How RH Reality Check got the Florida VBAC case wrong

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I’m already on record as a strong supporter of a woman’s right to refuse a C-section:

Our right to bodily autonomy is one of the most important rights that we have. Simply put, a woman (or a man) has a right to refuse medical or surgical treatment, regardless of whether or not the refusal might lead to death. In the case of a pregnant woman, that means that she has an absolute right to refuse a C-section regardless of whether the C-section is life saving for either her or her unborn baby.

Therefore, I believe that Jennifer Goodall, the Florida mother who wanted to attempt a VBAC (vaginal birth after cesarean) after 3 C-sections has an absolute right to make an informed medical decision to refuse a repeat Cesarean. It doesn’t matter that the refusal might lead the death of her baby or even her own death.

Nonetheless, I am extremely disappointed that mainstream media outlets got the case wrong in two important ways. First they neglected the fact that the medical decision must be an INFORMED decision. Second, they presented faulty statistics on the safety of VBACs. Specifically, every article I have seen presented the statistics for a VBAC after one previous Cesarean, instead of the statistics for a the far more dangerous VBAC after 3 Cesareans that was being contemplated by Goodhall.

The piece in RH Reality Check is a case in point.

Editor-in-Chief Jodi Jacobson writes:

Goodall is now 41 weeks pregnant and has told her lawyers she is terrified to enter a hospital. Given this and the weight of medical evidence in Goodall’s favor regarding the safety of the delivery she wanted to have, it is unclear whether the hospital or the courts are considering “best medical judgment” and in whose interest they are acting.

What would we need to know to determine “best medical judgement”? We’d need to know the specific outcome rates that Goodall is facing. First, we’d need to know quite a bit about Goodall herself. What were the reasons for her previous C-sections? How many times (if any) had she tried and failed to have a vaginal birth? How old is she? How much does she weigh? How big were her previous babies and how big is this baby estimated to be? These factors have a DIRECT impact on the chance of success for Goodall’s attempt at vaginal birth, as well as the risk that her uterus might rupture, the risk that her baby might die, the risk that she might lose her uterus, and the risk that she herself might die.

We’d also need to know the specific statistics for women attempting a VBAC after 3 Cesareans. Those statistics differ appreciably from the statistics for women attempting a VBAC after 1 Cesarean. The chance of success is considerably lower after 3 C-sections that after one, and the chance of a fatal outcome is considerably higher.

But Jacobson pulls a bait and switch. She starts with the standard misinformation spread by VBAC activists:

Medical and public health bodies have long criticized the high rate of cesarean sections in the United States. The World Health Organization points out that at the current rate of 30 percent of all deliveries, cesarean sections in the United States far exceed what should normally be between 5 to 10 percent of all deliveries…

Wrong! Jacobson is apparently unaware that the WHO recommendation was WITHDRAWN 5 years ago, with the WHO acknowledging that there was NEVER any evidence to support that recommendation. Indeed, the average C-section rate in countries with low rates of perinatal and maternal mortality is 22%.

Jacobson continues by misrepresenting the position of every medical source she quotes (out of context). According to Jacobson:

ACOG agrees. “The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns,” ACOG President Richard N. Waldman said in a statement. “[ACOG's] VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate.”

But that has NOTHING to do with Goodhall since she is a poor candidate for VBAC, not a good candidate.

Even more egregious:

“The risks associated with a vaginal delivery are lower than the risks associated with a C-section overall, as long as you can deliver the baby at a facility equipped to handle a C-section in case of emergency,” Roger W. Harms, an obstetrician at the Mayo Clinic in Rochester, Minnesota, and medical editor-in-chief of MayoClinic.com, said in a statement. And the recovery time is faster. Undergoing a cesarean surgery for the fourth time carries a 1 in 8 chance of major complications. In short, VBAC deliveries are safer for both the pregnant person and the fetus and lead to fewer complications.

But the obstetrician is NOT talking about women like Goodhall or situations like hers. He’s talking about women who have had one previous C-section NOT three, and it is utterly misleading for Jacobson to quote him out of context. Jacobson writes that these facts did not escape Goodall, without mentioning (and probably without understanding) that these fact DO NOT APPLY to Goodall.

While Jacobson quotes the risk of having 4th Cesarean, she utterly fails to mention (and probably doesn’t know) the risk of attempting a VBAC after 3 C-sections, the only valid comparison. The risk of a bad outcome in that setting is as high as 3.5% or more.

In other words, Jacobson’s entire piece is premised on the notion that VBAC is safer than elective repeat C-section and that Goodhall’s doctors are wrong in their assessment of the risk. But that’s simply false. There is no obstetrician or obstetric organization that would recommend a VBA3C as safe. So it is Goodall and her supporters who are WRONG in their assessment of the risk.

And that brings us back to Goodhall’s right to make an informed medical decision to refuse C-section regardless of the potentially deadly consequences. Goodall’s decision is not informed because it appears to be based on her understanding of the risks that apply to women who have had one previous C-section, not the much larger risks that apply SPECIFICALLY to her.

No one knows what Goodall would decide if she were in possession of accurate information and it is morally incumbent on those who are supporting her decision to opt for a vaginal birth to provide ACCURATE information so she can make an informed decision. The hospital, therefore, is caught between a rock and a hard place. Goodall claims (and probably believes) that she is making an informed decision, but her doctors know that she is making a decision based on erroneous information. In other words, her decision is anything but informed.

In the end, the issue was rendered moot when Goodall chose to go to a different hospital where someone agreed to honor her wishes. She labored without progress and ended up with the C-section that she had wanted to avoid, further emphasizing the fact that she was never a good candidate for a VBAC.

The issues raised in the Goodall case are extremely important, and therefore it is deeply unfortunate that they have been muddled by misinformation about the real risks involved. It is also deeply disappointing that journalists like Jacobson based their commentary on faulty medical information and the twisting and misrepresentation of the statements of obstetricians and obstetric organizations.

Jacobson may think that her piece advances the cause of reproductive freedom, but she more than most ought to understand that misrepresenting risks, taking quotes out of context, and misrepresenting professional organizations is wrong. It’s unethical when abortion opponents do it. It’s no better when proponents of reproductive freedom employ the same tactics. In her defense, Jacobson may have literally no idea that she is presenting inaccurate information, but as a journalist, she should have checked before repeating the propaganda of VBAC activists.

  • Francesca Violi

    Moreover to me it seems not so rational to insist getting a VBA3C in a
    place that has no experience in the procedure and the possible outcomes.
    Am I the only one who would not want to risk a emergency life saving
    surgical procedure performed by a surgeon and staff not so familiar with
    it? I mean, if the hospital do not allow VBAC, how many uterine ruptures may the obstetric staff may have witnessed and treated? If you can choose, as she could, why not going straight to the more experienced hospital?

    • Daleth

      I know, seriously!

  • Daleth

    Let me recap the logic of Ginger on this thread and the NCB-oriented blogs talking about this case:

    - It is bad for a hospital not to do what she wants! She should have been able to have a federal judge force the hospital to do what she wanted!

    And by that same token…

    - We should be able to have a federal judge force a caterer to prepare food for our event in a way that most caterers, including ours, think is likely to cause food poisoning.

    - We should be able to have a federal judge force a car mechanic to repair our car in a way that most mechanics, including ours, think is likely to cause an accident.

    - We should be able to have a federal judge force a lawyer to handle our case in a way that most lawyers, including ours, think is likely to get us a jail sentence or the death penalty.

    Uh… no. No, we shouldn’t. If we don’t like the approach recommended by our [insert service provider here], what we should be able to do is fire them and find another provider. Period. Which is what the judge said Goodall should do in this case, and it’s what she ended up doing.

    • The Bofa, Being of the Sofa

      Let me recap the logic of Ginger on this thread

      Actually, Ginger’s logic is beyond that.

      Ginger says that if the hospital doesn’t have the capability of doing a VBACS, they shouldn’t do any childbirth at all. And if a woman does a childbirth there and has an uterine rupture, they should stabilize her and transfer care to a place that can handle it. But in the end, they violated her autonomy by going to court to force her to have a c-section. What they should have done is to wait until she comes in in labor and transfer her to a facility that can do VBACS. Instead of just telling her to go there in the first place, like they did, apparently.

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  • Amy Tuteur, MD

    There seems to be a great deal if confusion on the part of Goodall’s supporters about what happened here. The Court did NOT rule on whether a woman could be forced to have a C-section. Goodhall filed for an injunction to force the doctors to allow a trial of labor. The judge ruled that he did not have the authority to compel any doctor to perform any medical procedure. Goodall and her supporters chose to spin this as a case of forcing her to have a C-section, when in reality the legal case was about Goodall forcing DOCTORS to violate their medical judgment.

    • The Bofa, Being of the Sofa

      I stand corrected.

      :)

      • Karen in SC

        Was that how it was reported? It seemed to me that “forcing” was in many headlines about this story.

        • Guest

          Exactly, it has been highlighted as she had been ‘sentenced’ to a CS without consent which is simply not true and unlikely to ever occur in a woman deemed of sound mind in the US.

          I really wish the public had the opportunity to hear the background story. There is much we haven’t heard or considered.

          Any woman presenting for OB care with a prior uterine incision is provided a discussion of the risks and benefits of RCS and TOLAC. I also discuss her personal factors contributing to the success or detriment of proceeding with a TOLAC. While I do support the option to proceed with a TOLAC after one or two prior CS, I am blatantly honest about whether I recommend proceeding. Additionally, I carefully screen woman for motives to VBAC. IF she is not a good candidate or she is an ‘ok’ candidate, but presents with a “VBAC come hell or high water”, I do not hesitate to discuss those concerns as well as my own. Most of the time, this weeds out the women who are not likely to change course if status dictates and prompts a transfer to a provider who will support their process over outcome. If they don’t or an adversarial I’m just not willing to take that risk. It’s my practice, my license and my desire for good outcomes that remains on the line. That situation doesn’t benefit either or us and I do’t hesitate to issue a 30 day letter terminating her from services. Unfortunately, every once in awhile a woman goes through the course of pregnancy appearing to be on board with a flexible plan and at the 11th hour becomes hellbent to put herself at risk. That’s when we all hold vigil, holding our breath for either a good outcome or a woman to consent to a CS. It’s an awful predicament to be in for providers and patients at that point. It’s my guess that Goodall’s relationship with her provider came to this level and the provider was left being held hostage by her demands to support her decision to put her and the baby’s well-being at risk by VBA3C and more notably, in an institution not able or willing to provide services outside an established level of care.

          • Guesteleh

            That was extremely informative, thank you.

          • VBACmom

            I personally have a copy of the letter sent to Jennifer by her OB’s stating they will report her to CPS and get a court ordered cesarean. This is why she took legal action.

          • Stacy48918

            Yea well there obviously are other hospitals in her area willing to take her as a patient. Why did the mother need to go legal and try to force the doctor to attend her VBAC? What did she have against driving to another hospital which is exactly what she did anyway?

          • Daleth

            I “personally have a copy” of that letter too, since Goodall included it in her court filing, making it available to the public. Did you read the rest of the letter, where the hospital said that if she wanted to transfer to another provider (i.e. one willing to let her try labor) they would get her records transferred over stat so there would be no interruption of care?

            In other words all Goodall had to do to avoid CPS, the risk of a court order permitting a c-section, etc., was go to another hospital or obstetric practice. Which she did–she went to a hospital all of 20 miles away and got her trial of labor (which failed, so she consented to a c-section).

          • An Actual Attorney

            Daleth – I’m curious but a little lazy. Can you post the letter? Or her filing? Was she pro se?

          • Daleth

            At least as of now, you can download the PDF of her declaration and exhibit (the hospital letter) here:
            http://advocatesforpregnantwomen.org/Declaration%20of%20Jennifer%20Goodall%20with%20Exhibits.pdf

            A couple of docket filings, including the judge’s opinion, are available here:
            http://law.justia.com/cases/federal/district-courts/florida/flmdce/2:2014cv00399/299997/12

            I haven’t checked the actual docket to see if she’s pro se but I doubt it because her declaration looks competently put together. My guess is either she hired a lawyer or she got behind-the-scenes help, perhaps from an ICAN-affiliated lawyer, preparing her “pro se” filings.

          • An Actual Attorney

            Wowza! I hadn’t realized how much nuttier this was than even Dr A’s summary made it seem. She showed up at this hospital at about 34 weeks pregnant, because her previous practice said she was a bad VBAC candidate, she planned to refuse an epidural (so as I understand it, any CS post rupture would be delayed and more dangerous), she had to be talked into a hep lock, she wouldn’t consent to cervical checks….

            And she wants to know why they might want a judge to decide if she’s really competent to make medical decisions?

            Then, from a legal disaster point of view, she wanted a court to restrain the hospital from going to court where there would be a hearing, at which she might very well win? And files for an ex parte order without contacting the hospital? (For the non lawyers, that’s very frowned upon, even in a legal emergency, you always call the other side’s lawyer and tell them you are filing and email them the complaint).

            The cray cray, it is strong there.

          • Daleth

            Yup. Seriously. By refusing an epidural she guaranteed that if she needed an emergency c-section for suspected uterine rupture, they would need to use general anesthesia (if no epi is in place then general is the ONLY way to prepare her fast enough), which of course is much higher risk to her than an epidural would be.

            So because she’s worried about the risks of a CS, she makes a decision that will INCREASE the risks of any CS she ends up needing.

            And her reason for declining cervical checks was that she believes “nature did not intend the cervix to be touched.” Well, that will be news to all the heterosexual penises out there, which (if they’re lucky) touch cervixes on a regular basis. It’s also an interesting viewpoint for an NCB-er, since she specifically said that she believes if the cervix is touched it will stall labor, but having sex is widely seen especially among NCB types as a way to get labor started (it’s a common recommendation–”try having sex, that way you won’t need to be induced!”).

            And the legal stuff… I so agree, completely cray-cray. “Hey Mr. Federal Judge, please violate a federal statute by ordering the hospital not to go to state court!” And on the ex parte stuff, I liked how the judge diplomatically explained that (paraphrasing from memory here) since the opposing party was a hospital right there in town, as opposed to a fugitive from justice whose location could not be ascertained, there was no reason she couldn’t have served her papers on them. Um… duh.

