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It appears that the statisticians at California Pacific Medical Center are wrong. And they will continue to be wrong. The hospital system will lose money and reputation and because of it. Risk-wise, the procedure they are going to disallow should only be discontinued in a hospital that is dangerously understaffed. Note the word “dangerously”; lots of hospitals are “understaffed”, but this (shouldn’t) be their situation.

A protest march walked past my window a few minutes ago with signs reading “Got VBAC?” I was curious and found out that the local hospital, St. Lukes, which just joined CPMC is changing their policy on VBAC in August. They will now completely disallow the procedure.

Read the SFWeekly article, on both pages and especially the comments after the article

And go ahead and google for “VBAC“. You’ll find lots of information, feelings and statistics. Just about all of it says that it is a safe method of delivery as long as the hospital maintains an appropriate reserve staff for the 5 in 1000 chance of a critical emergency.

Here are the (very useful) comments from the article. It includes recommendations as to other places in the city where you should have your baby instead:

1.

My wife wanted to attempt VBAC 11 years after the birth of her son, with her doctor’s OK. After 48 hours in induced labor, with a dialation of 3 cm, our daughter’s heartrate went from 100 to 180 in about 3 minutes, and we decided that a ceasarian was a better option. Thankfully she was already in a hospital setting where it could take place immediately. There is no way that she (or I) could have handled a 30 minute drive from home to the hospital.

Fortunately we had the option.

Comment by Nick Fitzsimmons – April 26, 2007 @ 06:26AM
2.

Thank you for covering this story, as it is a very important issue for all those involved and then some. I want to comment on your statement that it’s believed to be about money. This may be true for some, but please don’t speak for everyone. There is a much bigger reason in my opinion and that is control. CPMC is notorious for controlling the births that come their way, and meeting them with a fear based agenda. This mentality is contagious and needs to be stopped. Please let your readers know that we intend to protest this on Friday May 11th at 10:30 a.m. A rally of women, men and children who want to let St. Luke’s and CPMC know that we are aware of their attempts to take away our rights, will meet at 24th and Mission Bart and march to St. Lukes, where we will protest at 11a.m. Anyone who wants to have a choice in how they birth their own babies are obliged to come and march and stand up against this baseless decision. Thank you , Alison Luke

Comment by Alison Luke – April 26, 2007 @ 01:26PM
3.

St. Luke’s is by far the best place in The City to give birth, and the loss of the VBAC option is very, very sad. The tag line on this article says that activists suggest that this is about money and not safety. Actually it appears to be about both. If CPMC, which now owns St. Luke’s, would pony up the dough to keep an anesthesiologist and obstetrician on staff 24/7, then the safety condition would be met and VBACs would still be possible at St. Luke’s. In that way, this is a budgetary decision that negatively affects the pregnant woman’s right to choose the circumstances of her own labor and birth. This is tragic. This article quotes a phenomenal VBAC success rate of 85% at St. Luke’s. Note that the article does not quote a VBAC success rate for CPMC–but I assure you that it cannot possibly approach St. Luke’s, just like the c-section rate at CPMC is much, much higher than at St. Luke’s. “Natural birth at CPMC is an oxymoron,” says a woman in the article, and she is absolutely right. Pregnant women, if you would like to avoid a c-section, St. Luke’s is the place for you. Unfortunately this is no longer true for VBAC mamas. I really hope that this decision is reversed and CPMC decides to fully fund the stellar OB care at St. Luke’s that simply cannot be matched at CPMC.

Comment by Lisa G – April 27, 2007 @ 01:21AM
4.

Psst, proofreaders–cesarean section is generally spelled “cesarean” in this country and not capitalized.

Comment by Stella Mari – April 27, 2007 @ 01:25AM
5.

