Thursday, October 01, 2009

Elective(?) repeat cesareans

If a woman is forced to have an Elective Repeat Cesarean Section (abbreviated ERCS in the medical literature), but vigorously protests against it and does not agree to the surgery, can it really be called "elective"? One Arizonian woman says no. She is pregnant with her fourth baby. Her hospital, which allowed her to have a VBAC with her third child after her second was born via c-section due to placental abruption, has informed her that she will not be allowed to give birth vaginally. If she shows up in labor and refuses surgery, the hosital's CEO has told her they will seek a court order for a cesarean section. From the Lake Powell Chronicle:

A pregnant woman’s pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital’s general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.

Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

“Page Hospital is, as many small communities are, challenged with resources,” said Chief Executive Officer Sandy Haryasz. “Page simply does not have the physician resources to respond to an emergency."...

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women’s care clinic in Phoenix or have unassisted home delivery....

Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.

“I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order,” Joy said. “They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency....
The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

“My doctor doesn’t have a problem with me having natural delivery, but said that the hospital does,” Joy said. “The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn’t matter since the hospital has decided that all VBACs have to have an ‘elective c-section.’ I think my definition of ‘elective’ differs from theirs because I don’t want this.”
Read the rest of the article here.


  1. Hmmm... this hospital managed to have sufficient resources to safely manage the abruption the first time, and to safely manage the VBAC the second time. Wonder if they're saying that it's not safe to give birth at their hospital at all, in case of another abruption?

    That could be an interesting investigative report for some intrepid local journalist... :-)


  2. The woman in this article needs to get a "declaratory judgment" from the court, ahead of time, saying that the hospital cannot force her to have an elective c-section. She is likely to be successful in her claim. If even one woman can get such a declaratory judgment, than the very idea of a vbac ban will become against the law. This issue needs to be taken to the courts!

  3. Hi! Longtime reader and first-time commenter.

    I wandered onto the website of the "Duggar family" (you know, the ones with 19 kids) and saw that under the FAQ section she discusses VBAC and how flawed the medical system is. She has had 3 c-sections and 13 VBAC's. 13!!! Take that, VBAC haters!!

    Anyway, here's the link:

  4. Also, I would be scared to be under the care of someone that is so against what I believe in. I would be too afraid they would try to sabotage me to prove a point about it being unsafe. I'd like to think that would never happen, but you never know these days!

  5. Emily--I had wondered about her obstetric history. Here's the excerpt if any of you want to read what she has to say:


    Q: You just gave birth your 8th daughter, how was the 18th pregnancy compared to your 1st?

    A: As with any first time birth experience you might have fear of the unknown. As we approach each birth there are still the concerns of the unknowns such as the labor and delivery, each one has been different but having had the experience over and over does help some. Each time we have prayed for the health of mom and baby, and asked for a healthy, easy delivery.(As much as possible when were talking about labor!) I’ve had three C-sections, one with our second birth, twins, Jana and John-David, with our 15th, Jackson and with Jordyn-Grace. All the rest have been vaginal births, 13 of which have been VBAC’s. (Vaginal Birth After Cesarean) We were hoping to have another VBAC with this last delivery.

    I would say the greatest change that I have seen in the field of obstetrics, and I might add that it is very troubling to me, is the idea that once you’ve had a C-section you must have a C-section for any other pregnancy. It is much healthier for mom and baby to avoid major surgery and all the complications that go along with a C-section if possible. Granted, there are health situations that would warrant such, but for years obstetrics encouraged TOL (Trial Of Labor after previous C-section) with many successful healthy vaginal births. It was quite alarming to be told that I could no longer have a vaginal birth due to hospital or insurance companies regulations. It appears that what is best for the patient is not the priority with this decision. I feel our health care is being jeopardized by this unhealthy approach. Doctors are having to tell their patients that they no longer offer VBAC assistance due to hospital regulations and some might even state to the patient that they are not safe so as to avoid confrontation. Statistics prove much differently. For the many women that find themselves in this situation, ICAN is an organization that is very helpful in gaining more information on this topic. One of which I believe will be reversed in the near future as more women make a clear statement to health care providers and insurance companies as to how they would prefer to deliver there babies in a safer, healthier manner. (Now I will step off my soapbox!)

    We are thankful our hospital allows trying a VBAC as long as they have an anesthesialogist on hand in case there is an emergency. On Thursday, December 18th we went to get Michelle checked by the doctor after Michelle had been having labor pains throughout the night. The doctor checked her and said she was dialated to about 4cm, but the baby was transverse like her brother Jackson had been.

    Jordyn-Grace Makiya Duggar had to be delivered via C--section. We are thankful Jordyn-Grace is healthy and Michelle is recovering quickly.