          • Stacy48918

            Wow…thanks for posting those. I needed a laugh. This lady is NUTS.

          • Daleth

            You’re welcome. The NCB movement is not so great at picking its poster children, is it.

          • Daleth

            PS here is the info on her lawyer. She’s definitely not pro se:
            http://www.law360.com/cases/53c92a9e3ec3f10a18000003
            She’s represented by Farah Diaz-Tello of the National Advocates for Pregnant Women, and another attorney called Patricia E. Kahn.

          • Bombshellrisa

            “Farah Diaz-Tello, JD, Staff Attorney, is a graduate of the City University of New York School of Law, where she was a Haywood Burns Fellow in Civil and Human Rights. Her work at NAPW has focused on the rights to medical decision-making and birthing with dignity, and on using the international human rights framework to protect the humanity of pregnant women regardless of their circumstances. A proud Texan, she is an alumna of the University of Texas at Austin.”

          • An Actual Attorney

            Makes me wonder why I ever worried about passing the bar.

          • Ellen Mary

            Now she says she labored at home, went in for an Epi & was forced into a C. Which was it? So confused.

          • Daleth

            “Now she says she labored at home, went in for an Epi & was forced into a C. Which was it? So confused.”

            I know!!! I saw that on ICAN’s site! WTF is up with this woman?

        • The Bofa, Being of the Sofa

          Ginger (below) complained how the hospital “went to to court” to force her to have a c-section.

          Oh, so wrong in so many ways…

      • Stacy48918

        Me as well. I didn’t really understand the distinction either. The VBAC folks really have no leg to stand on…

    • Guesteleh

      Can you make your explanation a featured post? I think it’s important for all commenters to see this.

    • Ellen Mary

      I was also under the impression that the injunction was to prevent the hospital (represented by the CFO) from reporting her to CPS, as was threatened? If you wanted to force a Cesarean, that is seemingly how you would do it, through a protective action on the baby’s behalf?

  • Ginger

    Here is the thing, she is, I assume, an mentally competent adult. That means, no matter your opinion as long her doctors have given her the information required by law for her to make an informed decision, the decision stands as her’s. A woman’s right to bodily autonomy does not change because you think she is uninformed. If I refused life saving treatment at a hospital, they could not force it on me, even if I was in the wrong. The same applies here. You don’t get to decide nor does the doctor in case. Or frankly the hospital. They can say, we WON’T treat you, they can then if she shows up: stabilize and send her to a different hospital. BUT what THIS hospital is doing and what judge is doing, is destroying ALL women’s rights to bodily autonomy and that is wrong. And nothing you have wrote changes that. People fought and died for the right of bodily autonomy.

    • Young CC Prof

      Here is the thing: Everyone (except possibly commenter Herman Kant) agrees with you.

      We still don’t agree with writing an article that praises her choice as a good and smart one. I can defend your right to make a choice and simultaneously tell you your choice is stupid.

      • MLE

        Herman Kant dig it.

      • Ginger

        No, there were a lot of people saying she should have just gone along with hospitals demands. And by making issue on if someone on the internet thinks you have been informed and not about the major issue of autonomy, it sets the stage for exactly what happened here, where the hospital thought they could force a woman into treatment that she did not want (for whatever reason) and a judge agreed. The major point is not if you agree how a journalist wrote something, which may have nothing to do with how the patient was informed, but if the woman had the right to decide.

        • The Bofa, Being of the Sofa

          No, there were a lot of people saying she should have just gone along with hospitals demands.

          Yes, she should have chosen to do that. It would have been a lot safer.

          That doesn’t have any bearing on her right to choose. Autonomy is manifested in the ability to choose, not in the choice that one makes.

          Choosing to follow the doctor’s advice would not have affected her autonomy one bit.

          • Ginger

            When the hospitals decides to go to court and FORCE the decision, it does. When the judge decides that the hospital can FORCE her, it does. She went to another hospital and was allowed her choice, which was: try it and if MEDICALLY necessary have a c-section. This hospital and the judge tried to take autonomy and that means it affects all women.

          • Guesteleh

            Quoting from below: “It’s possible to both support this woman’s autonomy to make the decision she did and also say it’s a bad decision to make. Which is exactly Dr. Amy’s point if you’d read her post without whatever blinders it is you’re wearing.”

          • The Bofa, Being of the Sofa

            When the hospitals decides to go to court and FORCE the decision, it does.

            But that is the court that is forcing her to do it, not the hospital.

            The hospital can go to court all they want, but the court doesn’t have to agree with them.

            The decision to force her to do whatever is something court did, not the hospital.

          • Amazed

            She was trying to FORCE the hospital into something that was out of their standard of care. In this case, I believe the hospital was defending itself from what they perceived as unreasonable request of an entitled woman.

            You cannot come into my house and demand that I make you tea in my espresso machine. If you come here, you’ll either have espresso, or tea made in a teapot. You cannot FORCE me to use my machine for what I perceive as unreasonable and dangerous “intervention”.

            Or you can go over there, at this nice lady’s place. She doesn’t mind accommodating any sort of requests.

          • Guest

            Ginger, you’re not getting it. Performing a repeat CS after 3 prior CS IS MEDICALLY NECESSARY. No, not all hospitals are able to be equipped to handle this high risk of a case, nor should they be forced to be if alternative arrangements for care at a higher level facility with adequate facilities is feasible. The providers and hospitals made it quite clear they were unable to provide this level of care or assume this level of risk and I do not believe anyone would have held her down to FORCE her to a CS had she presented there. That’s a slippery slope no provider wants to take. More likely, the rationale went as far as providers and hospital wanting the ability to save the life of her and her baby had the situation arisen. For providers who have been held hostage by patients just like this, I’m sure they were trying to have a safety net to ensure nobody died.

            In regards to your comment about all hospitals being required to have resources to perform a crash CS in event of uterine rupture, it simply isn’t logistically possible in rural community hospitals. By that same token I assume you are against birth centers and homebirth as those options are clearly never available in those environments?

            As a provider at the beside for several decades in such a setting, I have seen and respected maternal autonomy. I have seen it go so far as hospital attorneys working diligently at 2am to traverse this legal storm in an attempt to ensure both mother and baby arrive safely at the end. However, in all that time I have never seen a woman forced or coerced into a CS. The closest I have ever been to ‘forcing’ a woman into a CS in a low resource setting was physically restraining a mother while the surgeon infiltrated with local anesthetic to perform a CS after a VBAC walked thru the door in the middle of the night. Sudden onset of bradycardia and proceeded to rupture her uterus within moments of arrival. Because that’s the reality of what happens behind the scenes when a hospital says we do not have the resources to meet the needs or demands of your risk status.

          • araikwao
          • Stacy48918

            And what about the doctor’s choice to not practice risky medicine? Just because the woman wants to do it she can demand that she be attended and her every whim catered to? She has a right to attempt a vaginal birth. They have a right to say, “that’s fine but you’ll have to find a different doctor”. So she did.

          • birthbuddy

            Sorry Ginger, she had a slap of reality that I wish all the NCB crowd would experience.
            You can only BS and push the boundaries so far.
            She played her hand and lost.
            The law does not put up with the crap that OB’s have to tolerate every day. They call it as it is.

        • Guesteleh

          Saying she should have agreed with medical advice does not equal supporting that court order. It’s like freedom of speech: there are plenty of shit-talking morons out there that I don’t agree with, doesn’t mean the government has the right to ban free speech.

          • Ginger

            Except she didn’t follow that hospital’s recommendation (no one is saying WHAT the OB said) and was fine. Personally, I don’t think we get to second guess a person right for autonomy and by arguing what should have done, people are, IMO.

          • Amy Tuteur, MD

            Not only does the obstetrician and hospital have a right to second guess the patient, they have a LEGAL REQUIREMENT to make sure that the patient is basing her decision on accurate information. Moreover, no one was forcing the woman to have a C-section; they were telling her how they would respond if she came to their hospital. She was always free to go elsewhere, which is what she did.

            The hospital won this round. They wanted her to go elsewhere and she did.

          • Ginger

            No, they said they would FORCE an intervention, which is NEVER ok. The fact that you seem to think so, even given the federal rights to refuse treatment EVEN up to death, is horrifying. And that was not if she consented to care because she could have come in via ambulance. The CFO letter said “perform cesarean surgery on her “with or without [her] consent” if she came to the hospital.” No one is forced to be treated just because they walk into a hospital. That is why we can check out AMA. That is WHY we have the requirement that one must consent to any medical procedure. Previous laws and lawsuits have given us the right to consent and remove consent no matter WHEN. Physical presence in the hospital should not remove her right to her personal autonomy. Could you imagine if a male was forced to have a surgery just because he darkened the doorsteps of a hospital?

          • The Bofa, Being of the Sofa

            they said they would FORCE an intervention

            AT THAT HOSPITAL, they would only do her delivery if it was a c-section. So she would have to have a c-section if SHE insisted on going to THAT hospital.

            She did, however, have the option of going somewhere else, so she was not forced into doing anything.

          • Ginger

            Which by federal law, they are suppose to not refuse treatment if you go in by the ER. So basically, either they broke federal law or personal autonomy, aka federal law. Great job hospital.

          • The Bofa, Being of the Sofa

            They didn’t refuse treatment. They refused to treat her the way she thought she should be treatment. However, their position is that it would not be a proper treatment for her condition.

            Of course, you were the one who below insisted that they not treat her and send her to a different hospital.

            Which is what they tried to do, but she refused.

          • Amy Tuteur, MD

            I know what they said, but that’s not what they wanted. They wanted her to go elsewhere and their tactic worked.

            The hospital may have threatened an intervention, but the hospital itself is incapable of any interventions. A doctor would have to perform a C-section and that would be up to his or her clinical judgement and assessment of the patient’s understanding.

            The hospital didn’t want to take responsibility for the death of Goodall or her baby. Can you blame them? It’s not like ICAN or any other activists or organizations want to take responsibility, either.

          • The Bofa, Being of the Sofa

            “They made her an offer she couldn’t accept”

          • Ginger

            That may not have been what they wanted, but based the lawsuit and the results of the lawsuit, that is what legally can be done.

          • Stacy48918

            “that is what legally can be done.”
            Except that isn’t what actually happened. The hospital bluffed and won. They didn’t actually FORCE her into a C-section so there still is no precedent for that.

          • Daleth

            They said they would, “if medically indicated,” go to court to get an order for a c-section… IF she came to their hospital in active labor.

            Meaning, IF she didn’t come to their hospital, they wouldn’t do anything (nor COULD they do anything).

          • rh1985

            Yep, I agree. I don’t think they wanted to have her as a patient at all. They were hoping she’d go away on her own.

          • moto_librarian

            She did end up having another c-section.

            IOW – the doctors were right.

          • Ginger

            No, because she never said would not have c-section. All she said, was that she wanted to try and decide when the intervention would be. That is a right given to all, in US. Except now, for pregnant women in Florida.

          • The Bofa, Being of the Sofa

            Down below, you suggested that he hospital should not allow her to labor to the point of a rupture. Isn’t that what they did?

            Since a rupture can occur at ant time, and without warning, the only safe way to do it is to not labor at all.

            Oh by the way, notice that your idiotic “don’t have a maternity ward” suggestion doesn’t solve this problem. If she shows up at the door in labor and insists that they treat her, how is it any different if they don’t have a maternity ward at all? Either she has to consent to transfer, or they have to treat her, right? And if she refuses, now they have to deliver her without even a maternity ward.

          • Ginger

            I believe that under the emergency medical treatment and labor act, they can force her to be transfered to another hospital if they MEDICALLY can’t treat the patient, but then they’d have to prove that.

          • Guest

            Under EMTALA it is illegal to transfer a woman in labor. This DOES NOT solve the problem.

          • Ginger

            I thought they could if it was medically necessary, AKA they don’t the resources to treat her, just like any other medical condition that comes through the ER.

          • The Bofa, Being of the Sofa

            And this hospital does not have the resources to treat her as a VBA3CS, but you want to force them to, anyway.

            They went to the court and claimed it was medically necessary to do a c-section, but you don’t like that.

          • Amazed

            Whether they could or not isn’t the matter here. The matter is that while they’re bodily restraining her and physically removing her, and physically meeting her at the door of this other hospital, the baby will die or at least get a brain damage.

          • Guest

            No, EMTALA prevents hospitals from transferring women in active labor and if in labor or has a medical condition, she must be medically stabilized prior to transfer. The purpose of EMTALA was to ensure laboring women were provided care and prevented dumping of these women on other institutions. It wasn’t designed as a limousine service and it would certainly not be of use if VBA3C presents in labor or with a uterine rupture.

          • Elizabeth A

            You can absolutely transfer a woman in labor under EMTALA. Don’t have a maternity unit? Don’t have OB on staff? Don’t have sufficient NICU facilities for the case? TRANSFER.

            Michelle Duggar wound up LifeFlighted to the nearest appropriate NICU just before her youngest was born. That was an EMTALA transfer.

          • Guest

            Please see above comment, transferring a term patient in active labor requesting care outside the standard of care is not an appropriate candidate for transfer. Had to look up Duggar case. It seems she presented with preeclampsia/HELLP remote from delivery, this is exactly the type of case that does meet requirements for transfer to provide a higher level of care and not care outside an established standard of care.

          • Amazed

            Yeah. Meanwhole, the baby will die or at least suffer brain damage. While she’s being transferred.

            Ginger, do you realize what kind of emergency uterine rupture IS?

          • birthbuddy

            Obviously does not have clue.

          • Stacy48918

            Except that it’s obviously far better to be at the more equipped facility BEFORE the emergency happens than to attempt to transfer once the mother or baby are in danger. Or to prevent the emergency in the first place with, say, a life-saving intervention.

          • Elizabeth A

            Under EMTALA, appropriate transfers of patients are pretty easy, but the transferring hospital has to pay for them.

            I was transferred from one hospital to another during an obstetrical emergency. The staff doing the transfer seemed untroubled by the idea that they’d be asked to defend their actions later – it appeared to me that “we lack appropriate resources or liability insurance for this case” had been already determined to be acceptable as rationale for transfer. (My transfer was uncontroversial and extremely appropriate.)

