How to navigate VBAC and many limiting healthcare system policies & barriers

How often have many of us heard:

“It’s hospital policy.

I’m sorry, that’s just our policy.

Well, that’s the policy.

I understand, but our policy doesn’t allow that.”

How many times along your VBAC journey have you heard the word POLICY? From our experience (and what we’re hearing in our community), this word gets thrown around an awful lot.

But what does it actually mean? And how do you navigate “policies” that you don’t want to follow?

Meagan and Julie recorded a really great episode on policies, which aired back in November. To give this important topic even more attention, we’re giving it space here on the blog. Catch episode 354 and keep reading here for common hospital policies around VBAC and how to advocate for yourself when the policy doesn’t match your birth preferences. 

Policy Definition

First and foremost, it’s important to understand what policy actually means. According to lawinsider.com, “hospital policy means the principals, rules and guidelines adopted by the Hospital which may be amended, changed or superseded from time to time.”

The bottom line here: policy does not mean law.

Policies, of course, are important for hospitals to run efficiently. These businesses should, indeed, have policies, procedures, best practices and standards of care. The problem we often see is that hospitals and their providers operate for so long under a certain “policy” that it becomes a tool, a threat to coerce someone into doing something, This is particularly the case in pregnancy, labor and birth.

Common VBAC Policies

Hospital policies obviously vary by state, location, hospital provider, etc., however, here is a list of common policies surrounding VBAC that you might run into while planning your birth.

Induction

This is a topic that we see a wide variety of different policies across the United States, many of which are contradictory. Some hospitals refuse to induce VBAC moms altogether, with their only options being spontaneous labor or repeat C-section. Others refuse to induce unless you get to 40 weeks and then will consider induction methods. Some require induction by 39 weeks. And others have restrictions on the types of induction methods allowed (i.e. no pitocin, pitocin up to a certain amount, etc). 

Things to consider: The fact that so many different policies exist on this topic (some of which contradict themselves) is a red flag. It is so important to discuss your hospital’s policy, your provider’s plan and YOUR preferences when it comes to your due date and induction. Ask hypothetical questions (“If my water breaks but labor doesn’t follow, what options will I have to induce labor if desired?”) ahead of time so that you aren’t trying to navigate these decisions in the moment.

Fetal monitoring

It is standard practice in most hospitals that laboring women have continuous fetal monitoring. This means that two monitors are strapped with elastic bands to the mother’s belly, one to monitor the baby’s heartbeat and the other to monitor contractions for the entire duration of labor. Because irregular fetal heart tones can be a sign of uterine rupture, most hospitals have a policy stating that women who choose to TOLAC are required to have continuous fetal monitoring. 

Things to consider: One reason continuous is standard is so that nurses and providers can watch a continuous feed from the computer rather than being present in the room. Many hospitals do have wireless monitors if you feel most comfortable with continuous monitoring. It’s also important to note that there are other types of monitoring including intermittent monitoring and hands-on-listening (read about the specifics on Evidence Based Birth). 

Epidural placement

Sometimes we’ll hear of policies that require VBAC moms to get an epidural placement, like a “just in case, doesn’t have to be turned on” epidural. Providers typically explain that if you don’t have the epidural placed and an emergency arises, they would have to put you under general anesthesia. 

Things to consider: In an emergency situation (talking, every second counts), you’re likely going under general anesthesia no matter what because there wouldn’t be time to dose the epidural. If you end up having a repeat C-section but don’t have an epidural placed, it takes about three to four minutes for a spinal to take effect. 

Advocating for Yourself

Pregnancy Justice is an incredible resource that works to defend the civil and human rights of pregnant people. We love their reminder that “There is no point in pregnancy in which people lose their civil and human rights, and yet all over the world, people often experience mistreatment and violations of their rights during pregnancy and birth and postpartum.”

When “I’m sorry, that’s hospital policy” just doesn’t align with your preferences, your birth plan or your intuition, it’s essential to remember that you have a voice. Your autonomy matters. You get to call the shots when it comes to your birth experience… even if it’s “against hospital policy.”

But we know that oftentimes, that’s easier said than done. Here are some tips…

• Research & Plan – Do your own research ahead of time. Taking a childbirth education course, or even better, a VBAC-specific course, will help you feel more educated, confident and equipped to make decisions that are right for you. Based on your research, make a plan for your ideal birth, including your preferences for everything from what you’ll wear to newborn care. 

• Discuss – Share your birthing preferences with your birth team and your provider. Bring a list of questions to your prenatal appointments and seek open discussions with your provider. Don’t be afraid to question their standards and policies, asking why they are instituted and what the research is. Consider their responses, but evaluate whether you are feeling bullied into a decision or being treated like you are in charge of your experience.

• Change Providers – If you feel like you don’t have time to ask questions, aren’t getting thoughtful responses or your choices aren’t being respected, remember that it is never too late to change providers. Check out our list of VBAC Supportive Providers and find more information here. 

If you take nothing else from this information today, we hope you hear this – you deserve to be in charge of your birth experience. Ask questions, do research, decide what you want, get the support you deserve and take ownership. Even if that means choosing not to follow a hospital policy. You are worth it. TRUST YOUR INTUITION.

As always, women of strength, here is an affirmation and reminder…