  6. So where do we go to contribute to this woman's legal costs so she can get a "declaratory judgment"?

    How can the hospital possibly say that they are not prepared for emergency situations?? That doesn't make any sense at all.

  7. Good for her for standing up to the hospital officials and making a big stink bout this.

  8. I'm curious. She shows up at the hospital, in active labor, or fully dilated. They get the court order to force the section (assault is more accurate). So they assemble the necessary staff (OBs, anesthesia, RNs, etc.), who just happen to be the staff needed for VBAC there. And they might have to cancel other surgeries, or call people in to do this. So they can get the staff to do an unnecessary surgery, but not for her to deliver vaginally? This logic makes absolutely no sense to me.

  9. Kathy took my thoughts right out of my own head. So this hospital is adequately equipped for obstetrical emergencies except for VBACs? Makes no sense. I agree this woman needs to have a declaratory judgment. She at the very least needs to contact a lawyer. ASAP.

  10. I think the answer is that this hospital got lucky with the first c-section and does not want to risk another Vbac. Here is the problem: small town hospitals don't require Doctors and anesthesia to be in house so their decision to incision time is 30 minutes. A baby has 10 minutes from the time the Mother dies to be born. If not, then the baby will be compromised. This I got from studies on post mortem c-sections. So if a mother has totally abrupted and the baby is cut off from oxygen, you have 10 minutes given teh baby was in good shape prior to the total abruption.

    so it depends of what you call safe. I think safe is delivering in a tertairy care center or a free standing birth center who has a tertiary care center moments away.

    Also this woman has a choice to go some where else to birth. I have taken care of women who have traveled a good distance to have a vbac.

  11. Pinky, that still does not explain how the hospital can be certified as safe for a vaginal birth OR a c/section that might go wrong, but NOT a VBAC that might go wrong. Her risks (and her baby's!) for an unnecessary c/sec, in terms of mortality, are actually *higher* than for a VBAC, especially if the hospital avoids induction agents like pitocin. This policy quite literally makes no sense in terms of medical care risks.

  12. Definitely not elective in my book. Between this & the VBAC Victory story that Sarah H. posted on her blog The Wonder of Birth ( )I'm thinking there is good evidence of the necessity for health care reform & perhaps enough legal grounds to actually move forward.

  13. She has to drive 5 hours to get her VBAC in a hospital. That is like driving about 2/3 of the length of the state of Mississippi, Alabama, Illinois or of the breadth of Tennessee. That's a long freakin' time in a car in labor, especially if VBAC is so dangerous.


  14. I think that this is just crazy. It is so sad that hospitals and doctors are stopping VBACs. I think they are really worried about insurance, being sued if anything went wrong, etc. It is sad that insurance, malpractice and patient, is changing how medicine is run in this country. I really hope that more people go into OB/GYN to fight the system and change things, at least that is what I hope to do. As for the hospital getting a legal order...I hate that judges can do this as well! If I were a judge I would surely deny it..I would hope there is several ways to get around that? is there?

  15. I agree with everyone else that the hospital's reasons for not allowing VBAC is illogical. If they can accomodate other birth emergencies, then they can accomodate a VBAC.

  16. Kari Birchler10/2/09, 4:25 PM

    I just wanted to nit-pick something: several posters have referred to vbacs and then mentioned "other" obstetric emergencies. I know what you meant, but vbacs are NOT emergencies. They are normal, vaginal births that sometimes (read: "rarely") need intervention because something goes wrong--just like any other normal, vaginal birth.

    Just sayin'.

  17. This just makes me sick! Seriously my stomach is sooo upset over this kind of thing! I just recently supported my sister in labor and witnessed a wonderful and safe VBAC. I'm just so sad to hear this...

    There is no way the hospital is making the decision for unnecessary surgery for mom or baby's safety. :(

  18. So Pinky, what happens to the women giving birth who need an emergency c-section immediately or the baby or mother will die? Are they just crap out of luck at that hospital because they don't have all the necessary medical staff on hand 24hrs? Would you like to drive 5hrs away while in labour to get to a hospital/birth centre that supports vbac? I bet an unassisted homebirth is looking pretty good to this mother right now...

    Your answers seem to reinforce the status quo in the current medical system, and that is disappointing. Another one absorbed into the system.

  19. So I actually watched the Duggar's show last night and she told the stories of each of her births. It was so interesting! She had all naturally (except the c-sections) and several were home births. She has a whole section on home births in her book. You can find the excerpt here.

    I haven't read the book, but I bet it would be a good read. She looks at birth in a spiritual way and I bet she has a lot of insight.


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