their malpractice insurance no longer will cover claims resulting from such births.
Certainly, I think it's within the doctor's rights to refuse to perform a risky procedure, and within a hospital's rights to refuse to allow doctors to perform it. They are on the hook for liability if anything goes wrong.
If actuarial data backs this up, then I think women who demand a VBAC need to pay a one-time insurance fee and release all other liability. Which would probably raise the price beyond what most people could afford.
It sucks, big time. I can't even evaluate the medical risks based on information available. But I can't see forcing a doctor to perform such a procedure unless he's relieved from liability.
Posts: 26071 | Registered: Oct 2003
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posted
Why are malpractice insurance companies allowed to opt out like this?
This is insane. Both because of the risks to mom (major surgery) and the medical costs. We should be trying to decrease the rate of c-sections.
Posts: 32919 | Registered: Mar 2003
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posted
I would think that medical insurance companies would be fighting this, because a c-section costs considerably more than a successful VBAC. Personally, that article made me very angry. I have had one c-section (which was NOT planned) and I don't ever want to go through that again. Why can't hospitals have the woman sign a waiver stating that she understands the risks of a VBAC?
posted
I think that the doctors and hospitals are put in a difficult position because of the wording of the policy (surgeons and o/rs "immediately available" as opposed to "readily available"). I also think that VBACs should be a viable choice for women having babies after having had a C-section. If VBACs aren't a choice in most hospitals, more women wanting VBACs will be having home births in order to be able to make their own choices.
ETA: Not that there is anything 'wrong' with home births, just that a VBAC at home is incredibly more risky than a 'normal' vaginal birth.
Posts: 1545 | Registered: May 2002
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posted
I know. That's what I don't understand; why are the companies allowed to cancel VBAC coverage? Is there another option for doctors or hospitals who wish to allow it, coverage-wise? I would think even so if a mother is willing to release liability, they might be willing to consider it. "Relocate to somewhere 4 hours away if you want one", like that one mom was told, doesn't seem like it's the best option available.
Posts: 21182 | Registered: Sep 2004
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quote:That's what I don't understand; why are the companies allowed to cancel VBAC coverage?
Why wouldn't they be? Insurance companies impose many restrictions on clients in all industries. Why is this different?
Posts: 26071 | Registered: Oct 2003
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posted
We're talking about the liability insurance company. It's not cheaper for them to pay for the VBAC's, because they only pay if something goes wrong. If it were, rest assured they would cover it.
I think it sucks when a patient can't get the procedure she wants. But I don't see how we can compel people to assume a risk they think is excessive.
Posts: 26071 | Registered: Oct 2003
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posted
Hmmm. Elective c-sections used to be an excessive risk. What I don't understand is why they are now covered and something that used to be hailed as the best, healthiest thing for the mother in many cases is not.
I guess it may be more a gut issue than a logic issue.
Posts: 21182 | Registered: Sep 2004
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posted
Wow, there's a lot there I didn't know about. My sister-in-law had to have a c-section with her first son because he was too big. (They tried natural birth for hours.) They said that she'd have to have a c-section next time, but I thought (and so did they) that it was because future babies are usually even bigger. Although I think her second son turned out to be smaller.
quote: If VBACs aren't a choice in most hospitals, more women wanting VBACs will be having home births in order to be able to make their own choices.
What will happen-is happening- is women having unassisted home VBACs because they cannot be attended by a midwife. In WA state a midwife can't attend a HVBAC unless it's a VBAC2. Even then she knows if something, anything goes wrong and she transports, she will lose her practice. I have several friends who had UVBACs because they could not get a midwife to attend them and no doctor would even go for a trial of labor.
Posts: 2711 | Registered: Mar 2004
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posted
That is so wrong. I bet anyone who was willing to get more expensive liability insurance and attend VBACs in those states and could work out a deal with a hospital or birthing center and an anesthesiologist would make a lot of money.
Posts: 21182 | Registered: Sep 2004
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posted
Most home birth midwives take on so many pro bono cases they could never afford that. ManY can barely afford the malpractice they have.
Posts: 2711 | Registered: Mar 2004
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posted
I'm curious. The article mentioned that some women would wait until the last possible moment to go to the hospital, to try to force the doctors to let them deliver vaginally. But it didn't say what the result of that would be. A c-section without consent? Being turned away from the hospital? Or would they get what they wanted?
I mean, if a woman showed up in active labor and fully dilated, just what are the doctors going to do about it if she refuses a c-section?
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romanylass, that's what I meant to say, of course. *grin* I feel for the midwives. It's a tough professional choice, and I don't think they get the kudos they deserve.
*sends kudos to midwives*
Posts: 1545 | Registered: May 2002
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posted
I think if you wait long enough, they have to let you deliver unless you or the baby is in distress. It's considered an emergency service, and they'll deliver in the emergency room if need be (if they don't have time to get you to the delivery room.)
