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A hospital not equipped for emergencies...Well I never!

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Gladstone hospital is apparently not equipped to handle emergencies. They have taken the move of banning VBACs due to this inability to handle emergencies. Yep – they are banning women from birthing out their vaginas because they can’t handle the risk. The ban is due to safety concerns, but here’s the 60million dollar question:

Whose safety are they concerned about?

Because this ban on VBACs actually increases safety concerns for a lot of women.

Let’s start with emotional safety and mental health concerns. You have a cohort of women who have been planning a vaginal birth who are suddenly, regardless of how close to birth they may be, being told that this is no longer an option for them. One woman was told at 41 weeks that she was no longer allowed to birth at this hospital. Some of these women may have previously suffered from birth trauma and been planning out a beautiful healing birth in their home town, surrounded by their family and a trusted care provider. Now they can either sign up for repeat surgery or make plans to leave town. Sound like a great way to decrease stress and increase emotional safety?

Support is important when it comes to birth! My own image.

For those women who decide that they still wish to go ahead with a VBAC they now need to leave town. The closest hospital for them is Rockhampton – just a little 2 hour drive up the road. So they can either plan to drive up to Rocky in labour or they can relocate their entire family to Rocky in the weeks leading up to their estimated due date. Gee…both those options sound wonderful – however will I choose?! A 2 hour drive up the highway during labour or relocate our whole family to Rocky while we wait to birth our baby surrounded by strangers. Keep in mind that it’s “normal” to go up to 42 weeks or more…so you could be relocated for quite some time. And I can think of places I’d rather spend 5 weeks than Rocky! (No offense to all my readers from Rocky!!).

Rockhampton. Image courtesy of Wikimedia Commons.

Now let’s get to the concerns about physical safety – because that’s what the hospital is interested in. The Executive Director of the hospital has said that she “will not apologise for putting the safety of mothers and babies first”. Yet there is no evidence that she actually is putting the safety of mothers and babies first.

For a start – the hospital is still performing elective repeat caesarean sections. When the alternative is to travel to Rocky to give birth without your support team there will certainly be a number of women who will consent to a repeat caesarean, despite it not being their first choice. Caesarean sections have a pretty long list of potential complications including an increased risk of death for the mother. Then there are all the risks that increase with future pregnancies. Current evidence suggests that a VBAC is an extremely safe and appropriate option for most women. The other question I’d be asking is this: Would you feel safe undergoing major surgery in a hospital that is “not equipped to handle emergencies”? Seems pretty counter-intuitive to me!

The only risk that is different with a VBAC over a “normal” low risk vaginal birth is the 0.5% chance of uterine rupture. So the hospital is totally okay with and equipped to deal with the possibility of cord prolapse, placental abruption, shoulder dystocia, complications with an epidural etc. All of which are more likely to occur than a uterine rupture.

Now let’s return to the point that women will be required to transfer to Rocky. They will need to either drive there in labour or will be transferred by ambulance if they present to Gladstone hospital. It’s a 2 hour (or thereabouts) drive up the highway to Rocky. And as homebirthing women are told so often – things can change from “safe and normal” to “unsafe” in a very short time – mere seconds if the fear mongers are to be believed. So tell me…how is it safer for a woman to be spending 2 hours of her labour travelling up the highway than either hanging out in her own home with a qualified midwife and her own support people, or in a hospital with a qualified midwife and her own support people? In a newspaper article one woman recounts that she was forced to birth her baby alone in the back of an ambulance while her husband followed in the car. Sounds like a wonderful way to welcome a baby into the world, hey?

The Bruce Highway. Looks like a very safe place to give birth! Image courtesy of Wikimedia Commons.

I see a couple of potential outcomes as a result of this. An increase in the number of caesareans performed at Gladstone hospital. An increase in women believing that a caesarean must be safer and less likely to result in complications. Both of these outcomes could have some far reaching implications in terms of current birthing culture in Australia. We could also see an increase in the number of babies being born on the side of the Bruce Highway. Or we could see a lot of women weighing up the options and deciding that planning to birth their baby at home is the best option. Because aren’t we always told that the reason to birth in hospital is because they are equipped to deal with emergencies? So if this hospital is actually NOT equipped to deal with emergencies what’s the point of planning to birth your baby there at all?

We may see an increase in homebirths - because what's the point of going to hospital if they can't handle emergencies anyway? Image courtesy of Wikimedia Commons.

To be fair to Gladstone Hospital they are not the first Australian hospital to put such hypocritical policies in place. I often hear stories from women who will only be “allowed” to have their baby at their local hospital if they agree to an elective caesarean. Due to not having an emergency team available 24/7. Yet women are “allowed” to birth in private hospitals which also often do not have 24/7 emergency care available on site. The obstetrician and anaesthetist often have to be called in the case of an emergency. Yet, private hospitals often claim that the reason for their higher caesarean rates is that they take on so many high risk women. So it’s obviously considered safe for “high risk” women to give birth in a hospital that doesn’t have an OB or anaesthetist on site 24/7.

The women of Gladstone are mobilising to get this changed. But for many women it will be too late. They have already been denied their right to choose where, how and with whom they will birth their babies. And some will bare permanent scars as a result.

Media coverage:

Lack of choice angers Gladstone mums

Women push for birthing choices to be protected

Further reading about birthing choices:

The illusion of choice in Australian maternity care
Why Australia needs a maternity care revolution
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I am sure Gladstone is bigger than Mareeba and we can do it here.
Yes. So true. Mareeba is fully equipped and able to "do" vbacs (and vbamc). Crazy!
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