          • Guest

            EMTALA does not mean a pregnant patient cannot be transferred, however, a VBA3C at 41 weeks in active labor cannot be reasonably stabilized for transfer. Certainly, if someone presents with premature labor and has been tocolyzed or with second trimester severe preeclampsia, they would be appropriate for transfer once stabilized. On the other hand, a primigravida with breech/breech term twins in labor desiring a vaginal birth would not be an appropriate transfer as she is in active labor and requesting care outside an established standard of care for any facility. In order for a medically indicated transfer to occur, she must be medically stabilized and the receiving facility must agree to accept the transfer. A VBA3C presenting in active labor at 41 weeks is unlikely to meet such criteria.

          • Daleth

            This case has no bearing on the situation for other pregnant women in Florida, except to the extent that it shows that no patient can force their doctor to provide what the doctor reasonably believes, in their best medical judgment, to be substandard and potentially dangerous medical care.

            Would you really prefer it if patients COULD do that–if they COULD go to court and get an order for a doctor to do something that the doctor thought was negligent and dangerous?

          • The Bofa, Being of the Sofa

            I can’t actually know whether to agree or not agree with the court’s order because I don’t know what argument was made before the judge.

            However, the fact that the judge granted the court order tells me that, legally, it’s not as simple as “I can make any choice I want and no one can tell me otherwise.” But we know that. For example, we concede that some people are mentally incompetent, and therefore not able to decide properly for themselves. So the concept that the state can never compel someone to do something they don’t want is not absolute. And once you are there, the only question is where to draw the line.

    • birthbuddy

      Nope, wrong. Autonomy means you can ‘decline’, it does not give you the right to ‘insist’ on a given treatment.

  • Young CC Prof

    Let me draw an analogy here: Recent laws and legal cases involving drug use in pregnant women. Now, these laws are wrong, and furthermore they are stupid and going to hurt more fetuses than they help. Their only possible purpose is to punish pregnant women who don’t do everything exactly right. I’ve read several (very good) articles arguing against such laws.

    Now let’s say someone tries to prove these laws are bad by claiming that recreational drug use in pregnancy is a good and reasonable health choice.

    That’s the problem with the coverage of this case. Taking legal action against her was absolutely wrong, but you can defend that principle without defending her choice as a good and smart one.

    • rh1985

      Exactly

    • MLE

      ^ Featured Comment up in here

  • Herman Kant

    Amy, you are wrong when you say: “It doesn’t matter that the refusal might lead the death of her baby or even her own death.” A woman’s autonomy is important but not an absolute and must be balanced against her responsibility to her unborn cild and her family. Do you really thinks it’s really OK for her to leave 3 small children alone and die just to prove the absolute of autonomy? Autonomy is not an absolute, and our autonomies must be balanced against the potential to harm ourselves and others. Autonomy to drive without seat belts? Doesn’t exist because there are laws against it. Autonomy to not use child seats? There are laws to use them. Autonomy to not pay taxes or to not do a tax return? You go to jail. Autonomy is important but it’s not an absolute and when it comes to harming yourself or others then it is often restricted.

    So think again when you say: “It doesn’t matter that the refusal might lead the death of her baby or even her own death.” Actually, it does matter.

    • Trixie

      We’re talking about her own body, and her right to not have surgery performed on it. It’s no one else’s decision but hers. Unless she is legally mentally incompetent, she gets to make the decision.

    • auntbea

      We’re not talking about ethics here. We’re talking about rights. And as long as the fetus is still inside, mom has rights but fetus does not.

    • The Computer Ate My Nym

      Do you really thinks it’s really OK for her to leave 3 small children alone and die just to prove the absolute of autonomy

      Well, how far are you willing to take this argument? It was a risk for her to get pregnant in the first place. Should she have had a forced tubal ligation with her last pregnancy so that she couldn’t take that risk and potentially leave 3 small children behind? Should she have been forced to get an abortion when she did get pregnant? And what about her partner? Should he be forbidden from high risk activities like smoking, sky diving, or coal mining because bodily autonomy is not absolute and he doesn’t have the right to risk leaving behind 3 small children and a pregnant wife? Where do you draw the line and is your concern only for pregnant women’s risk taking behaviors?

      • Herman Kant

        I guess you think it is OK to orphan 3 children. Just to prove that a woman’s autonomy supersedes anything else and that there are no other considerations. That is the same argument by the NRA in support of gun rights. A gun owner’s autonomy is more important than the health of the public. I rest my case here,

        • Cobalt

          A woman’s body is not a tool, or a toy, or a hobby. A gun is. Case rested.

        • The Computer Ate My Nym

          I notice that you didn’t answer the question. Where is the line? What’s too dangerous for a woman with 3 children to do? Is it only the mother who bears this responsibility or should the father also be prohibited from certain activities (or have certain activities be made mandatory)? Why do you say “orphan” when the children presumably have a father? I don’t know of any evidence that the father is dead or uninvolved in this case and certainly it isn’t true in the general case. Finally, how does prohibiting guns violate the gun owners bodily autonomy? As far as I know, guns are not part of anyone’s body. If the person in question is a cyborg with built in lasers, ok, you might have a case. But in real life at this time…not so much.

        • Stacy48918

          You’re ridiculous.

          I support someone’s right to ride on a crotch rocket/go bungie jumping/cliff diving/insert any dangerous activity you want even though they might die and leave their children orphaned. Doesn’t mean it’s a good decision or that I support the decision.

          It’s possible to both support this woman’s autonomy to make the decision she did and also say it’s a bad decision to make. Which is exactly Dr. Amy’s point if you’d read her post without whatever blinders it is you’re wearing.

          • sdsures

            How exactly do you do that? Walk me through the mental process, please.

          • Stacy48918

            It’s quite easy. I can’t believe so many people struggle with this.

            I support the Westboro Baptist Church’s right to free speech to protest outside funerals. My support does not mean that I will buy them markers or poster board to make their signs.

            If my town tries to ban the Westboro Baptist Church I will protest the city government. It’s *MY* freedom of speech too. But when the WBC does actually show up I will be on the opposite street corner with a sign counter-protesting their idiocy.

            A doctor can say “you have a right to risk your life and the life of your baby” without helping the woman plan her VBA3C. And when she shows up in labor he can again say “you are risking your baby’s life” though he cannot force her to have a C-section. And we can read about her rupture and say “Boy that was a stupid decision.”

          • MLE

            I think she is from a country that outlaws certain types of speech.

          • Stacy48918

            It seems that Herman and Ginger don’t quite understand it either, though.

          • MLE

            And, it doesn’t really matter because those who have that freedom are often the quickest to demand that it be revoked.

          • Stacy48918

            Very sad but very true.

          • sdsures

            Will reading her baby’s death certificate change her mind?

        • Anna T

          I don’t think anybody considers it “OK” for 3 children to be left motherless. I believe everyone here will agree that it is anything but “OK”. However, this is an area of the mother’s personal moral and ethical choices: do I risk my health (and potentially life) to have a VBA3C, or even another baby to begin with (because 4 C-sections aren’t a picnic in the park), when there are already people on this earth who need me? No authority or legal body can make that choice for her.

        • rh1985

          Morally, I think you are right, but legally, nope, unless she is found to be so mentally ill that she is incapable of understanding what she is doing.

    • sdsures

      “Autonomy is important but it’s not an absolute and when it comes to harming yourself or others then it is often restricted.”

      That’s what I was about to ask. It seems to run counter to a lot of Dr Amy’s posts that say the mom’s decisions should be overrided in certain cases where letting mom have her way (just to let her have her way for the sake of it so she doesn’t whine about autonomy) would endanger the fetus (i.e. allowing a VBA3-4C).

    • theadequatemother

      I think we need to differential between “bodily autonomy” which is the right of an individual to decide what is done to their person (medications, procedures, sexual acts etc) vs the broader concept of “autonomy” i.e. making decisions for yourself. When you decide not to put your child in a car seat you are exercising autonomy but not bodily autonomy. In that case, your right to autonomy is superseded by the right of the child to be cared for in a safe manner and to not come to unreasonable amounts of preventable harm. You are right to say that autonomy is not an absolute. It must be balanced with other ethical principles such as non-maleficence, beneficence….Bodily autonomy, however, is a much stronger right and that’s what we are talking about here.

    • birthbuddy

      Not in the eyes of the law.

  • Just Sayin

    You know, for someone who is so adamant that home birth is completely dangerous, you’d think you would try to raise awareness and put forth efforts to prevent abuse cases like this where women wind up so traumatized that they would rather have an unassisted home birth than go to a hospital. But no, you’d rather glaze over the human rights violation and point out your issues with the data provided in an article. Where is your scathing post about doctor and hospital policies, such as VBAC bans, that require women to have to potentially drive hours out of their way while in labor and risk an unassisted roadside birth in order to have their choices (which a VBAC with only one prior cesarean that was due to a breech presentation is an ACOG-backed completely evidence-based choice) respected. It seems to me that you care more about riling up the crowds against home birth and natural birth decisions than actually caring about the outcomes for these women and babies. If she only had 1 prior cesarean due to suspected big baby (that wound up weighing only 7 lbs.) and they were threatening to force her into surgery and call the DCF, would you have even mentioned the event at all? Judging by your past articles, I doubt it.

    • Cobalt
      • Just sayin

        Lots of posts about VBACs but that’s not specifically what I’m talking about. Where are the posts where she is calling out OB/GYNs or hospitals that are threatening/abusing their patients? She has no problem calling out midwives for this but if a doctor treats the patient the same way, it’s somehow the patient’s fault. For instance, on quite a few of those articles, she blames women for VBAC bans because people sue, not the hospital or doctors for putting money before their patient’s best interests because additional C-sections make subsequent pregnancies that much more dangerous.

        • Young CC Prof
          • Just Sayin

            THANK YOU for providing what I was actually asking about. Why aren’t these instances more important to Dr. Amy? Most of the HB advocates I know only started researching home births after mistreatment by a doctor or hospital staff. Some of them have even said that if they had assurance that things had changed, they would consider going back to the hospital for future births. There are many benefits to having birth is a hospital, as you all know. The biggest thing that I have found that drives women away is the environment of “lay down, shut up, and I’ll tell you when to push.” If you question the procedures they TELL you they will perform (because they don’t usually ask), you become a “problem.” We need to our health care workers to treat laboring women like they are people and not just baby-cocoons. I feel that if we had Improving Birth/Birth Without Fear on the NCB side and Dr. Amy on the mainstream side all calling for humane of pregnant mothers, we could see some real change in the hospital birth experience into a positive thing and, as a result, fewer women opting for a home birth.

          • Guesteleh

            If we’re sharing anecdotes, none of the women I know chose homebirth because they’d had a bad hospital experience. Two of them were first time mothers, the others had had uneventful hospital births. They did it because going all-natural appealed to them and they thought it was as safer or safer than the hospital. Reality: one woman’s baby ended up in the NICU (no long term effects, thankfully), the other two women suffered so much agony that one of them refused to hold her child after labor and the other vowed to never have a birth without pain relief again.

            It’s important for Amy to reach women like this who think, in the words of one of the loss fathers profiled on this site, “Choosing homebirth is like choosing Whole Foods.” Parents are being lied to and the perpetrators are deleting any reference to the deaths in order to keep the truth from getting out. Amy is one of the few people trying to hold them accountable.

          • Young CC Prof

            There may be some women in that situation, but there are many more who had a perfectly reasonable hospital experience, never delivered in the hospital at all, or who became upset by procedures that were definitely medically necessary. I see Dr Amy and some of her associates preventing birth trauma in another important way: Helping women understand what will happen in the hospital and why.

            For example, I’m grateful that I got to read straightforward, non-fear-based descriptions of cesarean procedures and recovery before I needed to have one, it allowed me to face the approaching delivery with far fewer stresses.

          • Stacy48918

            Is CanDoc treating her patient (see comment below) like a “baby cocoon” if he flat out tells her “I do not support your VBAC attempt and in doing so you may kill your baby?”. You really believe a nicer hospital experience would have persuaded that mother out of her decisions? Someone has and is LYING to her and inducing her to risk her baby’s life. Her decision to homebirth is not the result of mean docs and hospital policies.

          • Guest

            “The biggest thing that I have found that drives women away is the environment of “lay down, shut up, and I’ll tell you when to push” If you question the procedures they TELL you they will perform (because they usually don’t ask) you become a problem” “We need our healthcare workers to treat laboring women like they are people and not just baby-cocoons”
            Really? That is not only disrespectful, but arrogant and ignorant to lump healthcare providers in such a category when we are working our butts off to save the lives of mothers and babies every day! This nonsense of indiscriminately performing procedures without permission and telling a laboring mother to “lay down, shut up and I’ll tell you when to push” is absurd. What is your medical background? Nursing, physician, scrub tech? Exactly what hospitals have you witnessed this horrendous behavior in? Treating laboring women like “baby-cocoons?” Unbelievably ignorant. I have been a Labor and Delivery RN for over 13 years in two different countries, and I have never witnessed a physician or any other member of the healthcare team behave in this manner. We are professionals and treat patients as such. I have, however witnessed physicians “lay out the facts on the table” with a patient who has been grossly misinformed by a LAY PERSON and needed to hear the truth! The healthcare teams I have been privileged to work with go out of their way to alleviate patients’ anxieties in any way possible. I have seen many mothers and babies almost lose their lives from various problems and complications that had nothing to do with “interventions” or “unnecessary C/Sections” so please stop insulting us. However, I have seen NUMEROUS patients rushed in on an ambulance stretcher from a home birth gone wrong, expecting us to clean up the mess and “just fix it”. Interestingly, in that situation, no one seems to think we are treating them like a “baby cocoon” or telling them to “lay down and shut up”. Nurses and Doctors work their butts off EVERY DAY taking care of patients! 90% are grateful and appreciative and know that we are there to help. However, there are always a few, like yourself, who continue to attempt to discount our knowledge and expertise. Many times, we don’t get to eat, drink or even pee for 12 FULL HOURS. Yes, we work 12 hour shifts. Why don’t you shadow a Labor and Delivery nurse or an Obstetrician for a week or so, work our hours, deal with what we deal with, see what we see, then see what you think. My guess is you would be pale, slack-jawed and very, very humbled.