What's worrisome about it is that if something goes wrong before you get to the hospital, there's no one there to do anything about it. That's why in VBACs, labor is monitored very, very closely-- because if something starts to go wrong, they want to get you in for a c-section right away. Which is why it would be ideal for you to be in the hospital while you labor in a VBAC. But if they won't allow it, well...
Posts: 21182 | Registered: Sep 2004
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posted
OB/GYN's really are the first casualty of "risk vs. reward" in the medical profession. What the article quotes above is another.
At least that's what the last 2 OB/GYN's told my wife when they informed her they would no longer be practicing OB/GYN's. And my wife is PISSED about it. She's lost 2 great OB/GYN's who retreated to the "relative" safety of family practice.
In all honesty it is NOT cost effective to be one, put that simply. You are going to pay out MORE in Malpractice Insurance than you are going to MAKE as an OB/GYN who deliver's babies.
This IS the #1 highest malpractice insurance in the medical industry for two reasons. Every delivery DOUBLES (at least in single birth instances) your risk as you have a MOTHER and a BABY as sources for possible complications. Complications = much higher rate for malpractice lawsuits. More complications = potentially more malpractice lawsuits.
It's long and complicated but it boils down to the fact that having a baby is a MESS, but it's ROUTINE and at the same time NOT ROUTINE.
And it's going to get worse, much worse before it gets any better. We're talking possible mortallity rates here.
PART of the reason for a cap on litigious lawsuits that President Bush supported stems from this and similar.
I don't know if that is the right direction to go but it is at least addressing the problem.
Posts: 1533 | Registered: Sep 2004
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posted
I've been trying to find some decent statistics about this issue. The number I've seen the most often (which doesn't necessarily mean it's right, I know) is that only about 1% of attempted VBACs have a ruptured uterus. I haven't found any information on how many of those lead to the death of the mother or the baby. I also haven't yet found the numbers for the percentage of scheduled c-sections that lead to the death of the mother or baby. After all, it's major abdominal surgery. Given the very low percentage of ruptured uteruses during VBAC, I would be very surprised if scheduled c-sections are actually safer for the mother. It seems to me that it is just safer for the doctor.
Birth control pill packaging contains information comparing the risk of death from using them to the risk of death due to pregnancy complications. I would like to see a similar comparison between scheduled c-sections and VBAC attempts.
If anyone knows of a resource that does this (or multiple resources that would let me do it myself) I would much appreciate it. Meanwhile, I'm going back to google to see what else I can find.
posted
ICAN may have some statistics, keeping in mind that they are dedicated to lowering C-sec rates.
Posts: 2711 | Registered: Mar 2004
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posted
Wow, I didn't know about some of the laws referred to here. I find it interesting that if you have refused to have a c-section in writing and verbally and they say they're going to do it anyway, you have the right to summon the police.
Posts: 21182 | Registered: Sep 2004
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posted
Oh, yeah, they CANNOT do a procedure you specifically object to. It's battery under tort, and assault under criminal law.
Posts: 26071 | Registered: Oct 2003
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I like some of their strategies-- for instance, pre-register with the hospital no more than 30 days before your due date so that your doctor can't drop you.
Posts: 21182 | Registered: Sep 2004
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posted
Ah, now that was some good information. Thanks, romanylass, I will go through that website in more detail later. Good to know that there are ways to fight this.
posted
Dag, I'd have to do more searching than I have time for today, but doctors have gotten court orders against women to force them into c-secs. Sometimes they go into hiding and have their babies UC,sometimes they give in to fear of losing their children (of having them taken away, not of them dying).
posted
I would imagine that if you don't pre-register and/or do it very late, and go in when you're far enough along in labor, they'd have a hard time getting a court order on that short of notice.
That factsheet also did say that there are precedents and ethical recommendations against getting a court order for a c-section, especially at risk to the mother.
Posts: 21182 | Registered: Sep 2004
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quote:I think if you wait long enough, they have to let you deliver unless you or the baby is in distress. It's considered an emergency service, and they'll deliver in the emergency room if need be (if they don't have time to get you to the delivery room.)
Looks like I was right. From that factsheet:
quote:In addition, a federal law called the Emergency Medical Treatment and Active Labor Act requires hospitals to admit women in active labor and honor their treatment wishes.
posted
Honestly, I wonder how much of this is really the insurance companies, and how much of it is for-profit hospitals and physicians who are using insurance as an exucse to compel women to have procedures that bring in more money to the hospital and to a larger number of health care personnel.
Surely, there are better ways of assessing which cases are more at risk for a VBAC and which are not, other than just having a blanket rule that after a woman has had a C-section, all her subsequent births must be C-sections as well. If the statistics in that first link are valid, there are a whole lot of women out there who have successfully had VABCs.
Edit to insert a word I left out. Posts: 2454 | Registered: Jan 2003
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posted
Doesn't anyone remember than lady who didn't have the c section and one of her twins died? They got some nurse to claim it that her main objection was that it would mar her appearance.
quote:I'd be very surprised if the insurance companies did not do the math involved here. --------------------------------------------------------------------------------
I dunno, I had a friend whose clinic really wanted her to get a norplant even though she was already pregnant. It was a food stamps situation, but I wonder how many women they cowed into accepting that. Accountants should not have oversight over health policy.
