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Archive for Friday, July 15, 2005

Birth procedure investigated; woman to picket board

July 15, 2005

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Lawrence resident Devina Garrett believes every person has a right to say "yes" or "no" to medical treatment.

"I also think every person should educate themselves so they can make their own informed decision," she said. "Too many people rely on the advice of their doctor."

Garrett's beliefs today are leading her to Topeka, where she will picket the Kansas State Board of Healing Arts.

A board committee is holding a closed hearing regarding Dr. Josie Norris, medical director of the Topeka Birth & Women's Center. Norris said the state board had determined she should not be allowed to do vaginal births after cesarean section deliveries - also known as VBACs - outside of a hospital.

Garrett said she and others would picket the board from 8:30 a.m. to noon.

"I'm going to hold up a sign and walk along the sidewalk for four hours, and whoever sees me, I hope they learn something new, and I'm going to hand out pamphlets," she said.

Norris said the situation arose after a complaint was filed against her saying she performed VBACs in her office. She said the VBACs happen in a birthing center. But the complaint spurred an investigation.

Lawrence T. Buening Jr., executive director of the Board of Healing Arts, wouldn't confirm or deny an investigation, citing laws that stipulate complaints to the board must remain confidential, he said.

"We have review committees and disciplinary committees meeting continually," he said. "The next public board meeting is Aug. 13, and there will not be any public discussion until at least that date."

Norris said a committee today would discuss a potential settlement agreement with her. She said she didn't know what action she would take until she read the settlement terms. But if she disagrees with it, there will be another hearing.

"It's my belief that this is a loss of rights for women," Norris said. "We're one of the few places in the area that provides this option."

Under fire

Having a VBAC at a birthing center has been criticized of late. The American College Of Obstetricians and Gynecologists strongly advised women against attempting a VBAC unless in a hospital.

The most common concern with VBACs is the potential of uterine rupture, which can lead to emergency surgery.

Norris said she considered the risk low and said just as many problems were connected to repeat cesarean sections. But women should have both options, she said.

"We have a choice to get on a motorcycle without a helmet in Kansas," she said. "I think the chances are far greater for that person to have a head injury in an accident compared to a woman giving birth. But we haven't taken any measures to force people to wear helmets."

The American College Of Obstetricians and Gynecologists also stated in its 2003 standards that an anesthesiologist and an obstetrician should be immediately available during the delivery in case an emergency cesarean section was needed.

Other policies

Some hospitals have a policy of not allowing a woman to have a natural birth if she has had a previous cesarean delivery. Those hospitals include Stormont-Vail Regional Health Center and St. Francis Health Center, both in Topeka.

Lawrence Memorial Hospital has not been doing VBACs, said Isabel Schmedemann, director of LMH's maternal-child ward.

"But it's really a physician's decision and not a hospital decision," she said.

Schmedemann said the reality, right now, was that the American College Of Obstetricians and Gynecologists has suggested VBACs were too risky if an anesthesiologist wasn't immediately available. Physicians want to make sure their patients are safe, she said.

But the biggest factor limiting the availability of VBACs is that insurers are saying the procedure is uninsurable or charging premiums too high for physicians to handle, Schmedemann said.

"This has been such a struggle for our physicians and our staff because truly they want to be able to provide what patients want and a lot of patients would like VBACs," she said.

Comments

vbfree2 9 years, 5 months ago

Yes. It would be foolish to assume that we share the same priorities. Medicine is one of the most insular, paternalistic professions on earth; and these days, the obligations that are imposed on doctors by their professional organizations, partners, employers, regulators,insurers, hospitals and personal financial interests all to often intefere with their ethical obligations to their patients.

lori 9 years, 5 months ago

The issue boils down to this: c-sections are major abdominal surgery, and are not without risk. Multiple c-sections put women and their babies at an even greater risk for major complications. Vaginal birth, too, is not without risk. The risks of vbac and the risks of a single c-section are virtually equal, statistically. Why should a woman and her doctor or midwife not be able to weigh the risks and choose what is best for that particular woman and child?

Why do insurance companies get to limit a woman's reproductive decisions in this manner? Forget having 5 or 6 kids if you have all c-sections; the risks involved in that are much, much greater than a woman whose first birth was a c-section and her next four were vaginal. Even two or three c-sections put you at much greater risk for complications during pregnancy, surgery, and post-surgery.

Not to mention the risks in the long term. Ask any woman 25 years after her c-sections if she has general abdominal pain. Most do. It's due to the scar tissue that has developed in the abdominal cavity from the c-sections. The bowels can also be involved in the scar tissue, leading to chronic consitpation and pain, and occasionally they can lead to blockage of the intestines, which is a major medical emergency. Problems with urinary incontinence are not exclusive to women who have had vaginal births; these occur with women who have had c-sections, as well.

Ultimately it comes down to choice. You and your practitioner should be able to assess your individual wishes and risk factors (including the size of your future family, your individual health condition, and the birthing facilities available in your area) and choose what is safest for your specific situation. Not some insurance company. Not some random state board. Not some distant committee from the American College of Obstetrics and Gynecology.

I urge all of you who are intersted in this potential banning of VBACs to educate yourselves on the issue. A great place to start is the ICAN (international cesarean awareness network) website at www.ican-online.org. Let your state and federal legislators know of your opinion. Let your local physicians, midwives, and their associations (like the AMA, ACOG, ACNM, and NACC) know how you feel about this. You are health care consumers. You should have the ability to choose safe procedures, and to refuse consent to major surgery if it is not the best option for you.

Lori

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