C-sections and VBAC

I’m pretty sure I’m having a scheduled C-section with this baby. Mr. Pete says its because I want to be able to say I’ve had the entire childbirth experience. (I already have quite a birthing resume – non emergent C-section of a stubborn posterior 9 pounder, hospital VBAC, home birth x 2 at 10 pounds and 9 pounds 6 oz respectively, home birth with emergency transfer and C-section under anesthesia, and unassisted husband-delivery of a known stillborn). It’s really because we have better insurance, I have parts of my anatomy that I’d like to keep inside of me for as long as possible (prolapse can be messy) and I don’t really feel like bucking the system again. I’m sort of bucked out between all these home births and fighting the local school board.

Still, I totally understand that I’m having a C-section for medicolegal reasons on the part of my caregivers, not for purely medical reasons, and that ticks me off.

My sister sent me this article today on the topic. Here’s an excerpt:

Hospitals usually claim they’re trying to protect mothers and babies from harm. But the truth is that hospitals ban VBACs for legal and business reasons, not medical ones. Several mothers have sued in recent years when VBACs led to uterine ruptures and damage to mother or baby. Some of these women won awards in the millions, usually because the emergency C-section had taken too long or the doctor hadn’t warned them of increased risk. A key issue in such suits is a 1999 American College of Obstetricians and Gynecologists guideline calling for “immediate” availability of O.R. teams to support VBACs. Immediate, on-site availability of such teams thus quickly became a de facto legal standard.

Hospitals can sharply reduce their legal exposure by having such teams on call. But staffing these teams creates its own problem, which our Dr. Burgee calls “the harmony on the ship issue.” Some hospital staffs rebel at the request to remain in-house while a mother attempts a VBAC. Hospitals with round-the-clock staffs might already have all the people needed—a surgeon or OB, anesthesiologist, operating room crew, pediatrician, assistant surgeon—on the premises. But at other hospitals, particularly smaller ones, those people might have to make special trips to the hospital to stand by during a VBAC for as long as the labor takes. Such hospitals may have to choose between VBACs and a happy surgical unit.

I wonder how come a hospital can’t be ready to do a VBAC with surgery and anesthesia standing by. What do they do if someone walks in with a ruptured appendix? or trauma comes in from a car accident? It sounds like bulloney to me.

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