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 Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, an expert in obstetric research. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.
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Topic: Normal Birth Options? |
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Posted By on 16 Aug 2005 11:24 AM
I am sorry you are experiencing this problem. It is, to be blunt, an egregious violation of your medical rights. VBAC refusal is the only situation in which a person is forced to agree to surgery as a condition of obtaining medical care. Here is some ammunition that may help:
- Lamaze International has The Rights of Childbearing Women.
- The International Cesarean Awareness Network now has a link on its home page recommending what to do when a hospital refuses VBAC
- Here is the official position of the American College of Obstetricians and Gynecologists (ACOG) on the principle being violated in your case:
ACOG. Informed refusal. Committee Opinion No 237, June 2000.
"Once a patient has been informed of the material risks and benefits involved with a treatment, test, or procedure, that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. . . . Performing an operative procedure on a patient without the patient's permission can constitute 'battery' under common law. In most circumstances this is a criminal act. . . . Such a refusal [of consent] may be based on religious beliefs, personal preference, or comfort.”
In other words, women don't have to have what an obstetrician would consider a good reason. All they have to do is decline.
- Here is another patient rights document that might prove helpful on the Boston University School of Public Health website:
Patients Rights at Your Fingertips
The usual rationale for refusing VBAC is that the hospital cannot meet ACOG's recommended guidelines for VBAC, namely, that an obstetrician should be in the hospital throughout labor and that the hospital should have the capacity to perform an urgent cesarean at any time. (Although many hospitals with such facilities still refuse VBAC or none of their obstetricians will permit them, which amounts to the same thing.) You might also like to know that the American Academy of Family Physicians does not agree. They state:
Trial of labor after cesarean (TOLAC). AAFP Policy Action March 2005
"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."
The AAFP recommends that a management plan for emergencies requiring urgent cesarean should be documented for each woman planning VBAC.
ACOG's position isn't logical. Emergencies occur in labors other than VBAC labors, which means that a hospital that says it isn't safe for VBAC labors is saying it isn't safe for any labor. And, of course, the "safety" argument misses the human rights issue: a person has the right to refuse any medical procedure -- let alone major surgery -- irrespective of the doctor's opinion of the procedure's necessity or safety.
Obstetricians may argue in turn that doctors have the right to refuse to perform a procedure, but labor isn't a "procedure." It's the inevitable end of pregnancy.
I'm also sorry to say that if you can find an obstetrician and hospital willing to allow VBAC, you'll have to watch out for unreasonable restrictions that make it near impossible to birth vaginally, what I call Cinderella's step-mother's version of VBAC: "You can have a VBAC if your baby isn't getting too big and if you go into labor by your due date and if you progress at 1 cm or more per hour and if . . . " You get the idea. To get information on VBAC based on the best research, you can't do better than Should I choose VBAC or Repeat C-Section?.
Please let us know how this works out for you.
-- Henci By: Henci Goer |
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RE: Normal Birth Options? |
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| Topic Review |  | |
Archived User
Posts:354
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| 16 Aug 2005 04:24 PM |
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I am sorry you are experiencing this problem. It is, to be blunt, an egregious violation of your medical rights. VBAC refusal is the only situation in which a person is forced to agree to surgery as a condition of obtaining medical care. Here is some ammunition that may help:
- Lamaze International has The Rights of Childbearing Women.
- The International Cesarean Awareness Network now has a link on its home page recommending what to do when a hospital refuses VBAC
- Here is the official position of the American College of Obstetricians and Gynecologists (ACOG) on the principle being violated in your case:
ACOG. Informed refusal. Committee Opinion No 237, June 2000.
"Once a patient has been informed of the material risks and benefits involved with a treatment, test, or procedure, that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. . . . Performing an operative procedure on a patient without the patient's permission can constitute 'battery' under common law. In most circumstances this is a criminal act. . . . Such a refusal [of consent] may be based on religious beliefs, personal preference, or comfort.”
In other words, women don't have to have what an obstetrician would consider a good reason. All they have to do is decline.
- Here is another patient rights document that might prove helpful on the Boston University School of Public Health website:
Patients Rights at Your Fingertips
The usual rationale for refusing VBAC is that the hospital cannot meet ACOG's recommended guidelines for VBAC, namely, that an obstetrician should be in the hospital throughout labor and that the hospital should have the capacity to perform an urgent cesarean at any time. (Although many hospitals with such facilities still refuse VBAC or none of their obstetricians will permit them, which amounts to the same thing.) You might also like to know that the American Academy of Family Physicians does not agree. They state:
Trial of labor after cesarean (TOLAC). AAFP Policy Action March 2005
"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."
The AAFP recommends that a management plan for emergencies requiring urgent cesarean should be documented for each woman planning VBAC.
ACOG's position isn't logical. Emergencies occur in labors other than VBAC labors, which means that a hospital that says it isn't safe for VBAC labors is saying it isn't safe for any labor. And, of course, the "safety" argument misses the human rights issue: a person has the right to refuse any medical procedure -- let alone major surgery -- irrespective of the doctor's opinion of the procedure's necessity or safety.
Obstetricians may argue in turn that doctors have the right to refuse to perform a procedure, but labor isn't a "procedure." It's the inevitable end of pregnancy.
I'm also sorry to say that if you can find an obstetrician and hospital willing to allow VBAC, you'll have to watch out for unreasonable restrictions that make it near impossible to birth vaginally, what I call Cinderella's step-mother's version of VBAC: "You can have a VBAC if your baby isn't getting too big and if you go into labor by your due date and if you progress at 1 cm or more per hour and if . . . " You get the idea. To get information on VBAC based on the best research, you can't do better than Should I choose VBAC or Repeat C-Section?.
Please let us know how this works out for you.
-- Henci By: Henci Goer |
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Archived User
Posts:354
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| 14 Aug 2005 07:44 PM |
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| My first pregnancy resulted in an emergency cesarean due to fetal distress. Now, I am pregnant with my second child and really want to give birth naturally. However, my hospital is currently not allowing VBAC and forcing me to have a cesarean. What are my options? By: melissajones |
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