Legal Rights and VBAC

The Giving Birth With Confidence blog has a new series titled A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations. It includes a section on Legal Rights and Protections for VBAC [Vaginal Birth After Cesarean].

Is VBAC illegal? Is homebirth illegal?

The VBAC Facts blog has a great explanation of the legalities of VBACs and homebirth. To summarize, VBAC is legal everywhere in the US. Homebirth (whether VBAC or not) is legal everywhere in the US. The only legal restrictions are placed on providers, what they may do and where they may do it.

You may also be interested in my previous blog post, Is it legal for Florida midwives to do VBACs?

Oh, and if you haven't read it yet, don't miss Time magazine's article The Trouble With Repeat Cesarians in conjunction with ICAN's recently-released report on the organization's hospital survey. I especially liked this quote from the Time article:

But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Hm. Why give patients information about a "procedure" that is not offered by you or allowed by your hospital?

US Air Force Pays Record Settlement for Injured Baby

U.S. Air Force Pays Record Amount for Baby Injured in Government Hospital

What is the take-away here? That VBACs are dangerous? That VBACs shouldn't be augmented with Pitocin? Or something else?

The Latest from ACOG

The American College of Obstetricians and Gynecologists "reiterates its long-standing opposition to home births":

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.

Anyone besides me think that this statement is a response to The Business of Being Born?

Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death.

Oh, that's nice. More and more doctors and hospitals won't "do" VBACs, but they're telling you not to do them at home either. I think most HBAC-ing women would rather have been in the hospital, if they thought they would actually have been successful there.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan.

Really??? Then don't ignore our birth plans when we make them. And put pressure on the hospital staff to respect them, as well. How come the L&D nurses think that birth plan = cesarean section? What's up with that?

The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.

But the two aren't mutually exclusive, the "process" and the "goal"! Don't you get it? A healthy process creates a healthy mom and a healthy baby. Disturbing the process adversely affects the outcome.

And I'm sorry, women who are so traumatized by their birth "experiences" that they will not set foot in a hospital again unless they are dying, are not "healthy". Women whose bodies are cut and then stitched back together are not "healthy". Babies who leave the hospital formula-fed when their mother had planned to breastfeed them are not "healthy". Healthy is not the absence of disease or medical condition. Healthy is body, mind, and spirit.

So ACOG, if you don't like out-of-hospital birth, start practicing evidenced-based medicine. Start trusting women's bodies to birth. Stop pretending that you know everything (anything?) about natural (normal, physiological) childbirth. Stop lying to women. Try listening to them instead.

Is it legal for Florida midwives to do VBACs?

Occasionally one will hear that it is illegal for licensed midwives in Florida to attend VBACs (vaginal birth after Cesarian). Not so, as Sarasota midwife Heidi Dahlborg, LM, explains:

It is legal for a Florida LM to do a primary VBAC, but it does carry a risk score of 3, which requires a consult from a VBAC friendly doctor. Some midwives who can not get consults have mistakenly told people "its illegal to do VBACs at home" when they mean "it is illegal for me to do VBACs at home because I can not get the proper consult to comply with the law".

So you can legally have a VBAC with a homebirth Licensed Midwife, as long as she obtains a consult from a physician with OB privileges. There is a state risk assessment score for LMs that assigns points for various risk factors, and when your points reach 3 for any reason, you must have a consult with a physician that does obstetrics. A prior c-section scores 3 points for "prior uterine surgery". Prior uterine surgery with a subsequent successful vaginal birth (a secondary VBAC) is only 2 points. So if the mother has no other point scoring risk factors, she will only have a 2, and thus can have a VBAC with out consult. If she smokes, is over/underweight, or has other factors, she will need a consult based on her overall points. The risk assessment is in the rules, which can be viewed online at http://www.doh.state.fl.us/mqa/midwifery/mw_statutes.html under Rules: Chapter 64B24, its a large document and you must scroll down to Chapter 64B24-7, Midwifery until you see the Midwifery Practice Act, which includes the risk assessment. You can also get a risk screening tool from any practicing midwife.

If the midwife also has a birth center, that complicates things further. The birth centers are governed by a separate law, and it says the birth centers can only do VBACS in the birth center if they are participating in the National VBAC study, which has been closed for 7 years. So there has been no way to comply with birth center law, so there is no way to legally do a VBAC in the birth center. But midwives who own birth center will often do VBACs at home, even though they can not do them in the center.

I know an attorney that was drawing up a consent to allow midwives and moms to choose to go outside of the law or rules, as part of the alternative medicine law, but I do not know if anyone actually does that yet.

The American Association of Birthing Centers, the birth center association, is going to open the National VBAC study up again soon, thanks to Charlynn Daughtery a Tampa midwife that own Labor of Love Birth Centers. She has really been a strong VBAC advocate in political circles, working hard to keep VBAC options open at home and birth centers. Once that study open, hopefully in Fall, Florida women will be able to have VBACs in birth centers if the consults are obtained. You can contact them, AABC, to urge them to get the VBAC study opened again.

So, as it stands- in Florida you CAN have a VBAC at home, but not in a birth center, as long as the proper consults are obtained. Many women travel 3 hours or so to get the consult, at around 28 weeks, but you can usually get the consult anytime including preconception. It is generally just a review of your surgical record, and a conversation on risks and benefits.

Thanks, Heidi, for the great explanation!