          • Amazed

            And one former HB advocate had not great but not terrible hospital births before starting hanging on MDC. She had no intention to give birth at home before getting sucked into the “evil hopsital, evil interventions, you go mama, rah-rah!” mentality. At the near end, she had her first homebirth which went smoothly, so of course she had a second homebirth.

            Her name was Liz Paparella. Do I need to tell you how this homebirth end?

          • Sullivan ThePoop

            I have never seen a HB activist that actually had a bad hospital experience. Either their experience was traumatizing to them because they had pregnancy complications or it was just normal and they couldn’t handle little things like not being able to eat cheeseburgers or having an IV or god forbid monitoring the baby.

          • Karen in SC

            You are welcome to start your own blog for this issue. Dr. Amy has chosen her focus and she’s not obligated to change it for you or anyone else.

          • The Bofa, Being of the Sofa

            You are welcome to start your own blog for this issue.

            There used to be a “Hurt by Hospital Birth” but my understanding of it is that it was a complete disaster, because it turned into such a petty whine fest that no one could take it seriously.

            Ok, it could be partly due to the fact that people went there actually looking for stories about those who were actually harmed, but still, it was a total flop and the contributors did not come off well at all.

          • Durango

            I don’t think you know very many homebirthers then. Everyone I knew did because we *knew* it was safe (wrong) and it was a superior, more enlightened way of giving birth (cringe). I can’t think of a single woman who was fleeing a bad hospital experience.

          • moto_librarian

            Do you know why I cannot find common cause with NCB advocates? Because of claims like yours, that hospitals tell you to “lay down, shut up, and I’ll tell you when to push.” There are indeed bad providers out there, but this statement does not reflect the norm for hospital-based birth. I was treated humanely by everyone when I was in the hospital, as were all of my friends. And our experiences ran the gamut from planned unmedicated delivery to scheduled c-section due to previous uterine surgery to emergency section related to HELLP Syndrome. People like you foster an attitude of hysteria and suspicion towards hospitals, leading women to come in with bad attitudes and unreasonable expectations.

            Grow up.

          • Sara

            “People like you foster an attitude of hysteria and suspicion towards
            hospitals, leading women to come in with bad attitudes and unreasonable
            expectations.”

            Yes! This story was going around in NCB groups awhile back and if you read it, it’s pretty clear the mom made the choices she did because of unfounded suspicion… and she got the results she did because she was hostile and belligerent. Yet, the story is spread around the internet as “hospital threatens to take healthy baby away from family because they gave birth at home” or some similar BS. BAD BAD BAD hospitals and doctors, trying to care for a baby who was voluntarily brought to the hospital.

            http://web.archive.org/web/20140625083535/http://mswrightsway.com/they-called-cps-because-i-birthed-at-home-on-my-own/

          • Ginger

            I had to inform the attending that I would sign out AMA before my wishes were followed. And guess what, my wishes where within acceptable medical practice. And I have seen this more than once because grandmother had a major medical condition. Many doctors think they get to decide for the patient instead of advising the patient. Require your rights to be honored is not being childish.

          • Guesteleh

            How do you know your wishes were within medical practice? Where did you get that information?

          • moto_librarian

            So do you believe that hospitals routinely tell women in labor to “lay down, shut up, and I’ll tell you when to push.” That’s the question.

          • the wingless one

            Thank you!! I just hit my early 30′s and everyone is having babies. I literally cannot think of a single person who has been unhappy with the way the hospital staff treated them during labor. The only one person who wasn’t enthusiastically positive about her hospital experience is the one who probably would have had a HB if her hubby would have been okay with it (she comes from a large religious family and her mom had several HBs).

            When I told my coworkers which hospital I was going to deliver at, three different people told me how much they loved that hospital. Granted they were all men (I work in a male dominated industry) but I assume their wives were happy too given they each went on to have more babies there. The funny thing is, I read a few NCB opinions of the hospital in my area and mine was considered a “baby factory” and fell very far short in their eyes. I don’t even think it has the “baby friendly” designation – oh the horror!

        • Stacy48918

          If you think “threatening” patients by denying them a VBAC is even in the same ballpark as the preventable DEATH of a healthy baby at the hand of a homebirth midwife, you are part of the problem.

          Just sayin’

          • Just Sayin

            Where did I say they were “threatening” patients by denying them a VBAC? Anyway, a provider can choose not to attend the VBAC but you can’t stop them from having one unless you force them to have surgery.

          • Stacy48918

            But that’s what uneducated NCB women take away from discussions with their OBs. The OB recommends routine care for the situation at hand but because the mother has been led to believe that birth should be “hands off” or that breech is a variation of normal or that carrying to 43 weeks carries no additional risk because “babies aren’t library books” – all she takes away is that her doc is trying to “force” her to do things when he just wants to make sure her baby survives the experience.

            Hospitals are more mother and NCB friendly than ever. They have tubs and squat bars and lactation consultants. But because they find supporting a water birth VBA3C too risky it’s the hospital’s fault she goes with homebirth? No way. Who else is whispering in that woman’s ear, feeding her outright lies about her chances and encouraging her to defy her doc at every step because “your body knows how to birth a baby”?

            Midwives and the NCB movement LIE to women and babies DIE. The worst this woman faced was a repeat Csection she didn’t want because she’s bought the lie that vagiinal birth is always best for all women no matter what. But keep blaming the docs. Maybe they’re big meanies but they deliver live babies. Even if it is through the window.

          • Ginger

            A patient does “defy” her doctor because her doctor ANY orders to a mentally competent adult patient. A doctor is there to advise based medical knowledge, the patient is the one the decisions.

        • Susan

          For a while dr. Amy did run a blog called “treat me
          With respect” …. I believe it was. It was good but I don’t think it had the readership this one does. I agree with you that poor care
          Or disrespectful care in hospitals happens and that it’s an important thing to advocate for all patient’s rights. But, who are we to dictate to her what she should care about or spend her time working on? I think what she does talk about is important, it’s a topic that saves lives. Another way her blog makes
          an impact is I believe healing for
          Women who have been labeled as failures either in birth or
          Breast feeding. I think the message of hey,
          Get a grip, there are lots of safe
          Ways to have a baby and breast feeding, while it has real benefits, isn’t so superior that it’s poison to formula feed or something to be ashamed of.

          There are so many important issues. I am for glad she lends her articulate voice
          To the issues she chooses. So many people come here and say stuff like you have and unlike you they have a horse in the race. So that’s worse, the don’t look at midwifery/homebirth/me look
          Over there.

          (Excuse the typos)

        • Cobalt

          Could be because VBAC bans are directly related to liability issues, for reasons detailed extensively in those posts. As for future pregnancies, the fetus that exists is at risk in the present, future hypothetical pregnancies are given less weight because they do not exist. Furthermore, in many cases the risk to carrying future pregnancies does not approach the risk to the current pregnancy at delivery.

          Death or emergency hysterectomy from rupture means no more babies, ever.

          And Dr. A does call out stories in which a patient’s autonomy is violated. She does not, however, blame doctors for refusing to take unnecessary risks with a baby’s life.

    • Monica

      Hey Just Sayin, I’m just sayin’ that not every hospital is capable of providing for every single case that walks through the door. Wouldn’t it be a wonderful world if all hospitals were equipped with state of the art trauma centers and could have an anesthesiologist oncall 24/7? Sadly, that is not the reality though and therefore hospitals do have to send people off to other facilities to get them the care that they need. So if you’re so concerned about the hospitals around where you live and what they an and cannot provide for pregnant women, then perhaps you should help them do some fundraising to pay for that anesthesiologist. More important than that would seem we need to get the correct information out there since so many people are spreading misinformation about the safety of vbac. Do you not think that’s an important service so women like Goodall are not going around thinking that doctors are just trying to control women by scaring them into medical procedures?

      • just sayin

        But threatening to call the DCF on a patient and perform a surgery without consent IS “just trying to control women by scaring them into medical procedures”. I have been fortunate enough to have had my children vaginally (in hospitals, since you guys seem to care about that so much), so I couldn’t care less, for my own sake, whether or not a local hospital was VBAC-friendly. I’m saying it’s MORE IMPORTANT to try to stop abuse by providers and hospitals so women aren’t too scared to birth in a hospital. If a hospital is not equipped to handle a birth emergency, they shouldn’t have an obstetric wing. What if a seemingly normal first time mom’s birth goes wrong and requires an emergency C-Section? Where’s the anesthesiologist then?

        • Sullivan ThePoop

          I went to a hospital with my first that only had a level 1 NICU and when I had complications very late they sent me to another hospital. Granted I live in the suburbs and the hospital was no further away than the first but if I lived in a small town I wouldn’t think it was personal that I had to travel.

        • Guesteleh

          There are big swaths of the U.S. where the only hospitals available are critical access hospitals. You find them in rural areas that are more than 35 miles from another hospital or more than 15 miles from another hospital in mountainous terrain or areas with only secondary roads.They essentially function as basic care centers and triage centers. Anything complicated and the patient has to be life flighted out to a regional tertiary care hospital. Critical access hospitals can provide basic maternity care but they aren’t designed or equipped for high-risk births. They exist because while they don’t see enough patients to justify the staffing you’d see in an urban area, they serve a vital function of providing safety net health care in rural areas.

          I know that’s long-winded but I wanted to get into the details because you’re making sweeping statements about what hospitals should or shouldn’t be able to provide with absolutely no understanding of the many challenges of delivering health care in the U.S. You’re speaking from ignorance–literal ignorance, as in you may be an intelligent person but you have no education or experience in this area.

          • Just Sayin

            Chances are, she wouldn’t plan to birth at that hospital from the get-go as her provider probably doesn’t work there; therefore, that is not what I’m referring to. If a hospital regularly accepts vaginal deliveries and can perform emergency C-sections if the need arises but turns around and says they will not allow someone to have a VBAC because they don’t have the resources if something goes wrong, that doesn’t make sense to me.

          • Guesteleh

            Read this to try and understand the factors that go into decisions to perform CS: http://www.newyorker.com/magazine/2006/10/09/the-score

          • Just Sayin

            I’ve actually read that before. Not sure how it’s relevant to the topic at hand, though. If there is a medical reason for not having a VBAC, I fully support a provider in their decision not to attend the delivery. But an all-encompassing VBAC ban when so many women have non-recurring reasons for the first cesarean doesn’t seem right. One of the more dangerous things for an unborn baby (and his/her mother) is having multiple older siblings born by C-section. If we can educate doctors and patients to prevent medically unnecessary 1st C-sections and medically unnecessary RCS’s, the mothers and younger siblings get the largest benefit. I believe the risk to future children is something that many providers fail to mention when discussing cesarean as an option (when it is only an option and not an emergency.)

          • Stacy48918

            So if, for example, it had stopped at the doc refusing to attend the VBA2C but no legal action and the woman decided to homebirth instead? And her uterus then ruptures, leading to a dead baby?

            Should the doc have been nicer? What about the homebirth midwife lying to her and telling her it was ok?

            This happened in January of this year. A baby boy named Griffin died at an HBA2C because the meanie doctors wouldn’t support the attempt in the hospital and were pushing for a repeat C-section. But by-golly she just knew her body “knew how to birth a baby”. And it did. Right into her liver.

            But docs should be nicer.

          • moto_librarian

            The woman in this case had the option to go to a larger, tertiary care center that was 23 miles away from her home. I’m sorry, but many of us commute that distance to and from work every damned day, so I fail to see why it would such a BFD for her to plan to deliver there in the first place. Ultimately, she got her TOL at that hospital, and (surprise, surprise) ended up having another section.

            Before you accuse me of supporting legal measures to force a c-section, let me tell you that I am adamantly against such things. But we will never know what happened from the hospital’s point of view. They do have the responsibility to minimize the potential for lawsuits, and a VBA3C would not likely be recommended by any responsible practitioner. I delivered both of my children at a teaching hospital with the highest level NICU available and a CNM practice. They will allow a good candidate a TOL after 2 sections. And you know what? You would not believe the level of petty bitching from VBAC candidates. They whine about having CEFM (a requirement by the CNMs for VBACs, since it is the best way to determine rupture), complain about heplocks, criticize the midwives for being too “medical.” I will wager that the mother in this case was being incredibly unreasonable, and any practitioner would have taken steps to protect him or herself legally.

          • Sullivan ThePoop

            Because she is childish and selfish obviously. Just like all these women who want what they want and to hell with everyone else including their infants.

          • Karen in SC

            Because they’ve run the numbers and it’s not economically feasible for whatever reason. Why is THAT so hard to understand. If they are not equipped for 24/7, they most likely don’t get complex cases to begin with. VBACs have a 75% success rate and probably

          • Sue

            “”Just Sayin”, the fact that it doesn’t make sense to you reflects your lack of understanding, not their lack of logic.

            Any organisation has to manage a certain level of risk, both financially and operationally. Some hospitals can accept, and plan for, the risk of a previously ”low-risk” person needing a Caesarean delivery, and plan their guidelines, staffing and rostering that way. That doesn’t mean they can accommodate the (relatively high) risk of uterine rupture.

            A Ceasarean delivery in a previously intact uterus, done for delivery-related reasons, is very very different from a ruptured uterus. Think about it, and don’t assume that the managers and medical specialists who construct policies are less competent than you. The fact that you don’t understand their reasons doesn’t mean that they are wrong.

        • Stacy48918

          the reason I was “too scared” to birth in a hospital was not abuse or threats from doctors, it was fearmongering from the likes of Ricki Lake and a completely uninformed idea of “how birth should be”. I did not even think it was remotely possible that my baby could die at homebirth, but NO WAY was I going to have electronic fetal monitoring because that was the first step in the “cascade of interventions” and I would definitely have gotten a C-section if I’d let them put that belt on me.

          Your argument is a complete fallacy. Women seeking homebirth in ever more dangerous scenarios do so not because of abuse from doctors but because of misinformation, lack of education and outright lies from midwives and the natural childbirth movement. THAT is what Dr Amy seeks to counter.

