How does a hospital go about banning VBACs? Can they really perform a cesarean on a women against her will (assuming she’s compentent)? Do they transfer her to another hospital? What if that isn’t an option?
Cite that they do this? I’m sure that in some cases they strongly encourage the C-session, but I can’t see any means they could prohibit the vaginal birth (if nothing else, it’s possible to do it completely untrained without anyone else’s help).
In my experience the doctor, not the hospital determines what kind of birth is appropriate. I suppose you could try and override your doctor’s decision but then you would have to find a new doctor who would agree to do it. I don’t see how the hospital decides anything.
My friend has had 3 c-sections, and tried VBAC for the second & third pregnancies. It was her doctor’s decision to allow her to try VBAC, not the hospital’s decision.
Side note- thank God she was born in the modern era, or she’d have been in trouble for sure (two frank breach presentations, at least one cord wrapped around a baby’s neck, etc).
Okay, but what happens when the patient refuse to allow the doctor to perform a c-section? A patient can legally refuse care even when it will result in death, but how does that apply to a pregnant women with viable fetus?
A doctor can refuse to be involved in what he/she views as a dangerously irresponsible medical situation. In other words, you can refuse the doctor’s advice, but in that case the doctor can say he/she is no longer you’re doctor. So if the doctors at a hospital say “we think VBAC is a bad idea and we don’t want to be party to it” you’re stuck unless you can find another doctor or hospital to go along with it. Or you can just park your butt at home for birth - but you WILL be running some serious risks if you do that.
I know of at least one hospital that will not do a VBAC. Frederick County hospital in Frederick, MD will not do one. Or would not do one as of eight months ago. I know this because my wife had a C-section for the first child and she wanted to try a VBAC for the second. Frederick would not even give her the option. The local hospitals in the Rockville area have only just started again.
However, that said, I have just found this link, which says the exact opposite of what I said before. But I know they told us different last June.
What would happen if a woman came into a hospital, already in labor, no referring physician, having previously had a c-section, and refused to permit surgery for another c-section? IMHO that would be a foolish thing to do, but what if?
PAGING Cyn to GQ Imminent delivery.
Till she shows up
If you come into a hospital with a medical emergency, spouting orders rarely goes over well. Plan on having to sign a pile of forms that basically say you are proceeding against medical advice and that you are accepting responsibility for a number of messy outcomes. One of the most feared being uterine wall rupture which is highly likely to result in dead mom and or baby.
You’ll sign an AMA (against medical advice) form which basically says the doctors warned you not to do it, and you refused, and you release everyone in the world except yourself from anything that happens after that.
What do they do with people who won’t sign those forms? Do they just kick you out?
They can’t do the C-section without a form. They also apparently need a form to not do the C-section. Can they legally throw you out for being uncooperative (I don’t know how the “emergency treatment” laws work)
They can attempt to transfer you to another facility, and they can refuse to treat you until it becomes a medical emergency.
At that point, if you haven’t been transferred yet, they would be obligated to treat you according to your wishes. Everything would be documented, including your refusal to sign the AMA form.
If there is more time, a facility can attempt to get a court order overturning the mother’s wishes if they are sure if will endanger the life of the unborn child.
Cite: my wife, who is an RN. I take responsibility for any errors in interpretation; plus, she was half-asleep when I asked her.
ER teams see plenty of people die by no fault of their own every day. Someone setting themselves up for disaster by choice will not cause them to lose much sleep.
When I worked in ER, (I worked the PBX and admittance desk) I would see people come to the ER and tell the doctors what to do.
While it’s true they make you sign an “Against medical adivce” form, they most often work with family members. The reason is you have to be rational and of sound mind to sign those forms and if something happens to the patient, he/she will just come back and say they were not coherent when they signed. The especially is true if the patient dies.
In a case like a birth, this is arranged far in advance, since most births are not unexpected. If the hosptial won’t perform a procedure then the patient finds one that does. If the patient become insistant then, as one poster said, they will first try to transfer the patient, failing that they work with the family and try to scare them into doing what they want.
I’m a sucker for doctor blogs and birth stories, so I took notice of one posted a while back by a family physician. I could find the link if required, but hope my recollection of the account is sufficient here.
The hospital used to allow VBACs. Doctor had a patient with, IIRC, two vaginal births, a c-section for a transverse baby, and a successful VBAC. Patient wanted another VBAC, but the hospital changed its policy to “no VBACs allowed.”
Other doctors (from same hospital) told Patient she didn’t have a choice but to have the section. Blogging doctor intended to tell patient about AMA paperwork (long, involved red tape process), but didn’t see her again before she went into labor.
Patient showed up at a very busy time in the maternity ward, and by the time she was evaluated she was crowning. Doctor caught the baby just in time. Patient had her VBAC because there wasn’t time to do the section.
In more cases I’ve heard about though, doctors or hospitals play the ruptured uterus / dead baby card and convince the mother that VBAC is irresponsible and how dare she value the type of birth over the safety of her unborn child.
There are plenty of doctors who will admit to going along with the hospital’s rules so as not to rock the boat, even when they feel that a VBAC is a reasonable option to try. Doctors are not autonomous.
Problem is, even though VBAC is very possible, it incurs additional risks that the section does not. If the hospitals say “sure no problem we can do it” and 5% end up with some combination of dead mom and or baby, you have a multimillion dollar lawsuit because the hospital freely allowed her to try knowing that it was more dangerous. Of course the family forgets all the warnings when they have a dead loved one and crows about their rightness when it works…lose lose deal for the hospital.
Everyone thinks they are an expert until something bad happens then its finger pointing time.
the correct terminology is Precipitous delivery
Except that a VBAC is not significantly more dangerous then any other birth. The largest concern is a uterine rupture happens about 0.5% of the time, compared to 0.4% chance for someone who hasn’t had a c-section. cite. My wife thought long and hard about having a VBAC because people kept telling her the same scary stories that are just not true. She did a lot of research, and even talked to the few doctors who had also done the research to make sure everything would be safe.