I present to you one of my MPH writing assignments for Health Policy & Management Class which I completed in the Summer of 2011.
To: Senator Ed Hernandez,
O.D., Chair, Senate Committee on Health
Cc:
Subject: VBAC Support at Every California Hospital
From: Lisa Baracker, Doula and Birth Advocate, Whatadoula
Date: 23 June 2011
Problem Statement
California is the most progressive
state in terms of healthcare. California’s teaching hospitals and research
facilities represent some of the worlds best advances in medicine, its
constituents have passed laws allowing access to medical marijuana, and yet
California women are still subject to hospital policies that impede their right
to birth the way they choose. This is especially true after they have had a
previous caesarean section. What’s more shocking is that there are still
hospitals in California that are refusing to allow women to attempt Vaginal
Birth After Caesarean (VBAC) despite the preponderance of evidence that it is
safe for both moms and babies.
Proposed Solution
There is no reason for a limitation
on VBAC's at any hospital where women give birth, especially given that
"current evidence shows that the majority of women can have safe vaginal
births after prior cesareans.” "[1],[2] Legislation needs to be enacted that requires
hospitals who offer birth services to women to also offer VBAC to those women
who meet the criteria set forth by the American College of Obstetrics and
Gynecologists (ACOG) and widely accepted by the Association of Certified Nurse
Midwives (ACNM) and the Midwives Alliance of North America (MANA). These criteria are very straight
forward and simple to assess and now they need to be put into action at an
administrative level. "The preponderance of evidence suggests that most
patients who have had a low-transverse uterine incision from a previous
cesarean delivery and who have no contraindications for vaginal birth are
candidates for a trial of labor."[3],[4]
The Criteria for a VBAC:
- Women who have had one previous cesarean with a
low-transverse incision.
- Women with a clinically adequate pelvis.
- Women with no other uterine scars or previous uterine
rupture.
- A physician capable of monitoring labor and
performing an emergency cesarean should be immediately available throughout active
labor.
- Anesthesia and personnel for emergency cesarean
delivery should be available.
Major Obstacles/Implementation
Challenges
Currently, all Hospitals in
California that have Labor & Delivery Units are capable of performing
scheduled cesareans, emergency cesareans for vaginal deliveries with
complications, and are required to have anesthesiologists on call 24 hours a
day for emergency surgery. It is
therefore unacceptable that any California Hospital refuse a woman the right to
a VBAC to women who meet the aforementioned criteria. The only thing standing
in the way of VBAC rights are doctors who refuse to comply with the
recommendations of ACOG. Midwifes who offer VBAC services are offering a safe
and ethical service to their patients by allowing them a trial of labor after
cesarean, yet still hospitals and doctors are limiting this service and clearly
this has affected one if not many patients in an adverse, if not wholly
improper manner. Birth is a major life event that significantly impacts a
mother's physical and emotional well-being. A cesarean can be a life-saving
procedure for a mother and/or her baby, but overall, birth by cesarean puts
healthy pregnant women at risk for medical complications.
References, Footnotes, and Exhibits
[1] http://www.vbac.com/
[2] http://www.midwife.org/news.cfm?id=311
[3] Adapted from Vaginal Birth After Previous
Cesarean Delivery. ACOG Practice
Bulletin, Number 54. The American College of Obstetricians and Gynecologists,
409 12th Street SW, P.O. Box 96920, Washington, DC 20090-6920.
[4] Clinical Management Guidelines for
Obstetrician-Gynecologists, July 2004.
