California has been leading the way when it comes to access to health care, availability of abortion providers, even trying to get birth control more readily to those who need it. It has an expansive Medicaid program for uninsured and has been working on a program to allow nurse practitioners to also be trained in and allowed to provide early vacuum aspiration abortions, which could greatly increase availability in more rural areas of the state.
They’ve even made birth control pills available through registered nurses to loosen up the pipeline that can get backed up when a doctor’s exam is required before a prescription can be written.
When it comes to pregnancy prevention and termination, California is the gold standard of care. Which is why it makes it so much more unfortunate that when it comes to giving birth, there are so many fewer choices?
A New York Times article explores the state’s deplorable results when it comes to offering women who have had a previous c-section the ability to do a VBAC (Vaginal Birth After a Cesarian), reporting that just half of the hospitals in the state will actually allow a pregnant person to attempt a vaginal birth. Because a previous c-section provides a small chance for uterine rupture, hospitals, and of course the doctors within them, are choosing to encourage a second abdominal surgery rather than take that risk.
Although it has been nearly two years since the study came out citing the abysmal options for those who want to pursue a VBAC, hospital policy is remaining virtually unchanged. “Many hospitals that allow the procedure have just a few doctors handling them, the study found; many doctors are unwilling to perform V.B.A.C.s because of requirements that they be present during labor,” writes the New York Times. “Time is money for physicians, and they don’t want to have to spend their time hanging around waiting for women in labor,” Mary Barger, an associate professor of nursing at the University of San Diego, told the paper.
Judging by my own experience when I was preparing to give birth to my second child, after having my first by emergency c-section, I learned that it is not always just the hospital that will refuse to consider a VBAC, but certain insurers as well. When I briefly considered VBAC, I had to discuss the issue with my insurer and prove that they would cover any unforeseen events should there be a rupture, rather than it be considered me engaging in “risky” behavior, which would leave them not obligated to pay for additional medical care.
For the hospital, a VBAC delivery could only be done in a surgical room, with a full surgical team at the ready for the slightest emergency. In the end, a breeched baby took that decision out of my hands, but I had mostly given up on the idea of a vaginal delivery mainly because by the time all of the requirements would be put in place to allow me to do it, it simply seemed like too much hassle.
That a medical system would strong-arm pregnant people into undergoing surgery against their wills, and a surgery that is more likely to have complications than a VBAC is to have a rupture, is befuddling. It is even more befuddling once we consider all of the additional medical costs that go into a surgery than into a vaginal birth. Yet somehow, despite it being both physically and financially less burdensome to have a vaginal birth than a follow up c-section, modern medicine continues to resist it.
California has led the way on the right to control when and if to have a child. Maybe now they can lead the way on the right to control how to give birth to that child, as well.
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