This article is a joint reporting venture by Edhat and the Santa Barbara Independent and is part of an ongoing series of stories on maternal health in Santa Barbara. Read our last collaborative story here.
Santa Barbara Cottage Hospital announced it is planning to offer the option of VBACs ― vaginal birth after Cesarean section ― in the fall of this year, following an unofficial ban since 2003.
Spokesperson Maria Zate said Cottage is in the process of recruiting obstetric hospitalists to support VBACs. “When the option becomes available, a hospitalist and a dedicated anesthesiologist from our medical staff will be on-site 24/7, with an additional OB/GYN physician on call,” she said. “The hospital is committed to this level of physician coverage to respond to emergencies. This will ensure the highest level of safety for our patients, following the American College of Obstetricians and Gynecologists (ACOG) guidelines.”
Local advocacy groups and parents have been pressing Cottage, the South Coast’s only full-service maternal care facility, on the VBAC issue for years. They’ve cited studies and recommendations from ACOG that support trial of labor after Cesarean (TOLAC) and its successful result, a VBAC, since 2010. The physicians association deems VBACs “a safe and appropriate choice for most women who have had prior Cesarean delivery.” Its literature states most women with one previous Cesarean delivery with a low-transverse incision are candidates for and should be offered a trial of labor.
According to ACOG, those with a high risk of uterine rupture would not be good candidates, a sticking point some local doctors have pointed to in the past as a reason for not providing the service. Uterine rupture is when the Cesarean scar on the uterus breaks open during labor, prompting an emergency C-section surgery, although it occurs in less than one percent of patients.
“The scar separates in about one out of every 200 women,” said Dr. Stuart Fischbein, a Southern California board-certified OB/GYN who is an outspoken proponent of midwifery collaboration and allowing women to choose their own style of maternal care. “If you’re doing four VBACs a month, you’re going to have about one uterine rupture every four years. How many crash C-sections has [Cottage] done during those four years for other causes? Like fetal distress or abruption of the placenta or cord prolapse? Tons. And they seem to be able to handle those just fine.”
Cottage Hospital is the only Level One Trauma Hospital between San Jose to Los Angeles, meaning it provides the highest level of surgical care and is capable of responding to every aspect of injury, from prevention to rehabilitation. Many surrounding hospitals with equal or lesser levels of care are supportive of VBACs. Marian Regional Medical Center in Santa Maria and two Ventura hospitals offer the service. Larger facilities farther south such as UCLA Medical Center, Kaiser Permanente Los Angeles, and Cedars-Sinai Los Angeles have been supportive of VBACs for years.
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When asked why the ban was reversed now, what information was used to inform the decision, who actually makes such decisions, and so on, Zate referred to her original statement. “That’s all the info we can provide,” she said.
The local chapter of the International Cesarean Awareness Network (ICAN) hosts a maternal healthcare panel every year in Santa Barbara. When asked about their previous interactions with Cottage Hospital on the VBAC issue, ICAN stated the hospital had quoted outdated ACOG articles and would not respond to questions about a specific policy banning the procedure, and the legality of such ban.
Dr. Fischbein, who has performed numerous VBACs in home-birth settings, questioned Cottage’s announcement. “Cottage will quote ACOG and their guidelines when it suits them, and they’ll ignore ACOG’s guidelines when it doesn’t,” he said. “This is the classic cognitive dissonance that happens in hospitals. They cherry-pick their data.”
There is no law against VBACs, and federal statutes prohibit a hospital from refusing to accept anyone in active labor as a patient, but local doctors have reportedly expressed worry about consequences from Cottage if they went against its policy.
Jamie Davin, a local mother of two, sought the opinion of a Santa Barbara OB/GYN regarding a VBAC for her second child and was told she’d be a perfect candidate. “They very much wanted to support my VBAC but had to decline me as a client because they were not allowed to support VBAC at Cottage and they were afraid of repercussions if they were to do so,” said Davin. “They did not suggest I have a Cesarean but gave me the name of a doctor in Ventura who supports VBAC.”
The Santa Barbara Midwifery & Birth Center has been supporting VBACs for the past five years. Director Laurel Phillips applauded Cottage’s recent decision to address the longstanding need and to eliminate an unnecessary source of friction between the hospital and the community.
“Santa Barbara should be a destination for maternity care, famous for the best practices and the most choices. We have the resources,” said Phillips. “Pregnant people will no longer have to make the drive to Ventura in labor if they desire a VBAC in the hospital. That was an unacceptable and dangerous situation for the large number of people in our community who have had a past Cesarean birth and do not want another.”
Sansum Clinic, which employs six of the eight practicing obstetricians in South Santa Barbara County, declined to comment for this story.