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Post-C-section birth policy changed

David MirhadiKimala DeSena of Nevada City is due April 24. She had her first child by Caesarean section, but wants to give birth to her second vaginally.
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Because it can’t guarantee 24-hour emergency anesthetic services for expectant mothers, Sierra Nevada Memorial Hospital will no longer offer vaginal deliveries to women who have previously given birth by Caesarean section.

The change in hospital policy, which was announced last month and took effect this week, means so-called VBAC – vaginal birth after Caesarean – births won’t be offered as an option for mothers who request the procedure.



The major reason for the policy, hospital administrators and doctors said, is a risk of uterine rupture during vaginal delivery.




If there were danger of a rupture, which doctors said is small, SNMH would have to immediately summon an anesthesiologist to assist in performing a Caesarean.

Hospital spokesman Gary Cooke said there may not be enough anesthesiologists available on a 24-hour basis for such emergencies, adding that the demand for the services isn’t enough to warrant hiring the additional personnel.

“If we don’t have these personnel available, it is not safe to (perform the VBAC) procedure,” said Dr. Michael Dahle, an obstetrician/gynecologist who has practiced at SNMH for 15 years.

Part of the hospital board’s decision stems from a 1999 paper from the American College of Obstetrics and Gynecology stating that women desiring a vaginal birth after a Caesarean section should have anesthesiologists immediately available to perform an emergency surgery if there is a risk of uterine rupture within 30 minutes of the start of a vaginal delivery.

Performing a vaginal birth in this situation “puts the woman at a known risk,” said Dahle, who has delivered more than 3,000 babies – and by his count, about 300 VBACs since arriving at SNMH from Mather Air Force Base, where he was an obstetrician.

Dahle is a board-certified member of the American College of Obstetrics and Gynecology.

In addition to uterine rupture, such deliveries also pose the risk of cutting off blood supply and oxygen to the fetus or a hemorrhage.

And “The risk of uterine cancer is much lower for someone who does not have a scar in their uterus,” he said.

The number of women asking for the VBAC procedure is small, according to SNMH statistics.

From July 2000 to June 2001, 439 deliveries were recorded at the hospital. A total of 21 VBAC procedures were attempted, and 15 were successful. Six required some form of emergency surgery.

“We have been very fortunate not to have any uterine ruptures,” Dahle said, adding that he believes the VBAC procedure to be a safe one.

Sutter Roseville Medical Center is the closest hospital that will offer the VBAC option. Sutter Auburn Faith Medical Center recently dropped the procedure.

Though the policy has changed, “we will not turn people away who want the VBAC procedure,” Dahle said. “It’s still their choice.” The hospital is obligated to perform a VBAC delivery if an expectant mother insists, he said, but will not explicitly offer the procedure because of the risk involved.

Kimala DeSena of Nevada City begged her doctor to allow her to proceed with a VBAC delivery for her second child, due April 24.

“I don’t want to have a C-section because it is major abdominal surgery, and the recovery time is much longer,” said DeSena, who has a 21-month old son delivered via Caesarean at SNMH.

“I’m a woman, and it’s my right to choose how I want to deliver my child. I should at least be given the opportunity to try” a vaginal delivery, she said.

DeSena has spent months researching the delivery method and is convinced it’s safe, she said.

She said she believes doctors are afraid of the VBAC procedure because of increased risks if they use drugs to induce labor, which can lead to uterine rupture.

“I think the doctors are so concerned about liability issues, and it’s unfortunate they’re setting a policy based on their fears, rather than a woman’s choice,” she said.


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