Guest post by Samantha McCormick, CNM
On Wednesday, March 24th, the State of Florida’s Agency for Health Care Administration will move to permanently ban Vaginal Birth after Cesarean (VBAC) in Florida birth centers. Currently, VBAC is not allowed in Birth Centers in FL, but can be done at home with a Licensed Midwife and physician consult sign-off. After a request that the language be updated to include legalized VBAC’s at birth centers with Licensed Midwives and physician consultation, the State used the opening to move to make VBAC’s illegal in state licensed birth facilities.
This is a dangerous proposition. The State has evidenced already this year its assumed position as medical surrogate, in the January case of a Tallahassee woman who was confined to a hospital bed and subsequently court-ordered to have a c-section. This sort of treatment completely negates a patient’s right to informed consent. Further, if the State feels women should have VBAC’s in hospitals, then by the same medical surrogate token, they should mandate that AHCA hospitals allow women adequate trial of labor and welcome VBAC’s. If fewer than half of Florida hospitals ‘allow’ VBAC, and fewer than 1% of obstetricians ‘allow’ VBAC candidates as patients, and Florida women are limited in their choice of birth place and care provider…well, you do the math. Our primary c-section rates aren’t getting any lower (Florida’s average is around 37%). The best way to begin to chip away at these epidemic and very dangerous numbers is to increase the VBAC percentages.
Women who attempt to VBAC are successful over 75% of the time without necessity for intervention, yet at Sarasota Memorial Hospital, for example, only 1 to 3 women have successful VBAC’s each month. Why? Because they cannot find supportive care providers. Many providers, pressured by insurance and medical malpractice concerns, scare (for lack of a better word) women into believing they are making an unsafe choice (read this thorough comparison to learn for yourself).
While it is true that a uterine rupture (the primary concern of providers hesitant to accept VBAC patients) can be a devastating obstetric event, it occurs in fewer than 1% of VBAC candidates, and is responded to by emergency c-section—a procedure our hospitals are fully equipped to execute effectively. For those undergoing repeat c-sections, rates of serious placental complications, infections and NICU admission for the babies of those sections are rising rapidly. Women should and are legally obligated to receive balanced information that includes the risks and benefits of VBAC as well as the risks and benefits of repeat surgery.
Allowing the pursuit of VBAC at home or at a state licensed birth center with a Florida Licensed Midwife will keep healthy, safe options open for Florida’s families, and will dramatically reduce taxpayers’ investment in unnecessary surgery.
There is virtually no difference in medical equipment between a birth center and the gear of a homebirth midwife. If the state considers VBAC with a Licensed Midwife at home safe, it is literally contradictory to ban VBAC’s in birth centers. Many women would feel more comfortable in a birth center than in their homes, for a variety of reasons, and should be offered this opportunity. Physician consultations for VBAC’s take into account several factors regarding the woman’s previous surgery(s) and current health risk factors. Once again, we should be striving toward a collaborative model, one in which normal, healthy woman can choose the safe, cost-effective, nurturing care of midwives, and be reassured that obstetricians are available to provide their expertise and intervention if necessary—and only if necessary.
For these reasons, I urge you to sign the following petition and make your voices heard in support of legalizing VBAC’s in Florida’s licensed birth centers:
To: Florida Agency Health Care Administration
While we recognize the need to change outdated language in the rule, it is our position that the state consider similar language to that of F.S. 467. Such language would work to insure the patient received competent care from a licensed practitioner and respects the right of the patient to make an informed decision. We ask the State of Florida to remain a regulatory body and not take on the role of medical surrogate.
Photo credit: Baby Love Birth Center