Controversial Ban on VBAC in Iowa

Creative Commons License photo credit: Reading Tom

The rate of Cesarean births has been rising dramatically for years, and that’s caused quite a stir. Many women schedule elective C-sections for a number of reasons, such as wanting to have their baby born on a specific date, getting in under the wire for tax purposes, or just to not have to deal with the surprise of when labor comes. This practice – elective cesareans – is at least in part responsible for the overall rise.

In some places – such as in Sioux City, Iowa – there are other factors. St. Luke’s Regional Medical Center in Sioux City has shown an increase in C-sections every year. In 2006, for example, 27.3% of births were via Cesarean; in 2011, that number was almost 31%.

Dramatic change caused by policy change

In 2006, the hospital instituted a ban on having a vaginal birth for a subsequent pregnancy after having a Cesarean (a practice known as VBAC or “Vaginal Birth After Cesarean.”) The ban was put into effect because the hospital doesn’t have 24-hour coverage for surgery, anesthesia, and OBs.

Because of the risks associated with VBAC, the hospital doesn’t allow the practice. In about 0.8% of VBAC cases, there can be a uterine rupture. While a uterine rupture can be addressed surgically with a very high success rate, it’s still a significant risk: a uterine rupture has a 50% mortality rate.

Other options

Women in Sioux City who want to have a vaginal birth after Cesarean still do have options. There are hospitals in nearby Omaha that do allow the procedure, as they have 24-hour coverage. While it’s not ideal, of course, it can at least give the woman a choice.

Risks of multiple C-sections

Of course, this all brings into concern the fact that subsequent C-sections can also cause problems. There can be things such as pelvic pain, the development of scar tissue, and more. A Cesarean is abdominal surgery, which carries with it a number of risks – just like any surgery.

In the case of VBAC, however, the risks posed can be fatal, and so women really need access to 24-hour surgical expertise in case the worst happens.

So, what do you think? Is the hospital right to institute this practice?

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