The 1% risk of rupture is a real one but Dr. Main’s experience of the subsequent loss and morbidities is perhaps overstated. A study by Landon et al published in the New England Journal of Medicine (Jan. 2004) titled Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery found that “Among 17,898 trials of labor and 124 ruptures, we found two neonatal deaths, for an overall rate of rupture-related perinatal death of 0.11 per 1000 trials of labor.”
If CPMC had 1 – 4 uterine ruptures a year resulting in the “loss of uteruses, loss of babies,” as Dr Main was quoted as saying, this is indeed a run of very back luck. If CPMC is doing 6000 births a year and the Cesarean section rate is 25%, that is potentially about 1200 VABCS a year (at 1990 rates for trials of labor). It should have taken 15 years to have 2 perinatal deaths.
Dr Norrell’s concern that the OR could be busy and the OB team doing other surgeries is also a valid issue- however a theoretical inability to do emergency C/S for uterine ruptures is only one of several reasons that lack of staffing should be concerning to the public. Research also demonstrates that hospitals without adequate staff are much more likely to have higher rates of all types of medical errors.
Given that the life risk for death related to an automotive accident is about the same as for uterine rupture, simply doing repeat C/S- which carries it’s own risk of death and morbidity – seems a bit of an over reaction. It’s like deciding to fly everywhere rather than drive!
We should do the equivalent of wearing our seat belts, driving the speed limit and not driving drunk: Keep VBAC as part of integrated systems of care within hospitals where emergency care is available. Then each woman can make a decision about whether she gets in the car to drive to the hospital to have a repeat cesarean section or to have a VBAC!
Luckily women in San Francisco do still have choices; perhaps not at Sutter Hospitals but at UCSF Moffit Hospital and at San Francisco General Hospital Medical Center. Both hospitals have midwives and physicians who support a woman’s right to be informed and make decisions after thorough discussion based on all the scientific evidence. Either choice is a reasonable personal choice, as earlier comments indicate, but the ability to have a choice should be preserved.
Leslie Cragin, Certified Nurse-Midwife, PhD
Associate Clinical Professor
UCSF Dept. Ob Gyn & R.S.

Comment by Leslie Cragin CNM, PhD – April 27, 2007 @ 07:33AM
6.

I’m from Australia, where the situation on VBAC is pretty much the same as the US. The only way I could experience a normal straigtforward birth, a birth that in the end was ecstatic and joyous, was to choose to have my VBA2C at home.

Hospitals these days, (from my experience with my first 3 sons, at 3 different hospitals) show no respect to the miracle of life, and nearly half of all births lead to women experiencing PND or PTSD. That is NOT a healthy outcome. It is scandalous. Whilst women are traumatised, a lot of VBAC mums will choose homebirth despite a percieved ‘risk’ of UR. I still have PTSD from the c/sec of my 3rd son. Thank God I didnt have to be traumatised from my 4th sons birth, and instead had a normal safe birth they way nature intended.

Comment by Rebecca – April 27, 2007 @ 07:01PM
7.

Dear Editor,
Thanks are in order to the SF Weekly for your informative article regarding several hospitals in San Francisco and their policies regarding vaginal birth after Cesarean or VBAC. I am sorry that Ms. Smiley did not mention San Francisco General Hospital in her article even though I spent a fair amount of time speaking with her. Unlike any other hospital in San Francisco, San Francisco General has a large midwifery practice accounting for over 55% of our births. We are extremely supportive of VBAC’s, we provide one-to-one nursing care for all patients in active labor. We continue to support new mothers with couplet care after birth. We also provide extensive lactation support and services and are the only hospital in San Francisco which has applied for the WHO’s Baby Friendly status. If there are disgruntled and disappointed women wanting natural bith in SF, take a look at “the other” hospital in the Mission, San Francisco General!

Louise DiMattio, RN
Nurse Manager – 6C
San Francisco General Hospital
San Francisco, Ca. 94110
(415) 206-3299

Comment by Louise DiMattio – April 30, 2007 @ 04:49PM
8.

Emergencies occur in non-VBAC labors, and there are other situations that increase the chances of needing an emergency cesarean where hospitals don’t make special exceptions such as induction of labor and epidural analgesia. If a hospital states that it isn’t safe for a VBAC labor, it is saying that it isn’t safe for any woman to labor there.

As for using concerns about malpractice suits as a justification for VBAC denial, that violates the American College of Obstetricians and Gynecologists Code of Ethics, which states: “Conflicts of interest should be resolved in accordance with the best interest of the patient, respecting a woman’s autonomy to make health care decisions.” Not wanting to get sued is a conflict of interest.

Henci Goer

Comment by Henci Goer – May 8, 2007 @ 12:06AM