Sunday, February 22, 2009

ICAN Publishes Groundbreaking Survey Results

I think I am possibly the very last birth blogger to write about this (though not the last to think of it!), but it is so monumental that I can't possibly neglect to mention it.

Some initial information for anyone new to the birth world:

The current U.S. c-section rate is something like 31.1% (and is reportedly under-reported). The phenomenon of VBAC, or Vaginal Birth After Cesarean, is thus a common topic among birthing women, as many women wish to have a normal, vaginal delivery with subsequent births. However, the current political situation among the mainstream birth-world is extremely anti-VBAC, despite the overwhelming evidence that it is safe (and indeed, safer than repeat c-section), and many women are being funnelled, voluntarily or no, into the "once a c-section, always a c-section" pathway, due to doctors who refuse to attend VBACs and hospitals who refuse to "allow" them. ICAN, the International Cesarean Awareness Network, is an international organization dedicated to c-section awareness and to helping women achieve the goal of VBAC.

ICAN has just released the astounding results of a survey undertaken through their volunteers, in which all (or nearly all) U.S. hospitals were questioned about their VBAC policy and whether or not they "allow" VBAC. (I'm using "allow" in quotes because technically, no hospital can force a woman into unwanted surgery - although it's happened - though they can make it devilishly hard to avoid.) The amazing result of the study showed that 49% of U.S. hospitals now do not allow VBAC!! This was broken down as follows:

28% of U.S. hospitals have currently banned VBAC (this is an increase of 174% since 2004)
21% of U.S. hospitals have a "de facto ban" - i.e. the hospital technically "allows" VBACs, but no doctor at that hospital will attend a VBAC
51% of U.S. hospitals still allow VBAC

I am so floored by this data that I have a hard time processing it. This is an outrageous insult against the rights of birthing women, and one which will hopefully not stand the test of time. To be told that one cesarean birth has doomed a mother to a lifetime of c-sections which are statistically riskier than VBAC births, both for mom and baby, is the absurdest of absurdities.

To make things worse, just because a hospital "allows" VBAC births does not translate into a hospital that is "VBAC-supportive" or "VBAC-friendly". Many (or rather, most) hospitals have such strict limitations for VBAC births that a VBAC can be almost as impossible to obtain as in a hospital with a VBAC-ban. Among some of the "VBAC rules" seen at various hospitals:

- A VBAC mum must go into labor before her due date, or she will have a repeat c-section
- A VBAC mum must have her baby during daylight hours, or she will have a repeat c-section
- A VBAC mum must have a textbook labor that does not exceed set time limits, or she will have a repeat c-section
- A VBAC mum must have already had one VBAC (that'll make you chase your tail for a while)
- A VBAC mum must have a "proven pelvis" - i.e. had one vaginal birth before her c-section

With doctors urgin grepeat c-sections and hospitals having ridiculous VBAC protocols, it's no wonder most VBAC-aspiring mothers cave and go for the repeat cesarean. Unless one has knowledge, massive will-power, a supportive family (hubbies in particular tend to get nervous) and a great support system, achieving a VBAC in today's maternity wards can be nearly impossible.

In many states HBAC (home birth after cesarean) is an option; unfortunately, here in Arizona homebirth midwives are banned from attending VBAC homebirths. Hopefully this ridiculous law will change in the future, but for now VBAC mums are stuck either facing a hostile hospital system or doing an unassisted birth. An acquaintance of mine was recently able to have a "legal" assisted home-VBA3C (vaginal birth after three cesareans) when a naturopathic-doctor friend of hers was willing to attend her at home. Another recent online acquaintance of mine who is seeking a VBA3C has decided, after much deliberation, to have an unassisted homebirth in her attempt to achieve a VBAC.

It is a sad, sad state of affairs when mothers who are seeking the safe and sensible option of normal birth following surgical birth are forced to decide between repeat surgery and unattended birth.

Here is the homepage of ICAN, which has an article detailing the study and the issue at hand:

ICAN homepage

I spent some time browsing the database of hospitals, which you can see here:

ICAN Hospital VBAC Ban/Allow Database

I noted in passing that the hospital where I was born, Riverside Community Hospital in Riverside, CA, has banned VBAC.

