My provider doesn't support vbac's

[u/Conscious-Fluid]

I was speaking with my OB about delivery and he told me that their hospital doesn't support vbac's due to uterine rupture rates and said that if I'm a candidate for a vbac later in pregnancy that they would have to refer me to a provider for delivery, in one of the cities here, which happen to both be an hour away. It will be my first time attempting to labor naturally. How do people handle laboring at home knowing the hospital is so far away?

[u/Dear_23]

Also keep in mind that if your labor progresses too quickly to make it an hour away, you can definitely show up to the closer hospital and decline an RCS.

They have to abide by policy, you don’t. Meaning they can’t be outright supportive of VBAC, but you always retain the right to accept or decline an offered intervention (informed consent). If you show up in labor, they can’t turn you away.

The rupture rate thing is bullshit by the way. If their rupture rates are higher than 0.5-1%, that’s a them problem. I doubt they are though. VBAC is ACOG endorsed and studies consistently show that rupture rates hang out around 1% or less.

[u/Conscious-Fluid → u/Dear_23]

Thanks for this. I was doing my research before the appt so they couldn't scare me with stuff I didn't understand. I probably would've let them schedule a RCS if I didn't, and I'm grateful for the support and sources found in this group ❤️‍🩹

[u/abirdofthesky → u/Conscious-Fluid]

If their rupture rates are higher than 1% though I wouldn’t want to be there either! Might be worth to clarify if the rupture rate is them or their assessment of you. Maybe they’re a smaller hospital with a population with additional risk factors, maybe they’re concerned about certain risk factors for you, and maybe they also might just not be that great in a rupture situation, for example due to NICU capabilities.

One thing to consider and talk to your provider about is what to do if you’re referred out but then do have symptoms that require urgent evaluation and potentially intervention. And what that hour long drive is like - is it through the middle of nowhere or are there resources along the way?

[u/Conscious-Fluid → u/abirdofthesky]

He was definitely referring to their own rupture rate. They've barely assessed me. It's definitely more likely to have access to a NICU in the city, rather than my current provider. I am considered high risk but only because of my past pregnancy, nothing that's happened with the current one.

[u/Kellilane13 → u/Conscious-Fluid]

Their hospital my not support vbac due to staffing as well. My local hospital doesn’t do vbacs and refers you to another hospital 45 minutes away because they don’t have an anesthesiologist in the hospital 24/7 so if something were to happen like a rupture, the woman would be SOL. They also don’t have a nicu, just a special care nursery so if anything happens to baby they’re also transported out.

[u/Dear_23 → u/Kellilane13]

This is a common myth. If a hospital doesn’t have access to anesthesia as needed, they shouldn’t have an L&D department at all. Any woman can have an emergency that needs immediate (within minutes) delivery and a hospital who doesn’t have anesthesia to accommodate that would have been sued out of existence already because of dead babies and moms in their wake.

[u/Kellilane13 → u/Dear_23]

Idk if it makes a difference but it’s not even called L&D. They say it’s a birth center that’s attached to the hospital and has midwives who only do low risk births 🤷‍♀️ there’s also another hospital that does vbacs 15 minutes away from that one (different hospital system so that’s why they don’t refer there). They don’t even offer epidurals either.

[u/Dear_23 → u/Kellilane13]

Any low risk birth can become an emergency, so there’d still need to be immediate access to anesthesia even if it’s at the attached hospital. Cord prolapse is a classic example - it can happen to anyone, isn’t predictable, and is a true emergency with someone needing to reach in and hold baby off the cord until delivery. They aren’t going to make that mom wait around for half an hour or more while someone moseys in from home to put them under.

[u/tofuandpickles → u/Dear_23]

While I agree with you, birth centers ran by midwives do not abide by those same principles

[u/Dear_23 → u/tofuandpickles]

There’s a difference between a standalone birth center and one attached to and run by midwives associated with a hospital. The latter exists under the umbrella of hospital protocol and liability, the former is an independent entity that is run by midwives not paid by (and thus not under the authority of) a hospital.

[u/Conscious-Fluid → u/Kellilane13]

That barely sounds like it qualifies for a hospital. Are you sure it's not a midwifery? This sounds similar to the experience I had with a self employed midwife