Hospital VBAC Bans Hurt Women in Not-So-Obvious Ways

Trial of Labor (10-15)

At the last West Michigan Better Birth Network meeting, the other co-leaders and myself discussed lack of access to vaginal birth after cesarean (VBAC) at lakeshore hospitals.  Mercy Health Hackley, North Ottawa Community and Gerber Memorial hospitals all have official policies banning VBACs.  Despite the ban, doctors at Gerber have a national reputation for supporting the birthing decisions of moms who desire VBACs there, but not without resistance from administration.  We decided to take up their cause through a letter-writing campaign.

Although I do not have a personal story about VBAC, I do have the insight of a preventionist.  This is the letter I will send:

Richard C. Breon, President and CEO
Spectrum Health
100 Michigan St. NE
Grand Rapids, MI 49503

October 6th, 2015

Dear Mr. Breon:

I am writing concerning the official policy of Spectrum Health that does not allow women to have a trial of labor after a cesarean at Gerber Memorial Hospital, despite the fact that many women do safely have vaginal births after cesarean (VBAC) there.  I am a birth and postpartum doula, childbirth educator and Certified Prevention Specialist through the State of Michigan.  Prior to becoming self-employed, I coordinated the Muskegon County Fetal Infant Mortality Review for seven years.  During that time, I abstracted over 150 cases of fetal and infant death, compiling the data that informed Muskegon’s infant mortality prevention efforts, which I also spearheaded.

The Spectrum of Prevention, developed by Larry Cohen based on the work of Dr. Marshall Swift, places policy and legislation on the highest rung of influence, with the most potential to impact the strategies below it.[1]  For this reason, policies that prohibit women’s access to VBAC at community hospitals, despite ACOG’s recommendation that this decision should be made by the patient and her provider[2], have widespread implications far beyond the health risks of repeat surgery.  VBAC bans undermine women’s autonomy by taking the decision for where and how they will give birth away from them and their providers and placing it in the hands of administrators.  The underlying message is that women cannot be trusted to decide what is best for themselves and their families.

Groundbreaking research has recently been conducted that examines how structural and institutional policies impact individual behavior.  Several such studies have been published in the September 2015 issue of The American Journal of Preventative Medicine.  In “A First Look at Gender Inequality as a Societal Risk Factor for Dating Violence,” researchers show that there is a relationship between the Gender Inequality Index (GII) and adolescent dating violence[3].  While VBAC access is not an indicator on the GII, policies that respect the decisions of women and their providers in childbirth, so long as they are demonstrated to be safe, may reduce gender-based violence.  Domestic violence is not only one of the leading cause of pregnancy-associated injury deaths[4], it is also a risk factor for tobacco[5], alcohol[6] and other drug use[7] in pregnancy.

The official ban on VBACs at Spectrum Health Gerber Memorial should be lifted, not only for the health and safety of birthing women in West Michigan, but to improve gender equality, reduce gender-based violence, and prevent perinatal substance use and the resulting maternal and infant mortality.

Thank you for your time and consideration.  Feel free to contact me if you have any questions.

Sincerely,

 

Faith Groesbeck, BA, CCCE, CPS

 

cc: Dr. Tami Michele, DO
Dr. Stephen Rechner, MD
Randall J. Stasik

 

[1] The Prevention Institute. “The Spectrum of Prevention: Developing a Comprehensive Approach to Injury Prevention.”  Accessed online at: http://preventioninstitute.org/component/jlibrary/article/id-105/127.html on 10-6-15.

[2] American College of Obstetricians and Gynecologists.  “Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115.”  Obstet Gynecol 2010;116:450–63.

[3] Gressard, Lindsay A. et al.  “A First Look at Gender Inequality as a Societal Risk Factor for Dating Violence.” American Journal of Preventive Medicine, Volume 49 , Issue 3 , 448 – 457.

[4] Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: A Leading Cause of Injury Deaths Among Pregnant and Postpartum Women in the United States, 1991–1999. American Journal of Public Health. 2005;95(3):471-477. doi:10.2105/AJPH.2003.029868.

[5] Bacchus, L., Mezey, G., & Bewley.  “Domestic violence: prevalence in pregnant women and association with physical and psychological health.”  European Journal of Obstetrics & Gynecology and Reproductive Biology.  113: 1 (2004): 6 – 11.

[6] Project CHOICES Research Group.  “Alcohol-exosed pregnancy: Characteristics associated with risk.  American Journal of Preventative Medicine.  23 (2002): 166 – 173.

[7] Martin, S.L., Acara, J., & Pollock, M.D. (2012, December). Domestic Violence During Pregnancy and the Postpartum Period. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence.  Accessed online at: http://www.vawnet.org on 10-6-15.

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