Thursday, November 06, 2008

VBAC bans in Iowa

This article about Iowan women being forced to travel several hours in order to have a vaginal birth--Many Expectant Moms in Iowa Forced to Give Birth Away from Home--is particularly interesting to me since I used to live in Iowa City. I knew that VBACs were getting more difficult to arrange in Iowa, but was not aware that the UIHC was the only hospital in the state who will "allow" a vaginal birth after cesarean. I tried to double-check that fact at ICAN's VBAC Hospital Policy database, but Iowa hospitals do not yet show up there. (Anyone want to volunteer for ICAN to verify Iowa's VBAC policies?)

I have lots more to say about VBAC bans in the near (or kind of near) future...


  1. Almost all of the Iowa hospitals have already been called for the ICAN VBAC Policy project, but the search function is currently not working. We're hoping to have that back soon.

    There actually are other hospitals in the state that say they "allow" VBAC, but what they say and do are two completely different things. From the experience of ICAN of Central Iowa moms, we are finding University of Iowa Hospitals to be the most VBAC supportive. It is unfortunate that women are forced to drive across the state for evidence-based prenatal care & birth when many of us live in Des Moines (Iowa's capital, largest city, & home of 4 large hospitals).

    Lisa Houchins
    Co-Leader, ICAN of Central Iowa
    Education Director, ICAN

  2. This just makes me sick. HOPEFULLY if enough mothers complain and seek other care, something will happen. This is so sad.

  3. Rixa,
    I just want to tell you Thank You for working to support better birth options for mothers in America. You make a great crusader.

  4. Ugh. Safety my foot.
    How is it safer to leave women no choice but to travel a hundred miles while in labor? If UIHC will offer VBAC to a mother, then it's obviously safe for that mother to attempt a VBAC. Aren't local providers endangering her by refusing her the option?

  5. All the more reason to have a home birth. Ugh, it's so sad that there are people out there that can decide what a woman can do with her own body. Sad.

  6. Gah! I'm just perplexed as to why anyone would BAN VBACs. If something (meaning C-sections) is so dangerous that it supposedly gives cause to outlaw a normal vaginal birth then STOP DOING IT. I'm gonna keep saying it till someone hears me!

  7. Hmmm, at one point, Mercy of Iowa City (NOT Mercy in Cedar Rapids, shudder) had the lowest C-section rate and the highest VBAC rate. I think I found that information on ICAN of Iowa's site... Hmmm, low C/S and high VBAC, could the two be related?

  8. Rixa,

    Congratulations on your dissertation. That must feel so great!

    I heard a recent rumor, but from a credible source...

    The NIH is considering a consensus conference to review the data for VBAC and to develop a revised set of guidelines that would reduce the staffing burden for hospitals. Currently, per the ACOG guideline, all hospitals hosting patients for a trial of labor must have an anesthesiologist, an OB and an OR "immediately available" in the event of a uterine rupture. This is a tremendous staffing burden--not only must staff be present, but available (not tied up in another surgery). This is an economically impossible standard to provide at 2 am for centers with low delivery volume. Thus the number of hospitals that have stopped offering the service.

    As I understand, the consensus conference under consideration would first reconsider the definition of "immediately avaialble." Many centers have set an impossible 30 minute decision to incision rule. But at what cost??? Even 1 hour would be more realistic for many centers. The added risk should be epidemiologically quantifiable, and birthing women should be able to make an informed decision whether 1 hours is acceptable.

    Second, the conference would stratify VBAC candidates based on epidemiologic risk. So women with favorable factors (spontaneous labor, prior vaginal delivery, etc) may once again be welcomed to labor in hospitals without complete 24/7 in house staffing.

    Just a rumor at this stage, but something to watch for.

  9. Making a woman wait an hour for a STAT cesarean is not the way to go. It's a staffing issue, no doubt, but it's also a money issue. I don't think hospitals WANT to potentially tie up their ORs with women who could "just as easily" schedule a cesarean. People just don't seem to see the VALUE in supporting something as "uncertain" as vaginal birth when cesarean surgery is presumed so safe. And since the scheduled cesarean brings in much more revenue... all the more reason to support cesareans over vaginal birth - manageable & profitable.

    Rixa, I'm anxious to read what you have to say about VBAC bans. I'll be addressing the issue in my hometown in December 1 and need some guidance!!

    Congrats on the dissertation. I remember how AWESOME it felt to have it done! Now it's time to start publishing articles in scholarly journals, right? ;) Something I still haven't done with my body of research...

  10. I still don't see why uterine rupture has that special status among catastrophic obstetric emergencies that warrants the requirement of immediate availability of a surgical team. If I had a comparably low risk of something else potentially fatal, would I be an automatic cesarean in most hospitals? I might need a stat section for any number of reasons. Why is it acceptable for anyone to give birth in a hospital that can't section her in 30 minutes, VBAC or not?

  11. Judit, you're right on. Cord prolapse or placental abruption are also circumstances that can warrant an immediate c/s and that happen with roughly the same frequency as uterine rupture. It just isn't logical (not to mention ethical or fair or just plain right) to force women with one particular risk factor to have mandatory surgery, when a lot of other women might just as well need that immediate surgery but they at least get to choose a vaginal birth!


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