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Patients decry C-section rate

2/12/2010 © Health News Florida

“Once a C-section, always a C-section” is a dictum that became obsolete decades ago, women’s health advocates say. But in Florida, that notion still rules, now more than ever.

Some of the patients who are forced to have unnecessary scheduled C-sections in order to get medical care say they're tired of it. They've planned a two-day seminar on the subject in Miami, where more than half of births involve surgery. 

The Vaginal Birth After Cesarean (VBAC) Summit  takes place today and Saturday in Miami's North Bay Village.

Organizers say that in a large population of former C-section patients, a trial of labor in a subsequent pregnancy is safe and often successful. But they say obstetricians are reluctant to try it.

"I think it’s a silent epidemic," said Dr. Christ-Ann Magloire, an obstetrician in North Miami who will be a panelist at the conference.

The conference seeks to sift through the benefits and risks of VBACs, and to set the record straight on why Cesarean rates are climbing. In 2008, they accounted for about 38 percent of all births in Florida. No other state had a higher rate; only Puerto Rico's rate exceeded Florida's.

For women who’ve already had one C-section, the Florida Agency for Health Care Administration reported in 2006, the odds of having a vaginal birth during subsequent pregnancies drop to less than 10 percent.

"Vaginal birth has become the abnormal way to have a baby," said Miriam Pearson-Martinez, a licensed midwife and presenter at the VBAC summit.

Pearson-Martinez will address the legal issues surrounding VBACs. She said patient and physician understanding of its legality is murky, often incorrect.

Pearson-Martinez said she's worked with several patients who were told they would be reported to the Department of Children and Families if they did not agree to C-sections. Others were threatened with court orders if they continued to request vaginal deliveries, she said.

Many women say they were told that VBAC is illegal, she said; it’s not. But doctors are afraid to try it, she said. They reason that they can't be sued for doing an unnecessary Cesarean, while they can be sued if they don’t do one and there’s a bad outcome.

The International Cesarean Awareness Network (ICAN) says some hospitals actually have a formal policy against VBAC, but in most cases the ban on VBAC is the de facto result of having no physicians on staff who will participate.

"It’s a high risk situation but the reimbursement isn’t very good," explained Magloire. "The risk of litigation is very high."

Vaginal and Cesarean births both have their risks and benefits, Magloire said, but C-sections are invasive procedures. She said recovery time is longer with C-sections and the procedure carries a greater risk of complications and infections. Infants tend to have better outcomes and start breastfeeding sooner after vaginal births, she said.

The American College of Gynecologists (ACOG) says VBAC "is appropriate for most women" who are otherwise low-risk for complications.

"[VBAC is] a possible thing, it has a very high success rate," said Magloire.

According to the World Health Organization, the average population should not require more than a 15% Cesarean rate. Higher rates mean women are getting C-sections when they don’t really need them, WHO says, putting women and infants at greater risk of complications.

In March, the National Institutes of Health is hosting its own conference to discuss the declining rates of VBAC nationally, and what may need to happen to reverse the trend.

“Most women spend more time researching their nursery than their care provider,” said Shannon Mitchell, a summit presenter and director of BirthAction.org and BirthAfterCesarean.com.

Mitchell points out that right now, women have to be their own advocates if they want to have options during birth.

"My biggest hope is always the women will walk away with the idea that Cesareans are preventable," said Mitchell.