          • Anna T

            One does have to be fair and admit that many women went to birth in a hospital without suspecting anything horrible might happen to them, and *WERE* treated in an insensitive, rude, perhaps even medically incompetent way. Blaming Ricki Lake is too simplistic.

            The answer, however, isn’t giving up on hospital care to go with a provider who is incompetent but “nice” or “empowering” (translations: says exactly what you want to hear). The answer is making hospitals friendlier places and improving the bedside manner of doctors and nurses.

            Also, one has to remember that in labor/postpartum state, a woman is a lot more sensitive than usual, and perception can be vastly different. I recall after the birth of our second daughter, a nurse in the maternity ward casually mentioned I MIGHT have to give up rooming in (for administrative, not medical reasons). When my husband came for a visit he found me holding on to the baby in floods of tears; he was scared out of his wits, for a moment he thought something horrible had actually happened. Now, had I been my normal rational self, I’d realize that if I say, “I do not give you authority to take my baby to the nursery”, legally no one could take my baby to the nursery without my consent. But I was not my rational self. I was a woman a day and a half postpartum. I was on a hormonal/emotional rollercoaster and everything was blown out of proportion. We did continue to room in until the end of our stay, by the way.

          • Cobalt

            You don’t even have to be treated badly or have something bad happen to have a ‘questionable experience’. Sometimes it’s just the disconnect between staff that literally deliver babies everyday and a woman that may experience just one delivery, and without being fully informed as to what happens with even the most uncomplicated birth. Bedside manner really does go a long way.

            Example: for my first baby, I had a long but overall pretty boring birth as far as medical interventions. Right after delivery, a nurse goes to inject what looks to me like a huge amount of meds into my IV. I had no idea what that stuff was and she didn’t say anything about it. SO I ASKED. Granted, not nicely. She should have said something so I didn’t have to stop her and ask, as there was no emergency. It spooked me that someone would just do that.

            I didn’t know it was Pitocin for third stage management. I didn’t know about PPH risks. I didn’t know it was standard procedure. I didn’t know why I needed meds when my baby was already born. That’s information I should have had. And the nurse should have said something before going to administer.

            Real childbirth education is seriously lacking, and I think that leads to an awful lot of quack answers.

          • Sara

            Yes, simple communication can resolve a lot of common problems.

          • Anna T

            That was definitely wrong. No procedure should be performed on a conscious patient in a non-emergency situation without their consent.

          • Cobalt

            It’s what happens when you have minor procedures that are so routine that they become automatic. It should not have happened, and it’s the kind of error that leads to major mistrust, even though no harm was done and I was completely ok with it once I was informed.

          • Anna T

            Also, some people are allergic to the “routine” medications. Not long ago I read the story of a woman who developed severe allergic reaction to pitocin, and no one ever bothered to inform her that she was given it in her IV. She found out in retrospect.

          • Sara

            Exactly! And hospitals are scary, too, because a woman who wants a VBA3C who is having a conflict with her caregiver has had her story turned into a human/woman’s rights crisis that’s being spread all over the internet by people with INTENT to disparage all medical providers (and especially those that provide c-sections) as incompetent and malicious.

            Oh and CPS.

        • Stacy48918

          Should my little country hospital/ER shut down because they can’t guarantee a fast table time for thoracic surgery following a GSW?

          Every hospital needs boarded thoracic surgeons on staff just in case someone shoots themselves in the chest? Or shut down?

          GSWs can’t be predicted. We’ve got a pretty good time guess for a VBAC attempt. It’s so completely unreasonable to either ask mothers to drive a little farther or help them understand “we’re just not equipped for an emergency of that magnitude here.”

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          The last hospital I worked for was very near my home, and had a reputation for being very accomodating of patients’s wishes and very supportive of unmedicated birth and VBAC, although we hadall the facilities for even high risk birth, such as anesthesia 24/7 and NICU.

          Sometimes I would encounter pregnant neighbors on the street on which I lived, and, while chatting, I’d ask if they were going to have their babies at my hospital — after all, it was so conveniently close by.

          Often the answer was negative:”I’d rather go all the way across town to X because I,ve heard that ML FORCES you to have an unmedicated birth!”. No amount of denial that this was so would change their minds.

          • Sara

            This is exactly the case in my area, too. People hate our local hospital because of bad stories about the ER or other myths they’ve heard– nothing to do with L&D, which is a separate pavillion/birth center adjacent to the hospital. Our hospital does VBACs, has 4 CNMs, supports natural birth, and has a lot of great L&D nurses.

            Women are driving hours away to hospitals that, interesting enough, use the same midwifery staff, in order to get care that they could get just 15 minutes away or less. All because they hear great reviews of these other hospitals in the bigger city where the local natural birth community is centered. Or because they want a waterbirth.

            Or they go for homebirth with a local midwife who advises against ultrasounds in pregnancy, among other things.

          • Anna T

            Do you believe there is even a real difference between Israeli hospitals? Such as “good” and “bad” ones to have a baby? I mean, you talk of a reputation, but try as I might, I can’t even find consistent reputation for anything for any hospital. As much as I tried to look things up, all I could find was a bunch of anecdotal evidence. “Place X has terrible midwives!” “Not true, I had a baby there and the midwife was superb!” “They are horrible!” “They are angels!”… of course, every person has a different experience – and so it seems to me most women choose for reasons of convenience. I do know, of course, that there are differences in C-section rates (lower in hospitals which mainly cater to the Orthodox population).

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            In Jerusalem, now that Misgav Ladach has closed, no, there isn’t much difference MEDICALLY. Hadassah Ein Karem and Shaare Tzedek have invested a lot of money in new units which are physically more pleasant, but, by American standards they are still cramped and lacking many conveniences in the maternity wards. ST does a huge number of deliveries per month [more than 1000], so that it is rather a conveyor belt but many Orthodox women prefer a hospital which caters to religious Jews [the C/S rate is not that low, btw]. Bikur Holim is in a building that dates to Ottoman times, but has undergone internal renovation and has as good a medical reputation as the highly-publicized two Hadassah hospitals.

            Misgav Ladach could be more flexible because it was smaller — small hospitals always are. But our C/S rate was about average in spite of our jacuzzis and NCB outlook [and the majority of patients opted for epidurals, despite the NCB hype]

            Countrywide, it does vary more, but in general, OB in Israel is conservative.

        • yugaya

          I suggest shutting down all hospitals in USA that cannot secure a VBAC to women who want to have one. Screw everyone else, this is a major human rights issue and no hospital that segregates women based on birth choice should be allowed to exist!!!

        • momofone

          I was fortunate enough to have had a c-section that quite possibly saved my son’s life. The route of delivery didn’t matter in the least to me; his oxygen supply did.

        • toni

          I would actually like to know the answer to this as well. No local hospital where I live can do VBACs, the one in the capital an hour away I think will but the biggest OB practice in the city that almost everyone uses doesn’t allow TOLAC I guess for litigation reasons. But the smaller hospitals can’t accommodate VBAC because they don’t have 24 hour anaesthesiologists or NICUs.. but mightn’t they need an anaesthesiologist for any birth? How do they manage to deliver so many babies without all that stuff or are they only doing scheduled c-sections

          • The Bofa, Being of the Sofa

            It’s based on the likelihood of whether it will be needed or not.

            With a VBACS, the likelihood of a rupture is relatively high. Therefore, our society, through its tort system, has made it clear that if you are going to do that, you need to have adequate safety backups, which includes having timely anesthesiology.

            It’s a question of “risky” or “not risky,” but “how risky”

          • toni

            (this is to both of you)
            So does it happen occasionally in smaller county hospitals that low-risk patients who need an immediate c-section are out of luck?

          • The Bofa, Being of the Sofa

            Yes.

            But that is the case with anything. If you have a heart attack and your local emergency department doesn’t have easy access to a cath lab, you are also “out of luck.” You either have do do without, or get transported to one that does, which costs precious time (but make no mistake, there is a lot of research being done involving these places to determine the best approach – do you bypass them altogether or should you give them a chance to intervene and throw them on the chopper)

            Some hospitals are better equipped than others. Therefore, if something bad happens, you are better off being in the better equipped hospital. There is nothing that can be done about that unless we have all hospitals equipped fully.

            Therefore, our approach is based on the idea that, if you know you are doing something that is more risky, do it in a place that you know can take the appropriate precautions.

          • fiftyfifty1

            “So does it happen occasionally in smaller county hospitals that low-risk patients who need an immediate c-section are out of luck?”

            Yep, it happens. Lack of access to advanced care is one of the risks of living in a rural area. My parents would like to retire to the small town where they vacation, but have ruled that out because my dad had a small heart attack 10 years ago.The local hospital is excellent, but it’s small and can’t place a stent. They have also debated whether to stop offering maternity services. They already don’t do VBACS. The reason they have kept maternity services is that they are the closest hospital for 2 hours in each direction that does. If they weren’t there, there would be nothing. But high risk patients are advised to rent an apartment in the “big city” near term.

          • theadequatemother

            yes. It is important for women to understand what services their intended place of birth can deliver. For example, is anesthesia in house overnight or do they need to be called in? What about an OB, in house or called-in? How quickly can a c-section be done if required? Who are the team members responsible for neonatal resus? Is there a NICU, what level? If the baby needs to be transferred to a higher level of care, where would that be and how would that be done? Is there a blood bank? (note: this is important. Some of our smaller hospitals have a few units of PRBC and that’s it. No plasma, no pts, no cryo).

            Then when you know the answers you have to think about balancing those risks with the risks of relocating to a larger center at the time of delivery or (gasp) booking an induction or CS at term at that larger center. In some of our smaller communities there are risks associated with transfer. There are mountainous places without air traffic control towers where all flights (rotary and fixed wing) can be grounded due to weather. In the winter, road travel may not be an option either.

          • Young CC Prof

            First, a huge percentage of c-sections are scheduled in advance. Second, a lot of them are done for failure to progress, and with that, it’s perfectly reasonable to take 30-60 minutes to set up the operation. Third, a lot of labors are induced, and you can try to time inductions to happen during normal business hours.

            Fourth, yes there are emergencies in low-risk births that appear with no previous abnormal signs, but that isn’t as common as VBACs going wrong.

          • Ginger

            Even a scheduled c-section may need a anesthesiologist and ANY birth may need a emergency C-section.

          • Daleth

            A scheduled c-section would be scheduled for a date and time when there is an anesthesiologist on site, obviously.

            And any birth may need an “emergency” c-section, but most emergency c-sections are not “sudden occurrences that will cause death in a matter of minutes”-type emergencies. In other words there is time to page the on-call anesthesiologist and wait the 20 mins for him/her to get to the hospital.

          • Ginger

            Mine was within minutes because I started bleeding out, but I have not read of the timing required for the average emergency c-section. If you have it cited, I like to read it.

          • rh1985

            Yep, there is a difference between emergency CS and crash c-section. I had an unscheduled, pre-labor c-section because my daughter needed to be born that day due to pre-e causing dangerously high blood pressure. She was born around an hour after the decision to deliver, she needed to be born but not within minutes. Crash CS is usually under general anesthesia because someone (usually baby) is going to die if not born immediately. For most emergency CS, having someone on call that can be there in fifteen minutes is enough, but not for the kind of catastrophe that has a chance of happening during a VBAC.

        • Daleth

          Just Sayin’, what are the hospital’s options? Here’s the situation we’re talking about:
          - Hospital is not equipped to handle VBACs (because it doesn’t have anesthesiologists, etc., on site 24/7).
          - Woman wants a VBAC and refuses to consent to a c-section.
          - Woman insists on delivering at that hospital, rather than traveling to whatever is the nearest hospital that’s equipped to provide VBACs.

          Hmm. The woman wants something from this hospital that this hospital is not equipped to provide, and she makes it clear that if she shows up there in labor, she will NOT consent to a c-section.

          What… exactly… is the hospital supposed to do?

          • Ginger

            Stabilize and send to another hospital because obviously they are not equipped for a vaginal birth much less a C-section because guess what, ANY birth can go wrong and need ALL those people.

          • The Bofa, Being of the Sofa

            Stabilize and send to another hospital

            How do you stabilize a uterine rupture?

          • Ginger

            You don’t have to allow her to labor until then, she comes in, you send her in ambulance (or chopper). The same way they would send ANYONE who came in with something they could not treat. And then maternity ward because obviously you are not capable of treating laboring patients. Because of the things that could go wrong, could go wrong in any laboring patient. Yes, it is higher risk, but risk is always there. If you cannot accommodate, don’t have a maternity ward.

          • Daleth

            Ginger, I don’t think you understand uterine rupture. It’s not something that can be “stabilized” for 20-60 minutes while you take the time to life-flight the patients (mom and baby) to another hospital. If it happens it requires an immediate c-section, and I mean IMMEDIATE, or the baby will suffer hypoxia (a fancy way of saying it will suffocate) and die.

            That’s why you need 24/7 on-site anesthesiologists: so that when it happens the anesthesiologist can sprint into the room and knock the mom out instantly with general anesthesia.

          • The Bofa, Being of the Sofa

            You don’t have to allow her to labor until then,

            I just noticed this comment.

            I should point out that this is EXACTLY what the hospital was trying to do with this patient! They were trying to “not let her to labor” until a rupture occurs. SHE was the one insisting to do it!

            The hospital told her, if you want to deliver here, you have to have a scheduled c-section. We aren’t going to allow you to labor, given your risk of rupture. We aren’t capable of adequately supporting that. Therefore, if you want to labor, you must go somewhere else.

            Yet, you are complaining about that, despite the fact it is exactly what you insist here that they should have done. They were perfectly happy to send her off to another, better equipped hospital. She didn’t want to accept that.

            Your proposed solution failed.