Posts: 2010 | Registered: Apr 2003
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posted
She didn't have a c-section after her twins were demonstrably in distress. While I don't necessarily agree with the decision there, I know some people do. However, most VBACs are not in the LEAST the same situation.
Posts: 21182 | Registered: Sep 2004
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quote:In all honesty it is NOT cost effective to be one, put that simply. You are going to pay out MORE in Malpractice Insurance than you are going to MAKE as an OB/GYN who deliver's babies.
This is absolutely true. I was very close with my ob/gyn and he stopped practicing ob for a few years and made much more money because of the drop in malpractice. He went back to it simply because he loved it, and I was lucky that he went back to it because he was able to deliver my twins.
Few doctors are going to be sued for doing a c-section of there is risk to the mother or baby, but the chances of them being sued for NOT doing one are much, much higher. That's why the insurance company would rather them do the sections in the cases of breech babies, or multiples, or people who've previously had a section.
My delivery room was crowded so much people could barely move around and many of the people there were watching - it was the first time a doctor had voluntarily delivered twins vaginally that anyone could remember and one nurse who'd been in labor and delivery for more than 10 years told me she had never seen a doctor deliver twins where one was breech, like my case. My doctor took an enormous risk, all the conventional medical wisdom of the time would look at me and say "twins, one breech - automatic c-section." He didn't do it, because he didn't want me to have to recover from a c-section while home with four children.
Another case in point - my husband delivered a breech baby in the back of the rescue unit on the way to the hospital once. The baby and mother were both fine. He asked the attending OB if he had done everything right and the doctor said "How would I know? I've never vaginally delivered a breech baby."
Posts: 14428 | Registered: Aug 2001
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posted
My mom delivered my sister breech when that was routine. At the time, c-sections were considered more risky than a breech delivery. She was a footling breech, the "worst" kind apparently, and wore a cast for a year because both hips were dislocated, but it didn't slow her down any.
My father, a family practitioner, has delivered two breech babies-- one because the mother refused a c-section, and one because the mother came in so far along that the baby was already partially in the birth canal when she got into the emergency room.
In any case, he is all for VBACs as long as the doctor says the mother is a good candidate and the mother is truly informed of the risks.
I think that's a good attitude.
Posts: 21182 | Registered: Sep 2004
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posted
I have all sorts of bad words that I can's post on this forum that are floating around my head because of the news article. I'm disgusted that many women have the right to choose taken away from them, all law and insurance considerations aside.
There are times I would love to swing a bat at large groups of people, and this is one of them.
Posts: 8355 | Registered: Apr 2003
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quote:Marlowe's wife, Amber, checked out against medical advice from Wilkes-Barre General Hospital on Wednesday morning after physicians there insisted she have a Caesarean section because of concerns about the fetus' weight, which was estimated at 13 pounds. She later gave birth vaginally at Moses Taylor Hospital in Scranton.
Unbeknownst to the Marlowes, after they left General Hospital, attorneys for Wyoming Valley Healthcare System sought a court order to gain guardianship of the fetus in case the Marlowes returned to their hospital. The order, granted without the Marlowes' knowledge, forbade them from refusing a Caesarean section if doctors there deemed it medically necessary.
quote: In 1987 the New England Journal of Medicine published a study of court-ordered c-sections that revealed that 81 percent of the patients were low-income women of color.
posted
I think what those precedents show is that if you had a lawyer prepared to fight who was familiar with the law and the precendents, if they tried to get a court order to make you undergo a c-section instead of a VBAC, they would probably fail.
Posts: 21182 | Registered: Sep 2004
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posted
Yeah, I'm against those. It's a different issue from hospitals refusing to carry out procedures they feel are too risky, however.
Posts: 26071 | Registered: Oct 2003
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posted
Right. But if a patient comes in for a delivery, under law they can't refuse to deliver the baby. And if she's previously had a c-section, and refuses one, wouldn't they be forced to?
Posts: 21182 | Registered: Sep 2004
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posted
In that situation, I think the hospital is going to have to admit her, and have to concede to her wishes. Mandating treatment of emergent conditions is good policy, and if that causes a conflict with the patient's wishes, then I think the patient trumps in that case.
I hope, though, that there would be a waiver of liability for them in that case, at least for certain types of liability. Especially if the patient purposely delayed to circumvent hospital policy.
Posts: 26071 | Registered: Oct 2003
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posted
You know, when I had a baby, my first, not a VBAC, I had to sign all kinds of liability waivers anyway.
Posts: 21182 | Registered: Sep 2004
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posted
Liability waivers are (rightfully) notoriously difficult to enforce. So litigation costs can be quite high even when they are signed.
Just getting a lawyer to draft the motion to for summary judgment and argue can reach 5 digits very quickly.
Posts: 26071 | Registered: Oct 2003
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