The market cannot function when the supplier determines the supply, and consumer demand has no value. #birthmonopoly


This week, the New York Times reported on moms in Casper, Wyoming, who want to have the choice of how they give birth, but are denied that right by hospital policy (“Refusals Cut Options After C-Sections“).  These women have had prior Cesareans, which places women like them in a “mandatory surgery” category in over 1,200 U.S. hospitals.

Why is this such a big deal?  It’s two things.  First, surgery is riskier for women—riskier to the tune of a three times greater chance of death, although still rare; it’s the more mundane effects like infection, longer recovery time, and hospital readmission that plague greater numbers of women.  Repeat Cesarean is also riskier for future pregnancies, as abnormalities with the placenta become more likely with each surgery and can result in the loss of the baby, the mother, or the uterus.  Second, there’s a real rights issue here: Since when did business people get the decision-making power over how a woman gives birth?

The article included contrasting statements from the chief medical officer at the Casper, Wyoming, hospital—who affirmed the hospital’s stance, calling vaginal birth after Cesarean (or VBAC) an “inappropriate risk”—and the president of the American College of Obstetricians and Gynecologists, Dr. Jeanne Conry, who “said she and other doctors at her hospital strongly encouraged V.B.A.C.s because they are less invasive.”  The paper also reported that Dr. Conry was “concerned and surprised” that hospitals were making it difficult for women to have VBACs.

As an advocate for women facing mandatory surgery policies, I was interviewed at length for this article, but only a fraction of that interview made it into the story.  That tidbit concerned the logistical problems women face when they realize they’ll have to switch providers and hospitals in order to be “allowed” a vaginal birth.

These logistical problems can be daunting, and many of them are tied to money, when women must travel well outside their own communities for safe harbor.  Transportation, lodging, childcare, and leave from work for birth partners can get expensive.  The ability to pay may be the only difference between a vaginal and a surgical birth.

Now, multiply that problem by the thousands of women who are served by the over 1,200 hospitals where VBAC is not an option.  Yes, 1,200 hospitals.  That’s over 40% of all maternity wards in the United States.

In fact, among the documentation we provided to the New York Times were statements from women in more than 25 states. They said things like:

·      I was floored when not one of the doctors in the area would take me on as a patient and “allow” me to go into labor. . .  I fought against the hospital for making me stay in bed, getting Pitocin to speed up labor (contraindicated in VBAC!), and having a repeat c-section. I fought and my husband fought and after 23 hours of broken waters I did have my 2nd VBAC. (Florida)

·      They are lied to by the doctors here, they are scared by the doctors about risks, they feel they have no voice. OBs here actually tell women that vaginal birth is ILLEGAL. . .  Many women are not able to make the drive out of town. Many women are too afraid to. (Iowa)

·      My local hospital has just placed a ban on VBAC, which leaves me in a huge bind.  I will NOT be having unnecessary surgery, but there is nowhere else to go.  Because of this, I won’t be getting pregnant until I have a plan for giving birth that doesn’t include forcing me into surgery.  I feel sorry for all the moms who planned to give birth normally and now are being forced to either switch care or have surgery. (Kentucky)

·      I live less than 5 minutes from our VBAC ban hospital.  Now pregnant with #5, I am faced with the same 6 hour round trip drive to doctors appointments and hotel stays for laboring all at my own cost.  This should never have to happen.  As an American, I should be allowed the freedom to labor at home comfortably and then drive the 5 minutes to the hospital to birth my baby just like any normal laboring mother.  (California)

Back to Wyoming.  The other part of the story is that local women there organized into a group and have been fighting that ban for almost a year now.  They’ve met with the hospital—unsuccessfully—and have been on the local news several times about their efforts.  The hospital continues to maintain its stance, and the women continue to assert that they shouldn’t be subjected to non-medically indicated surgery.

Here’s what Chelse DePaolo-Lara, the lead organizer, had to say:


When we launched the VBAC Casper movement we assumed that Wyoming Medical Center would review the evidence based, updated medical research and immediately change their outdated VBAC ban. It is overwhelmingly clear that VBACs are a safe, healthy option for many women and their babies.

Instead, we have been slapped in the face with ridiculous replies such as, “[we] have seen no demand for VBAC.”  We’ve been protesting for almost a year with hundreds of local supporters!

I am absolutely disgusted that the women of Wyoming are being forced into surgery they don’t need or faced with hundreds of miles in travel with extensive expenses just to deliver their babies. The hospital has made it clear that they don’t really care about our business and as a Casper native, it’s heart-breaking to me. Business really is more important than people at Wyoming Medical Center.

(Join the Casper women here on Facebook)

My opinion?  These policies are outrageous.  They are in direct violation of national health policy and our most basic rights about our bodies – how we give birth and in our healthcare, and whether or not we have prophylactic surgery.  They are a wide open door to a frightening idea: that third parties get to decide how women give birth, based on the interests of that third party.

In 2014 America, that’s got to change.

If you want to learn more about these policies and how they affect women, grab a copy of my eBook Vaginal Birth Bans in America: The Insanity of Mandatory Surgery.

Version 2A former communications strategist at a top public affairs firm in Baltimore, Maryland, Cristen Pascucci is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and, since 2012, vice president of the national consumer advocacy organization Improving Birth.  In that time, she has run an emergency hotline for women facing threats to their legal rights in childbirth, created a viral consumer campaign to “Break the Silence” on trauma and abuse in childbirth, and helped put the maternity care crisis in national media.  Today, she is a leading voice for women giving birth, speaking around the country and consulting privately for consumers and professionals on issues related to birth rights and options. 

Consult with Cristen | Resources + more Articles

Free handouts + monthly-ish updates from Birth Monopoly: click here