Arizona Mom Threatened with Court Order for Refusing Unnecessary Surgery

You would think that after having delivered two babies vaginally–one after a cesarean section–Joy Szabo’s ability to give birth is sufficiently proven.

Not so, according to Page Hospital of Page, Arizona, where Mrs. Szabo delivered all three of her babies (including the one VBAC), but now faces an unnecessary and unwanted “elective” cesarean for her fourth. Page recently enacted a ‘VBAC ban,’ a policy that is more appropriately referred to as a “denial of service for women with prior cesarean unless they preauthorize surgery” since a vaginal birth is not so much a “procedure” that a hospital can elect to perform or not, but rather is a biological process which they can attend or not attend, but will happen either way. 

According to the hospital Chief Executive Officer Sandy Haryasz, the hospital’s choice not to attend vaginal births for women with a prior cesarean seems to be that birth is just too unpredicatable, VBAC just too risky. From the Lake Powell Chronicle:

“Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week.

“Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist.”

Never mind that the recommendation that “because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care” (p. 6) is a “Level C” recommendation (based “primarily on consensus and expert opinion” — as opposed to “good and consistent scientific evidence” (Level A), or even “limited or inconsistent scientific evidence” (Level B)), whereas the statement that most women are good candidates for VBAC and should be offered a trial of labor is “Level A.”

As Mrs. Szabo points out, however, “that’s why women go to the
hospital to have their babies – in case there is an emergency.” A
hospital that admits that they don’t have the resources to perform an
emergency cesarean should probably not be holding themselves out to be
any safer than a birth center or midwife-attended home birth (both of
which are very safe for women with low risk pregnancies, incidentally),
seriously calling into question why Arizona midwives are prohibited
from attending VBACs. 

This also raises another question: if vaginal birth is a biological
process that will happen with or without the hospital’s help, what if
Ms. Szabo shows up in labor? In fact, isn’t she protected by EMTALA
(Emergency Medical Treatment and Labor Act), which requires all
hospitals that receive Medicaid funding to stabilize everyone who walks
in to the Emergency Room in active labor?

Yes and no. While the Act specifies that “stabilization” for the
purposes of active labor means delivery of the baby and the placenta,
it makes no provision for how a hospital must treat a woman who refuses
unnecessary cesarean surgery. Page Hospital is prepared, though.

“I asked Sandy [Haryasz, hospital CEO] what would happen if I just showed up refusing a c-section and she said they would obtain a court order .”

So, despite the fact that as a matter of law and medical ethics
hospitals should only seek recourse to the courts to override patients’
wishes in “extremely rare and truly exceptional case[s],” In Re AC. , 573 A.2d 1235, 1252 (D.C. App. 1990), the hospital is basically saying that it plans to ignore ACOG’s ethical guidelines
and trample on a woman’s rights to bodily integrity, informed consent,
and due process to comply with its lowest-level reccomendations,
completely irrespective of the mitigating factors Ms. Szabo presents
(i.e. two prior vaginal deliveries, including a VBAC; only one prior
cesarean, etc.). Nice.

Adding insult to injury, Bill Byron, Senior Director of Public Relations for the hospital system tweets :

Re: VBAC issue & w/ all due respect, our VBAC practice based on
ACOG practice guidelines common in all if not most hospitals across
nation.

which, sadly, is true , and

Banner pro-VBAC w/ appropriate patients . Many large, urban Banner
hospitals provide, but not in hospitals lacking high-risk capability.

I guess he forgot to add “pro-coercive medicine in hospitals lacking high-risk capability.”