Oklahoma VBACs are legal....

I was surprised today at a baby shower to hear several moms agree that vaginal births after cesareans are illegal in Oklahoma. "Yes, they passed a law last year. Or some time." I was pretty sure that wasn't true, as I have several acquaintances who are planning VBACs for the next six months. The conversation moved nonchalantly on to how dangerous VBACs are...and the MORE kids you have, the MORE dangerous it is.

I assured them that it was not true, as my c-section was my first child, and before ACOG (American College of Obstetrics and Gynecology) changed it's mind, it was assumed that most women would at least trial VBAC. About the time Sam was born, they were changing their minds again, because they saw rupture rates 'go up'. Well, yes, they went up because ACOG was directing OB's to initiate labor through chemical means, which is very hard on the uterus and would cause rupture itself. (I had two induced vbacs...with no complications) The rate of rupture in an uncut uterus is much higher when cytotec is introduced...and pitocin causes abrupt and immediate contractions for which the uterus may not be prepared.  So, without taking that into consideration, in 2003 (?) ACOG decided to protect its members by recommending against VBAC.

The immediate consequence is that the primary insurance company for doctors within Oklahoma, PLICO, (owned by physicians and "created to stabilize liability in Oklahoma") decided that they would NOT allow their members to perform VBACs. If a member does attempt with a patient, regardless of the patient's desire or ability to handle vaginal birth, they will lose all liability insurance. 

However, 25% of physicians within Oklahoma are NOT covered by PLICO, and there are OBs in OKC and Tulsa both who can and will deliver VBACs...not to mention midwives across the state. A few examples include OU medical center, as well as St Anthony's, in OKC, and in Tulsa at Southcrest and St Johns.  

It just makes me sad that people will mislead these poor pregnant women, who really just want what is best for their babies...utilizing FEAR to get what they want. And they want easy to manage births with few surprises. Life is full of surprise...get used to it.


Heather said...

I knew you'd set the record straight ;)!

Anonymous said...

ACOG is not against VBAC. They still support VBAC in Practice Bulletin #54. The guidelines on who they consider a good candidate are more restrictive, but they do support a trial of labor for women who fit the criteria.

Melissa said...

But the fact is that the recommendation that trials of labor occur only when a physician is willing to remain constantly present and only when there is an OR and an anesthesiologist present, grossly limits viability in most hospital settings, esp with a rupture risk of less than 1%.

Other fact is that in light of ACOG's publication, PLICO used that information to 'protect' their doctors and refuse VBACs.