I then took some time going through Arizona hospitals and browsing the results. After counting up the results, I came up with the following:

33% of Arizona hospitals have banned VBAC (9 hospitals)
15% of Arizona hospitals have a de facto ban on VBAC (4 hospitals)
52% of Arizona hospitals allow VBAC (14 hospitals)

I did notice at least one hospital which was not listed in the results.

Out of interest, I looked at the hospitals that are closest to me here in Chandler. Here are some of the results, which may interest local readers:

CHW Chandler Regional - allowed
Tempe St. Luke's - banned
Banner Desert in Mesa - allowed
Banner Good Samaritan - allowed

I also (while we're on the subject) wanted to throw in this TIME article on "The Trouble With Repeat Cesareans", which was a very illuminating read. Check it out!

So what's the moral of the story?

#1 - We have a lot of work to do to clean up the maternity system in the U.S., both the hospital system and the homebirth system (which is often unnecessarily strict on midwife attendance at birth events such as VBAC).

#2 - If you are a mother or a prospective mother, you'd better work like a maniac to avoid a primary c-section (that is, if a vaginal birth is a goal for you), because it is extremely difficult to work back to normal birth after one cesarean in today's maternity culture. How to do this? Read, research, take classes, hire a doula, and stay out of the hospital as long as you can (if not permanently!). The World Health Organization has repeatedly stated that no maternal or fetal outcomes are improved by a cesarean rate higher than 10-15%, bringing us to the uncomfortable conclusion that a minimum of half, and up to two-thirds (or more) of today's cesareans are completely unnecessary.

(As a side note, I can completely corroborate this from personal experience.... Of the many women I know who have had c-sections, a huge majority of them were completely unnecessary - either due to maternal choice, doctor coersion, or iatrogenic complications - such as a botched unnecessary induction or "the doctor wants to leave on his vacation and you're not progressing fast enough" - seriously!)

We have a lot of work to do.


  1. Hi,

    I stumbled across your blog in my intense search for learning more about natural childbirth.

    Long story short, I am expecting my 8th baby and am contemplating going natural for the first time! (More details, some quite humorous, on my blog if you're interested ;-)

    I was so encouraged by a post you wrote last Oct.--Why Natural Childbirth.

    I'm still trying to wrap my brain around the fact that pain in childbirth is not something we should be trying to avoid--I've always equated it with any other pain, and therefore felt perfectly justified in trying to avoid it.

    I'm still not all the way there, but I'm moving in that direction!

    Thanks for the post!

  2. I would take this list with a handful of salt. The designation of “de facto ban” is based on ONE conversation with whomever the caller was able to reach on the phone. seemed to be OB nurses rather than, say, a charge nurse or the head of women’s and children’s services.

    it seems very arbitrary whether a hospital was designated “de facto ban” or “allows”. 2 hospitals in my area had virtually identical narrative details yet received different designations. Another nearby hospital received label of “de facto” when I know for a fact the only OB practice in that little town is totally on board with VBACs.

    women are basing some pretty serious decisions on this hospital list. check your facts, everyone.

  3. Hi, there! Thanks so much for your comments on my blog! (Birthing at Home) I always love getting feedback, and I also loved the opportunity to discover your blog and check it out. Thanks for visiting!

    I will definitely take the study with a grain of salt. The reason that I accepted ICAN's results on this without going into the matter personally is simply that I have found ICAN to be an incredibly reliable and accurate source of information in the past, and I consider them extremely trustworthy. I know that they may have had to make some calls on hospitals in order to classify them, but I also know that this data was based on in-depth phone calls and was also based on what the hospitals said about themselves - not what third parties said about them. So I do consider the information to be fairly accurate. Also, hospitals do have the opportunity to contest their classifications if they so desire - I believe an address was given for people to email if they had a problem with any of the classifications. Anyway, I believe that the information was in the main reliable, even if there were some errors. But thanks so much for the input! I always value cautionary advice and will do my best to heed it.

    Best wishes!!!
    Diana J.


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