          • moto_librarian

            Are you really this dense? Smaller hospitals do triage emergency cases and send them elsewhere, but they do not perform complicated procedures that they do not have the resources to support. If you present in the ED in the throes of a heart attack, they will try to stabilize you and send you to a larger facility. If you go in for a routine physical and lab work and an exam suggest that you are having cardiac issues that may warrant a bypass, they aren’t going to wait until you have a heart attack before figuring out what the hell is going on. They are going to refer you for further testing and schedule procedures before you are actually dying of the condition. So if you come into the hospital as a low-risk pregnant woman and the tracing starts to look questionable, they are going to transfer you or get the on-call anesthesiologist to the hospital to prep for a c-section. If you come to the hospital wanting to have a VBAC after three c-sections, they aren’t going to want to stand around and wait to see if you rupture – they want you at a facility where you and your baby can be saved!

            Why is this so damned difficult to understand?

          • Amazed

            WHAT? The entire thing happened because SHE wanted to labour there and deliver there. No one forced her to. They didn’t want her, she wanted them, and you are now claiming they should have acted as the personal airport to a woman WHO DIDN’T WANT TO BE TRANSFERRED? What on earth?

            Oh wait, I get it now. You want to save poor mom from the annoying necessity to drive 23 miles to that other hospital. She’ll go there for the ride. Amiright?

          • Sue

            Ginger, it’s clear you have never been in the position of providing health care, let alone in life-threatening situations. Many people here have done so.

            There is a big difference between an ED accepting someone arriving off the street, stabilising and transferring, vs accepting a planned risk. Any ED has to stabilise a person arriving unxpectedly with a head injury, but that doesn’t mean that the general surgeon has to have a neurosurgery list and just ”transfer the patient” if something goes wrong.

            It might be wise to resist pontificating about what should be done, since you have never done it. You might learn something from others who have.

          • LibrarianSarah

            So it’s either a hospital offer top of the line medical care or none at all? Damn and people say I am prone to black and white thinking.

          • Ginger

            You do realize that in any labor you have that, right? In fact, according to a recent journal article in The New England Journal of Medicine, the rate of uterine rupture in vaginal birth is 0.7 percent, should we now force ALL women to have c-sections because of the risk? Or do we keep bodily autonomy?

          • Young CC Prof

            Um. No?

            0.7% is the rate of uterine rupture in attempted vaginal birth after one transverse c-section. Ruptures in women who have never had uterus surgery are extremely rare, something like 1 in 30,000, and usually seen in women who’ve had lots of babies.

            You keep throwing out these comments, but your facts are wrong.

          • Ginger

            I am going with what I read in The New England Journal of Medicine, it stated overall rate was .7%. Please tell me where you find the 1 in 30,000, I’ll read it. But honestly does not matter. Every person has the right to REFUSE treatment and this woman was told she could not. That is wrong, no matter what you think of her refusal.

          • The Bofa, Being of the Sofa

            Every person has the right to REFUSE treatment and this woman was told she could not.

            Of course she could! SHE DID REFUSE TREATMENT! She went somewhere else. So she, clearly, had it her way. She just couldn’t do it there.

          • Young CC Prof

            Here’s the citation from NEJM: http://www.nejm.org/doi/pdf/10.1056/NEJMoa040405

            0.7% of women undergoing trial of labor after cesarean. Not of all women in labor. I presume that was your source, and you just misread it?

            That’s my point. You’re making a lot of mistakes, and you aren’t listening.

          • The Bofa, Being of the Sofa

            You do realize that in any labor you have that, right?

            You have what?

            A risk of uterine rupture? Of course. But the question is not whether there is risk or not, but how much risk.

            See YCCP’s comment below. The difference between 0.7% and 0.003% matters.

        • Monica

          Threatening to call DCF was because the hospital didn’t want to deal with this mother’s unreasonable requests and wanted her to go elsewhere. Did they do any of that? No! Would they have, doubtful. They told her we won’t risk it and it’s the hospital and doctor’s right to do that. Because they don’t have to risk their institution and practice for one unreasonable patient. This clearly escalated to a point where they knew it just wasn’t going to work out. They have the right to say no I won’t do that.

          I’m not sure what you think the other option is if a hospital is unable to have an anesthesiologist on call 24/7. They just shouldn’t do births period in that case? So now they inconvenience thousands of women who don’t need an emergency c-section. Look, if you go to a hospital with a gun shot wound and the hospital doesn’t have a trauma center, they will do what they can to patch you up and send you to another hospital. Same is true of a woman in labor. They might take you in and hopefully have time to assess your situation and get you an ambulance to a better equipped hospital and if not they’ll do what they can for you. They aren’t going to throw you out into the street. Having an OB even without an anesthesiologist is better than no OB at all. Your idea that if they can’t provide everything, then they shouldn’t do anything at all is far more detrimental to women than a hospital without an anesthesiologist. And by your rational if they can’t provide a fully equipped NICU, then they shouldn’t treat babies at all either. This is just far worse of a plan all around than a hospital without an anesthesiologist on site 24/7.

          And you know what, I had 5 hospital births. Two vaginal, one c-section, one stillborn at 20 weeks, and one vbac. While there were certain things about each birth I could probably point to and say the hospital was awful because of this or that I don’t because in the grand scheme of things they did the best they could for me. I gave birth in 3 different hospitals and not a single one was anything as bad as NCB activists like to make hospitals and doctors out to be. So if anyone is guilty of making hospitals out to be a place that women don’t want to go, then it’s not the hospitals. It’s loudmouths with an internet connection who were fine with things until they started talking to other women and decided that hospitals were evil. It’s midwives who want you to pay them to do your homebirth who make hospitals out to be an evil place. It’s the misinformation being passed around saying that our c-section rate is too high according to WHO and that vba3c is just as safe as vbac. This is what causes the problems with hospitals where they have to put their foot down and say no we won’t take the risk, we told you that your information is wrong that this is the risk, but you won’t accept it and we won’t allow you to attempt a trial of labor here. You will have to have a c-section if you are going to use our hospital and if you insist on coming here in the final stages of labor or when things have gone completely south, then we will have no choice, but to call DCF on you. Sounds to me like they knew they weren’t getting through to her and felt that she was going to take risks in their facility that they did not want to deal with.

    • Sullivan ThePoop

      This post is so blind to the reality that every hospital cannot accommodate a VBAC even after 1 CS. I hate to be rude but it is a childish point of view where everyone should do exactly what you want and screw the consequences to them.

    • JennG

      Are there some cases of actual medical assault? I’m sure there are. Are there also cases where a busy or less than refined team communicates badly with a mother in labour? Probably many more. I’m very much for women being treated with respect as patients. They deserve accurate information about risks, about details of procedures…and most of all they deserve expert care that keeps their health in mind, including (but not limited to) mental health.

      However, I am not sure about the last time I read a thing asking why men were not given more say in their needs around bypass surgeries (not all of them are necessary that are performed by the way!) or people were complaining about physical therapists not lighting enough candles. The idea that labour is somehow special and different is a _construct_.

      Here’s the thing: Homebirth midwives are selling — and I do mean SELLING — the idea that a birth experience is about a particular approach where it’s the _experience_ that is being purchased. That a woman who has had a c-section deserves a better _experience_. Why? If it was medically necessarily and she still didn’t like it, so what? I didn’t like having surgery on my wrist but I needed it for a break. Not everyone who breaks their wrist needs surgery. But you know, I wanted to use it after and there was a question about whether setting it would result in that. It wasn’t

      For me, and lots of other reasonable people, the day you have your baby is maybe 24-72 hours of care. It does not have to be super special. It does not have to be about a kind of triathlon-like event where you stay in touch with your body and use it for some kind of performative experience. Labour & delivery is about one thing: Getting baby and mum through to go on to have decades of amazing life experience.

      Why are women _traumatized_ if they can’t have a vaginal delivery? My husband tore his ACL. The first time, he had a simple little procedure to snip the end that tore. The second time, he needed knee surgery. Because the second tear was different. It wasn’t a moral issue. It wasn’t Evil Doctors Against Caring Knee Masseuses. Why do women consistently permit people to put their experiences on pedestals that do not serve their best interests?

      FTR I have had three vaginal deliveries, one unmedicated. The first, however, was a clusterf* and resulted in the death of my baby. _That_ was traumatic. That sucked. What I value most in a care team is _competence_.

      • Karen in SC

        JennG, very true. No one tried to make my gall bladder surgery a more “homey” experience. There’s a large room with curtained off beds where the surgery patients wait, in either complete boredom or anxiety until their turn, gowned and IVed up.

        When I asked for a local for the IV, it was denied (as it was for 4 or 5 other procedures/operations I’ve had since). In fact, the only local I’ve ever received for an IV was the one I got on the maternity floor since I needed antibiotics for GBS. Go figure!

      • Sue

        ”the day you have your baby is maybe 24-72 hours of care. It does not have to be super special. ”

        So well said, JennG. And it is super-special, it’s because a new little person joined your family, not because you are a special snowflake. You have an entire lifetime to fill with special times.

    • yugaya

      ” If she only had 1 prior cesarean due to suspected big baby”

      But she did not have “only one prior cesarean due to suspected big baby”. She had three prior cesareans (3), which was enough to not even consider her as a candidate for a VBAC attempt in that hospital. Ever.

    • Amazed

      Disappointing, Just Sayin, disappointing. What a bunch of dramatic blubber. Dr Amy happens to have made it her goal to warn people about a practice that leaves babies dead and damaged left and right and you’re whining about evil hospitals not wanting to risk lawsuits and financial ruin to accommodate the choice of women who couldn’t be moved to park their butts in the car and drive to the service they desire when they’re unwilling to utilize the service that is accepted.

      Feel free to start a blog of your own where you can ooh and aah, and wring your hands at the injustice of hospitals not wanting to accommodate unsafe choices. Don’t tell other people how to write their own blogs. And get off your high horse before someone unhorses you, potentially painfully.

      • yugaya

        “What a bunch of dramatic blubber.”

        A real tearjerker – I almost cried reading all about the suffering VBAC women who ” have to potentially drive hours out of their way … in order to have their choices”.

        • Amazed

          Yeah. Especially given the fact that in the part of the world where you and I live – waves at you, dear neighbour – our grandmothers hopped into the donkey cart, our grandfathers lashed the whip and off they went to the nearest regional hospital, a village or three away. And considered themselves damned lucky that there was a hospital so very near. But hey, lives of women from bygone times and places that were not OK were soooo romantic and inspirational!

          Somehow, the poster have missed the fact that evil doctors that poor women should be warned about turned out to be right – she was a poor VBAC candidate and she got a labour plus a c-section. Lucky her.

          Oh, and the fact that they sought legal options to have their way, as contrasted to all those lovely homebirth midwives who crowdsource facebook (I am glad this tragedy brought you here, by the way, I enjoy your posts greatly) and lie to their patients? Who cares!

          • yugaya

            When I was pregnant with my eldest child there was a treasured two-liter plastic bottle of gasoline which had been smuggled across the border waiting in the pantry. It guaranteed that I would not have to hop onto a horse driven cart myself in order to get to the hospital in time. Such “romantic” memories are probably to be blamed for my occasional lack of empathy towards people with first world healthcare problems. :)))

          • Amazed

            Yeah. I was the kid who was driven by the freshly awoken neighbour in the ER in the dead of a winter night because he was the only one in a whole block of flats who could afford fuel for his car. I don’t remember anyone whining about how hard we had it. People just grinded their teeth, ploughed through it, and were quite grareful that there was a hospital to go to.

            Now, we see whining about following one’s choices being too uncomfortable if they are more than a block away. But hey, I cannot say I am surprised. Sometimes, when I am out and it rains, I can swear that around here, there are more cars than umbrellas. Getting wet is becoming uncomfortable, so people go by the easiest road and take the car. I suppose having your choices accommodated in a place that takes some time going to is a hard road now. Hereby, I proclaim that I want to give birth in the presidential residence, with a circus taking care of my entertainment and the prime minister being my support team. If I don’t get this, my rights will be infringed on and I expect unconditional support from everyone around. Dear neighbour, you can come over here to take part in the rally. Just don’t expect that I’d pay for your fuel and hotel room.

    • Daleth

      Just Sayin, do you know why some hospitals impose VBAC bans? My understanding is that it’s primarily because in order to safely provide VBACs, they would need to have anesthesiologists, OB’s and surgical staff on site 24/7.

      Having those people 15 minutes away isn’t enough. It’s enough for most emergent c-sections, because in most cases you can see things going wrong in advance (baby flips to breech during labor, fetal heart trace starts not looking good, labor isn’t progressing well, etc.). But a uterine rupture typically happens with little or no warning, and 15 minutes travel time plus pre-op prep time is too long to save the baby.

      That’s why women may have to travel hours out of their way: because they live near a small hospital that doesn’t have the number of births per year or the resources to have anesthesiologists, OB’s and surgical staff on site 24/7.

      What solution would you propose to that problem?

      • Ginger

        Given that when I gave birth, they had all those people because ANY birth can go wrong, either have a full OB ward or don’t have one. Simple.

        • The Bofa, Being of the Sofa

          So that means that a very large number of hospitals will not have an OB, even for low-risk birth.

          Thanks for making things a shitload worse.

          • Ginger

            Given the things that could go wrong with ANY birth, why have them go to hospital if they can’t be treated? It is like sending someone with a major heart condition to a rural hospital, THEY SEND YOU TO A BIGGER, FULLY EQUIPPED HOSPITAL. Why should birth any different?

          • The Bofa, Being of the Sofa

            Given the things that could go wrong with ANY birth, why have them go to hospital if they can’t be treated?

            So you admit that there are a lot of things that could go wrong, but insist that they are able to deal with ALL of them or they are worthless?

            Talk about throwing the baby out with the bathwater.

            Let’s continue an example below. You know what else that could go wrong during a delivery? The mother could have a heart attack. Does the place have to also have a fully equipped cath lab ready in case she does? If they don’t have a cath lab, they shouldn’t do deliveries?

            What if there was an earthquake that hit right in the middle of delivery? Does a hospital in Minnesota have to properly equipped for a 9.0 earthquake?

            It is like sending someone with a major heart condition to a rural hospital,THEY SEND YOU TO A BIGGER, FULLY EQUIPPED HOSPITAL. Why should birth any different?

            But that’s what they do. If you have the birth equivalent of a “major heart condition” (such as a high risk birth), they send you to a hospital that is better equipped to handle it.

            However, if you don’t have a heart condition, they don’t send you somewhere else because “heart attacks can happen to anyone.”

