by Melinda Kane
In part I of this post, I covered the ins and outs of why it’s so hard for women in Saratoga and points north (and east and west), to obtain access to VBAC. So what if you’re a mom considering a VBAC? Those barriers aren’t going to fall overnight. What are your options if you live in the VBAC twilight zone of the Adirondacks and Saratoga/Glens Falls area?
To quote Diana Korte and Roberta Scaer, authors of A Good Birth, A Safe Birth, “If you don’t know your options, you don’t have any.” So let’s make sure you have options. (Here’s the big fat “NO” part of the answer to my original question… is it REALLY that bad?) Here’s what women in the Capital/Saratoga region have been doing in order to find support for their VBAC plans:
Make a pilgrimage…
You may need to travel to a hospital and a provider who does offer VBACs. Where can you go? Albany Medical Center and St. Peter’s Hospital, as well as Ellis’ Bellevue campus in Niskayuna and the Burdett Care Center within Samaritan Hospital in Troy (a recent merger of the maternity units of Samaritan and St. Mary’s Hospitals) all offer VBACs. Click on the names of the hospitals linked here to find NYS Department of Health statistics about their cesarean and VBAC rates. (You won’t find any for the Burdett Care Center because of the time lag in the release of the data, but you can look at the rates for St. Mary’s Hospital and Samaritan Hospital to get a sense of the rates of the providers who used to practice at those facilities when they were separate. The same doctors and midwives are now working at the Burdett Care Center).
Even within those facilities, there can be great variation in the level of support you will find for your VBAC plans. Interview potential doctors or midwives carefully and recognize that you are *hiring* a medical care provider. You wouldn’t hire a plumber to paint your house, even if he were the only handyman in town and you wouldn’t go to a Chinese restaurant when you really wanted Italian food. So find a provider that offers the service(s) you want and has experience supporting families through the process. Ask specifically about their cesarean and VBAC rates, and if they say they’ll support a VBAC, ask specifically about the conditions under which that support would cease (Are they concerned about a big baby? Going past your due date? Other things? Compare those criteria against your own comfort zone and then find out if those criteria are backed up by research.) If you don’t know where to start looking (apart from cold-calling offices), start asking around from people you know who’ve had VBACs. If you can’t find anyone, like the mom I talked about at the beginning of this post, the mother-to-mother support found at your local ICAN chapter can be a great place to start. More on that in a minute…
Bring the provider to you…
Home birth is a reasonable and expanding option for women seeking VBAC. Just five years ago there were no licensed homebirth midwives practicing in the Capital/Saratoga region. Today there are six separate homebirth practices with licensed midwives practicing in the area. Most take insurance and/or Medicaid and will work with you.
In some rare cases, homebirth is nearly the only option available, but ideally homebirth is not a constrained decision. It’s may not be something you and your partner are both comfortable with, nor is everyone a good candidate for homebirth, but for certain people it seems like a very intuitive and natural choice. Maybe it’s something you’d like to consider but you just don’t know if homebirth is really for you? Call and make an appointment to just have a conversation with a midwife to find out what homebirth really looks like. Or get connected with the local ICAN chapter and talk to other women who’ve had VBACs at home.
Get connected and supported…
As one local midwife blogged recently, you have to “find your tribe.” When it comes to VBAC support in this area, I can say with great pride and just a small amount of bias that the place to be is with the women of the local chapter of the International Cesarean Awareness Network (ICAN). ICAN of the Capital District has both monthly meetings for that face-to-face connection, as well as a Facebook page and a yahoo group email list. The group offers peer support and education in the areas of cesarean prevention, cesarean recovery and birth after cesarean, especially VBACs but also including a more family-centered experience for when a cesarean is medically-indicated. And we have a lending library so you can do your own homework and decide what’s right for *you*. You can get more information about any of these things by emailing me, Melinda, at firstname.lastname@example.org.
You can also consider bringing in the extra support of a doula. A doula is a woman with specialized training in supporting a family through pregnancy, birth and the postpartum period. The Doula Network of the Capital Region provides a listing of affiliated birth and postpartum doulas who all adhere to a high standard of care. Mamatoga also lists some doulas in her Preggotoga list of links.
Besides these local resources, the internet is your friend. There are a number of websites and blogs with excellent, evidence-based information about cesareans and VBACs (and also plenty of places to read false information and horror stories – choose your sources carefully!). Besides the ICAN website linked above, here are a few of my favorites:
- Childbirth Connection, especially the section specifically about VBAC vs. Repeat Cesarean.
- A Woman’s Guide to VBAC at the Giving Birth with Confidence site, a blog powered the folks at Lamaze International (which, by the way, now has excellent resources and no longer teaches the funny breathing patterns you remember from watching sitcoms as an adolescent).
- VBACfacts.com – The tagline for this blog is “Don’t Freak. Know the Facts.” Indeed. The author wades through the numbers game to give you really useful information on how the research and the conventional wisdom apply to you.
- VBAC.com – another great blog with links to all kinds of evidence-based information.
- Henci Goer’s writings on VBAC at iVillage – Henci Goer is the original bringer of evidence-based information to the masses with her longtime go-to book, The Thinking Woman’s Guide to a Better Birth, which also has a great chapter on VBAC and of which we have multiple copies in our ICAN lending library.
- And for sub-topics within the realm of VBAC, like vaginal birth after multiple cesareans, or VBACs for women of size, there are other wonderful resources like The Well-Rounded Mama and Plus-Size Pregnancy, one of my favorite sites for really comprehensive take on the research surrounding certain topics, regardless of mom’s BMI. Leave it to kMom (the author’s pseudonym) to put out really well-researched, well-written blog posts on an amazing number of topics related to cesareans and VBACs.
Be an agent of change…
Do you have to travel outside of your home community because your local hospital does not offer VBACs? Let them know that you’re not satisfied, and that you’re willing to go to the extra effort to ensure a safe delivery for your baby and a satisfying delivery for yourself. The more they hear that women in their communities are demanding these services, the more incentive they will have to adhere to the NIH’s recommendation to reevaluate those barriers to VBAC access. Call the hospital’s ombudsperson to find out where to direct your feedback. Also check out ICAN’s page about what to do if your local hospital bans VBAC.
Melinda Kane is a birth doula and chapter leader of ICAN of the Capital District.
Here’s some quick facts for you: VBAC by the numbers in New York State:
- Hospitals offering maternity services: 138
- Hospitals formally banning VBACs: 25 (18%)
- Hospitals not formally banning VBACs, but with no physicians willing to attend VBACS: 14 (10%)
The upshot: More than 1 in 4 hospitals offering maternity services does not offer VBAC.
(Source: ICAN’s VBAC policy survey, 2009)
Even at hospitals that offer VBACs, they are not common:
- 100 hospitals have VBAC rates of 10% or less.
- The highest published VBAC rate in NYS is 34.4% (in Rensselaer County!)
(Source: Guide to Avoiding Unnecessary Cesarean Sections in New York State, Public Citizen 2010)
BUT… Research suggests that around 75% of women who plan a VBAC can have a successful vaginal birth!