          • Ginger

            I’ve given birth, EVERY birth has a risk to the mother and fetus. There are many hospitals that don’t have materity ward because they can’t handle an emergency C-section. They respond exactly with what I am writing here: you send them to someone who has the ability to treat. If the hospital have the ability to treat a emergency c-section, they do not have the ability to FULLY treat a laboring woman. A emergency C-section even for a non-high risk delivery is common enough, you need have the ability to do so. If not, it is like having a cardiologist and nothing else. This is not everything, this basics when it comes maternity care.

          • The Bofa, Being of the Sofa

            You didn’t answer the question.

            Where is the line? Since a laboring woman can have a heart attack, does that mean every hospital has to have a cardiologist available for L&D?

            As I said, the question isn’t about whether there is risk or no risk, it is about how much risk.

            Of course, that’s what we do with everything in our lives. We have to draw a line that says this level of risk is too high and this not.

          • Ginger

            And that choice is up to patient, not the MD. That is what personal autonomy means.

          • Young CC Prof

            Actually, both have veto power. The patient can say, “This procedure is too risky for me, I do not consent.” And the doctor can say, “This procedure is too risky in your case, I will not perform it.”

          • Ginger

            Not always, and if the judge had ruled otherwise or refused to rule, no. If the patient is under the care of an MD or is an emergency situation at ER, the stabilization has to happen, within consent or the patient has to be transferred to another’s care. Well, at least according to the laws in my state (which the ER is federal). A doctor can refuse a treatment but can’t force another treatment which is why this one is such an issue.

            If a woman comes in, unless you have another treatment, it is a vaginal delivery.

          • The Computer Ate My Nym

            Emergency care can occur without overt consent if there is no time to obtain that consent or the patient is not in a position to give the consent. Emergency care can NOT be given if it is known to be against the wishes of a competent patient. For example, a patient who is a Jehovah’s witness with a documented refusal for transfusion even in the case of life threatening bleeding can not be transfused in an emergency unless there is reason to believe that he or she has changed his/her mind.

          • Sue

            Ginger – are you just making stuff up as you go along?

          • Amy Tuteur, MD

            No, personal autonomy means the right to make and INFORMED choice, not any choice that comes into the patient’s head.

            The hospital is not off the hook if they believe that the patient does not understand the risks, and based on what this woman was saying, her decision rested on erroneous information. The organizations and people supporting Goodall were not prepared to take any responsibility. Indeed, organizations like ICAN won’t even warrant that the “facts” that they present are even true.

          • Ginger

            But again, you don’t know, for a fact if she was fully informed. Your entire article is based on your personal belief not any actual knowledge. She is stating general knowledge in the article but her OB should have given her information. Decide the risk is worth it, was up to her. And evidently, given that she got what she wanted, some OB and some hospital thought that laboring before hand was not so horrible. All she asked was for the CHOICE when interventions would occur. Even if you don’t think she understood, that choice should remain her’s. Because, she is a mentally competent adult, the judge, though he was willing to force the c-section on her, did not declare her incompetent, therefore her decision, no matter if we disagree with it (and nothing here has been anything but opinion), should stand.

          • The Bofa, Being of the Sofa

            We have to draw a line that says this level of risk is too high and this not.

            And that choice is up to patient, not the MD

            But only if she actually knows the risk.

            How can she make a choice that a given level of risk is acceptable if she doesn’t know what the actual level of risk is?

        • MLE

          That’s one way to enforce a lot of unplanned home births. Do you live in NYC or something?

    • Sue

      General rule of blogs: someone posting as ”Just sayin”, or finishing their post with ”Just sayin”, will rarely contribute anything constructive to a discussion.

      If you object to ”VBAC bans”, do you also oppose “neurosurgery bans” for small hospitals that don;’t have neurosurgeons or operating rooms?

  • Spamamander

    I wondered if you were going to cover this Dr. Amy… I was really disappointed when this story ran across my news feed. While I absolutely believe the woman should be able to make a medically informed choice, the misinformation about risk made my skin crawl.

  • jtmo

    To be fair, we don’t know what info Ms Goodall was basing her decision on. The “facts” reported in the linked piece are a terrible risk-benefit comparison, way under representing risk and way overstating benefit, but we don’t know that she used a similar risk-benefit analysis. I’m glad she was able to be treated at a different hospital and apparently delivered safely.
    I’m so disappointed in the court. How chilling to have an order granted to operate on a competent adult “with or without consent”! That has to be terrifying.
    This wouldn’t be a decision I’d make personally (or support professionally in counseling a patient) but I support her right to informed refusal of a repeat cesarean.

  • CanDoc

    I’m currently caring for a 412 lb woman with two prior CS, one after attempted HB, the other a repeat for failed VBAC. This time around baby >97th %ile weight, and she’s refusing a repeat CS because she is determined to have her vaginal birth. Our department will not intervene without consent. But there is no such thing as a “crash” cesarean section when it takes 20 minutes from cutting skin to getting baby out. Train wreck waiting to happen. Sigh. NCB is pernicious.

    • Who?

      My thoughts are with the baby and you and your team.

      So much focus on rights, so little on responsibility.

    • attitude devant

      I’d refer that one to Perinatology. When you get sued, they are just going to ask you why you didn’t anyway.

      • CanDoc

        Perinatology also following, but they don’t do any intrapartum care in our centre. We have a laborist-hospitalist model (that works extremely well), so I’m just hoping in the world of call-roulette that it’s not my duty shift when she shows up. She loves her kids, I just think she’s been wooed by ICAN. In good news, my gut feeling (read: desperate hope) is that she’ll come around to the riskiness of what she’s proposing as things get more uncomfortable in the short amount of time left, and go for a CS voluntarily but blame us for bullying her into it. (Which I’ll gladly take so long as she’s consenting and safe.)

    • BelligerentBruncher

      Maybe she wants the baby to die. Sad.

    • Amazed

      I hope everything turns out in the best way posible. I am scared for both of them.

    • The Computer Ate My Nym

      If you can do so without violating patient confidentiality, could you tell us how this comes out?

  • Jenny_from_da_Bloc

    Of course on the RH Reality article The Feminist Breeder is calling it rape by scalpel much to the dismay of actual rape victims and another woman is commenting about her forced c-sections and calling it just the same a rape. When are these women going to learn that not having an optimal birth experience isn’t being raped or birth raped. It makes them look so ignorant and invalidates real sexual violence victims

    • rh1985

      An actual forced c-section would be some kind of medical assault, not rape, FFS.

      • BelligerentBruncher

        Technically battery, not assault, but I see your point.

        Although I wonder how that would play out if the operation was actually ordered by the court.

      • Jenny_from_da_Bloc

        She was more concerned with her rape by scalpel than the real issue at hand

    • D/

      Was just reading a fb conversation about this very thing expressing absolute shock about getting some “super negative” feedback and about how offended some people are about this project. The only commentary went along the lines of “cognitive dissonance” and “just world fallacy” … Oh, and “I’ve been deleting the public comments as they come, but left one up that I did respond to to illustrate a point.”

      https://www.facebook.com/hashtag/breakthesilence

  • poop on dr bitch amy

    haha bs. you are always talking about how women who make an informed choice to homebirth are murderers.

    • Guest

      How “informed” is their choice? If they truly know that home birth not as safe as hospital birth, and they truly know the record of their care provider, I don’t think any of us really care. I can’t relate to someone that would make a decision that even slightly raised the risk of their child dying, but if they feel that increase in risk is worth it to them, that’s their choice, and they’ll have to live with it if something goes wrong. The problem is that most homebirthers aren’t truly informed of the increased risk and go around saying that home birth is safer than hospital birth, which just is not true.

      • Guest

        That should say, “home birth is not as safe.”

    • Jenny_from_da_Bloc

      You can’t be truly informed if the information you base your decision on is false or inaccurate information.

      • Karen in SC

        Yes, that is the issue. Many times someone has commented that they know the risks and did this that and the other thing to mitigate the risk and they were proceeding with homebirth. Dr. Amy has replied in those cases that homebirth is the “right choice for them.” And she continually says she doesn’t support making homebirth illegal. Informed consent, access to MANA data, trained midwives, real understanding of the risk vs the experience. Those are the issues here.

        • Jenny_from_da_Bloc

          Agreed 100%, though IMO home birth will never be safe and if they think they are truly informed then they can’t blame anyone but themselves when the placenta hits the fan.

    • Young CC Prof

      Nope, we consider incompetent midwives to be the killers.

    • auntbea

      Yay! Poopie is back!

      • Ellen Mary

        Got to love the ‘make up your own username’ feature on here!

    • Who?

      Your remarks are as foolish, paranoid and meaningless as your tag.

      I can see all sorts of people being won over to your arguments that way, do carry on. I’d certainly take life advice from a foul mouthed ad hominem moron.

    • Trixie

      You’re tenacious, PODBA, I’ll give you that. Wrong, but tenacious.

    • Guesteleh

      Jesus Christ, your user name is why the word fontrum was invented.

  • Renee

    PLEASE offer to write for RH Reality Check. They are generally a good page, but their views on NCB, and birth in general, have been both dismal and factually incorrect. You could add much needed facts and wisdom over there.

    I cannot see how a group dedicated to women’s bodily autonomy would miss this one. Autonomy gives you the RIGHT to control your body. Period.

    • fiftyfifty1

      “I cannot see how a group dedicated to women’s bodily autonomy would miss this one. Autonomy gives you the RIGHT to control your body. Period.”

      Excellent point. Why does RH Reality Check feel they need to argue that this woman’s choice is a medically advisable one or otherwise “good” one? They specifically reject the idea that women who choose contraception or abortion should have to prove they have a good enough reason. Women have the right to bodily autonomy whether you approve of their reasons or not.

    • Spamamander

      Agreed, I love much of what RH Reality Check does but their record on some aspects of pregnancy and birth is poorly informed at best.

  • Ellen Mary

    From my time on VBAC boards I can tell you that some women just refuse to believe in any risks. Pregnant 6 weeks after a C & planning a HBAC? No problem. Wait until your uterus heals before TTC? Just a recommendation!

    From my time on RH reality check I can tell you that a fetus matters to that crowd not at all. So if course VBAC is ‘safer’ to them because they only think about the mother & support ABO through all 9 months, on demand, without apology. Of course the crucial mistake there is that an intrapartum loss is just devastating for the mother & thus adversely affects her health but RH Reality Check admitting THAT would be a slippery slope indeed.

    • attitude devant

      Wow. Because I live in an area where home birth is popular I sort of have a subspecialty in working with women who have lost a baby to one of our less talented midwives in town. These women are devastated. Some of them never really recover.

      • Ellen Mary

        When I realized that, I scheduled a hospital birth. I used to say: cesarean recovery is 6 weeks, intrapartum loss recovery is 10 years, however I was wrong. It probably took me 6 months to recover fully from my C & I never would have recovered fully from an intrapartum loss.

      • Renee

        There are so many more than there ever ought to be.
        You are an excellent OB, and are the perfect doc for anyone, but especially someone with a pregnancy complicated by prior loss, trauma or health issues.
        I wish ALL WOMEN had access to care that is as high quality as the care YOU give. You are the only doc I have met that truly respects bodily autonomy, even when its a very unpopular decision.

        (yes, this was my doc, and she is GREAT)

        • attitude devant

          Renee is too kind. (Thanks, honey.)

      • Guesteleh

        What a shitty thing to have to sub-specialize in. That must really suck.

        • attitude devant

          I do wind up exceeding my usual Kleenex allotment for the exam rooms…

    • Renee

      No care for the fetus, not at all? Come on now. Caring for the fetus/baby, and accepting/promoting that the woman has the most rights in this situation, are NOT mutually exclusive ideals at all.

      They simply understand that the woman MUST have the right to control her body, even when it’s ethically suspect to some, or disgusting to others. Women cannot be full participants in life without this basic right.

      YES, this means the baby comes second to moms rights, as it should be, as it MUST be. I don’t know a single choice, or even pro abortion, advocate, that thinks nothing of the fetus, especially after the 1st trimester. They just put the woman first.

      • rh1985

        There’s legality and then there’s morality though. It’s morally wrong for a website to promote certain unsafe choices as medically safe, even if the woman has the legal right to make those choices.

        • The Bofa, Being of the Sofa

          And remember, “autonomy” is manifested in the ability to make choices, NOT in the choices one makes. Therefore, choosing the safest option does not contradict anyone’s “right to control their body.”

      • Ellen Mary

        Saying that VBAC is ‘safer’ shows no concern for the fetus because it fails to even acknowledge that there is another patient with rights & a different risk assessment than the mother. In fact, RCS is safer for the fetus. That doesn’t mean that a mother has to choose it, I myself may not, but what is offensive is to not even mention it.

        • rh1985

          The mother has the legal right to make whatever decision she wants. However, it is horribly irresponsible of the media to portray it as a safe, medically reasonable decision when it’s not.

  • Lena

    This is the kind of patient I’m talking about when I say hospitals should be exempt from any lawsuits if something were to go wrong. Because I agree, no one should be forced to undergo a C-section. But a doctor/hospital not be sued by someone who thinks she’s educated because she has an internet connection, either. Let women like her sign contracts that prevent them from seeking damages when they suffer the consequences of their petty desires.

    • The Bofa, Being of the Sofa

      Unfortunately, that doesn’t work. Sure, it seems like a good idea, but it’s far more likely to be abused by the provider. The “I didn’t really understand the risks ” is a hard excuse to accept, but if you waive the right to sue, unscrupulous providers are going to prey on patients. The old, “This is just formality saying you understand the risks, but don’t worry, the risks aren’t big. We take risks every day.”

      It’s far more important to protect the patient’s right to sue. I agree that it puts the provider in a really tough situation, but it’s the only way you can do it. The alternative is far, far worse.

      • ex-ncb

        I had to ponder this in my NCB days (I did end up having two VBA2Cs, doctor-approved). One of the ways I came around to accepting mainstream medicine once again (all else being equal) was thinking that it wasn’t exactly in keeping with the humility I wished to practice to dismiss entirely the education and experience of doctors. And I began to realize that we treat doctors as “authorities” *because* they are held responsible for using what they have learned in greater depth than the rest of us to make decisions we may never be able to be able to be truly, fully “informed” about. Even taking a couple of introductory college anatomy courses increased my respect for doctors who study a lot more than that. Of course I think we should be given accurate, relevant information, but is it some kind of disrespect and discrimination or just reality to say that the doctor’s recommendation deserves respect because he or she will rightly be held responsible for making a poor one with the inevitably greater knowledge gained in the course of becoming and being a doctor?

        • Young CC Prof

          Is the doctor always right? No. Is the licensed physician who has examined and talked to you far more likely to be right about your health than most other folks, especially random people on the Internet? Yes.

          • The Bofa, Being of the Sofa

            Though I do like ex-ncb’s additional point: Moreover, what are the consequences if either is wrong? If you doctor gets it wrong, they’ve got problems. If the random people on the internet get it wrong? Oh well…

  • Anna

    This is an honest question, not a challenge -
    If the risk of major complications with a 4th c-section is 1 in 8 and the risk of a VBA3C is 3.5%, isn’t the risk of the VBA3C smaller? What is it about the specific risks that make a planned c-section a better choice? Is the 1 in 8 number wrong? Are the VBA3C risks more life-threatening than the c-section risks? Does it depend on whether someone considers the mother’s or baby’s life more a priority over the other, or is the repeat c-section hands down safer for both?
    I’m not pregnant now and didn’t have a c-section before, so I’m just asking a question, not seeking a medical opinion for myself.

    • moto_librarian

      The type of complication is the bigger issue than the rate. Repeat section is demonstrably safer for the baby – the mother always bears the potential consequences of a c-section (other than TTN, which resolves relatively quickly and can also occur in babies born vaginally). The rate of rupture is 3.5%. That is a catastrophic complication that can kill the baby, lead to a hysterectomy, and even kill the mother. So yes, other complications can occur more commonly, but most are easier to resolve.

    • Smoochagator

      This is a good question, and something I was confused about, too. I’m looking forward to the answer.

    • Amy Tuteur, MD

      The “major” complications of a 4th C-section include things like blood transfusions and adhesions, as well as the risk of accreta in a subsequent pregnancy. The major complications of an attempted VBAC are rupture of the uterus and death.

      That’s one of the biggest problems with the way the media has addressed this issue. They’ve made it sound like the doctors are inexplicably recommending C-section when just about every obstetrician would recommend C-section in this situation because of the high risk of fatal consequences.

  • Anna T

    A hospital can’t force a C-section on anyone, and bullying/threatening is unethical. Period. It is HER choice.

    It is, however, a very dangerous choice. I’m not sure what statistics there are about VBA3C – probably (hopefully) not too many women do it, because the risk is crazy – but if I were this woman’s husband, I’d do anything possible to talk her out of this. Glad she and baby came out OK.

    Having said that, I think that 4 C-sections are no piece of cake either. Actually after 3 C-sections I’m not sure I’d risk getting pregnant again at all.

    • moto_librarian

      So why didn’t she go to a different hospital to begin with? I am not stating that she should be given a section against her will, but the hospital is between a rock and a hard place too. She can sue if her baby dies or is damaged, and chances are that the hospital will settle. I wish VBAC enthusiasts would quit bitching about “meen” doctors and hospitals and look at the role that malpractice plays in these situations.

      • attitude devant

        It’s a small town. Nearest bigger town is 23 miles away.

        • moto_librarian

          Personally, I don’t think it’s unreasonable to drive 23 miles to a bigger town with a better-equipped hospital.

          • The Bofa, Being of the Sofa

            It’s not like you are commuting back and forth or anything. Once you get there, you get to stay.

            Yes, it’s inconvenient for your neighbors to come visit, and if you have kids at home, dad might be commuting, but these are just part of the trade-offs./

          • me

            Exactly. I wasn’t having a VBAC with my last child, but I did opt for the larger teaching facility about 20 minutes away over the smaller community hospital 5 minutes down the road. Less convenient, perhaps, but the peace of mind was nice.

          • Ginger

            Except this ruling counted for ALL hospitals in the state AND allowed to force the c-section on her even if she happened to step foot on the property for something ELSE.

          • Young CC Prof

            No, that isn’t what happened at all.

          • Guesteleh

            If she’d gone to another hospital the court order wouldn’t have been issued in the first place. Having said that, I think it’s horrible that the order was issued at all and that it was that broad. No woman should ever have medical procedures forced on her against her will, even if she is making a foolish or misinformed decision.

          • Daleth

            I highly doubt this ruling could have counted for all hospitals in the state. The hospital that went to court to get this order would normally be the only hospital that would be covered by that order, and the court you go to for “step 1″ of any legal process does not have jurisdiction statewide, but only in its own county.

        • Renee

          If you mean our town, that is not a good excuse. There IS a hospital that would likely accept this plan, and would have staffing that could support such a thing, and would probably even have docs open to trying it. It’s a 2 hour drive, max.

          Unless she is totally indigent, this is really not the burden she would say it is. People routinely fly across the nation, and stay there for long periods, in order to get the care they need! But she thinks everyone ought to do what she wants because she cannot drive a few hours? Not cool.

          I know what this is like- With my second, I drove 3 HOURS, both ways, *every week*, to get the care I needed (and wanted)! This is why I just do not see this as a good reason to choose a place that cannot/will not accommodate you. And in the safest manner possible, without screwing everyone, and putting them in a dangerous, scary, potentially career ruining, possibly traumatic, place, in the process. No, this is SELFISHNESS, writ large (and a first world issue, to be sure).

          Is 2 hours ideal? Nope. With my first I drove 1.5 hours, and crossed the busiest land border in all of N America, in order to get to the hospital of my CHOICE. I passed several good ones on the way too. I get it, I really do.

          I am not the only one that has done this. Remember Joy, the ultimate VBAC warrior? She also drove a few hours to get her much desired VBAC in a safe place, instead of just showing up at her local hospital. I really respect her for doing this, for being willing to go elsewhere to find care that she wanted so badly.

          Maybe NCBers and VBAC advocates could support women in their travels, maybe have a fund or something. Offer them other help, instead of giving bad advise on how to screw over the staff at a hospital that doesn’t do VBAC/VBAMC.

          • attitude devant

            Nope. Florida.

      • Anna T

        Here is something I don’t understand: suppose a patient opting for a VBAC against her doctor’s opinion signs a consent form in which she states that she is aware of all the risks and potential consequences, and refuses a C-section (unless in emergency). Can this be done? Can a hospital still get a lawsuit then?

        • attitude devant

          You can have them sign a form (and in fact our standard VBAC consent form lists the risks) but they can still sue you. All it takes is for her to say she signed it but didn’t understand it.

          • auntbea

            WTF is the point of a signed consent form if the signer can say she didn’t really understand what she was signing? Assuming you are literate and of sound mind, that is what signing something MEANS.

          • attitude devant

            Awful, isn’t it? But hell, I know people who have been sued because someone claimed that she didn’t agree to the hysterectomy that she signed a consent for AND showed up for as planned. Bofa is right. You can’t sign away your right to sue.

          • auntbea

            But did that person win?

          • Who?

            It’s trickier than that, unfortunately. A judge once said that getting dragged into litigation is like dancing with an orangutan-you can tell the orangutan to start dancing, but you can’t tell it when to stop.

            Doctors who get sued spend hours and hours with lawyers, reviewing everything they said and did, everything the plaintiff says they said and did, and their records of what they said and did.

            And since the whole thing is likely to be funded by insurers, the litigation is run in such a way as to get the insurer the best outcome. Sometimes it’s easier and cheaper to pay up regardless of the rights and wrongs, depending on the size of the claim.

            As a recovering lawyer, I’m confident that our adversarial system isn’t able to find the truth, or even what happened, it is about winning and losing which is mostly about money.

          • Anna T

            Then is the consent form totally useless?

        • The Bofa, Being of the Sofa

          See my comment above.

          You cannot sign away your right to sue.

          And as I note, you don’t want to let people do that. It will be completely abused by providers.

      • Renee

        I am also sick of hearing that malpractice changes care in a way that is wholly detrimental. Sure, its not always a plus, but it does keep women safer.

        • moto_librarian

          Generally, I agree with you. I am just sick to death of the idea that a medical professional is somehow obligated to condone your birth “choice” even when it is demonstrably risky and against the standard of care.

        • Daleth

          Yeah, I have a problem with people who complain that “hospitals only do that/refuse to do that for liability reasons.” As a lawyer I can tell you that “liability,” in the medical context, means somebody got injured or killed.

          In other words, the correct translation is “hospitals only do that/refuse to do that because they’re trying to avoid hurting or killing their patients.”

          Call me overly cautious, but that’s what I WANT my hospital to be doing…

          • The Bofa, Being of the Sofa

            “hospitals only do that/refuse to do that for liability reasons.”

            To summarize your response: “they say that like it’s a BAD thing”

          • Daleth

            Haha. Yep.

          • toni

            Hear, hear!

          • Ginger

            Given that people did die when the right to have bodily autonomy, I don’t you or anyone else gets to say, “Oh, yes for everyone, let corporation decide, no bodily autonomy for you, you might chose death”. Guess what people did.

          • Poogles

            Please skim your comment before submitting – there are entire words missing from this comment and it makes it very hard to follow what your are trying to say. Or perhaps english isn’t your native language?

  • Young CC Prof

    Yes, she definitely had the right to refuse a c-section, and ethically, her doctor should have tried to convince her, not resort to legal action.

    However, the journalists were extremely ignorant and irresponsible in painting her decision as a reasonable medical option, and even implying that it was better than the hospital’s plan. Contrasting the risk of VBAC in a good hospital for a good candidate with the specific risks of a 4th c-section is a classic ICAN maneuver, and I’m really tired of it.

  • Mel

    I’m not a doctor, but if some is literally “terrified” of a medical procedure, perhaps a psychological consult is in order.

    In the US, teenagers can legally drive at age 16. I started at age 21.

    Did I think I was making an informed decision? Oh, of course. I had LOTS of reasons as to why I didn’t need to drive: I could ride the bus and save money and carbon, and who needs a car?

    What was really going on?

    I had a raging anxiety disorder that manifested itself in a deep-seated terror that I was going to cause a traffic accident that would kill someone. I was SURE I was going to kill someone. Absolutely fricking sure I was going to be the cause of someone’s death while driving a car.

    So the years passed. I got severely depressed at age 19 and started seeing a therapist. More time passes.

    The first time my therapist brought up the idea of my driving I apparently looked like a deer in the headlights and she was worried I was going to bolt out a closed window.

    Tackling that fear was the hardest thing I’ve done in my life so far. Doing that also gave me the courage and tools to LIVE my life.

    What I’m trying to say in my rambling way is that I hope Ms. Goodall gets the support she needs to face whatever issue(s) that makes the idea of being in a hospital – or having a CS – managable rather than terrifying.

    Ironically, now one of the activites that I find relaxing is …. driving. Oh, the irony. :-)

    • Bombshellrisa

      Mel-I too didn’t drive until 21, for much the same reason. Being able to face down a situation because you understand what is REALLY going on is liberating.

    • Cobalt

      I think this really gets to the core of a lot of NCB appeal. Women who have major anxieties about birth don’t have a good support network to ‘catch’ them and get those issues addressed responsibly. The big groups reaching out to women with something that helps them feel better are NCBers. They may be doing it for ideology or profit, but it works. Mainstream medical doesn’t do a good job of addressing these anxieties, leaving a gap for quacks.

      It just gets worse from there, as fear is transferred to the medical system, which increases risk and creates new reasons to worry.

  • The Computer Ate My Nym

    In the end, the issue was rendered moot when Goodall chose to go to a
    different hospital where someone agreed to honor her wishes. She labored
    without progress and ended up with the C-section that she had wanted to
    avoid, further emphasizing the fact that she was never a good candidate
    for a VBAC.

    This was the best possible outcome, I think, given the limitations of the case. The patient got to make the attempt that she wanted and yet was somewhere safe when the inevitable failure occurred. And she was not used by politicians to further reduce the rights of pregnant women.

    Ms. Goodall made, IMHO, a bad decision medically. But it’s her right to make a bad decision. It’s also the right of the doctors originally caring for her to protest her bad decision but no one has a right to force an operation on a competent patient. End of story. And calling CPS when there is not yet a child is completely inappropriate.

    • BelligerentBruncher

      “no one has a right to force an operation on a competent patient.”

      I think that’s true. But, as stated in the article, without the knowledge of the actual risks, or her inability to properly interpret the risks, then she lacks capacity for consent. Then her competency would have to be determined by a judge.

      • Young CC Prof

        Okay, ignorance or misinformation is NOT proof that someone lacks the capacity to consent. A patient lacks the capacity to consent if she is unconscious or otherwise unable to communicate, or if it has been demonstrated that she lacks the mental capacity to comprehend the situation as a result of a serious mental disability. Being “wrong” does not make you mentally incompetent.

        • BelligerentBruncher

          That’s not necessarily true. I ran in to a patient who was against having anesthesia. She needed an appendectomy and wanted to have the surgery without sedation – or local anesthesia. She obviously was wrong. We tried to explain to her that it wasn’t going to go down that way just because she wanted it like that.

          Psych declared that she lacked capacity and the judge declared her to lack competency and she was assigned healthcare proxy – who then signed consent to administer anesthesia before the surgery.

          What do you think we should have let her do?

  • Zornorph

    How long before this woman gets pregnant again and goes for a VBA4C?

    • Lisa from NY

      It’s still within her legal right to try for a VBA4C.

      • The Bofa, Being of the Sofa

        So what? That doesn’t mean that it’s not stupid or that she doesn’t deserve to be criticized for it.

      • BelligerentBruncher

        At what point, risk wise, is it not for her to proceed? Legally or ethically?

        Some believe, as I do, that after a certain point there is an intention to cause harm. Are you OK with allowing this woman to intentionally harm her baby or herself?

  • Karen in SC

    Anyone that would like to tweet this article to Ms. Jacobson, use @rhrealitycheck. A responsible journalist should respond to criticisms about fact-checking and taking information out of context.