Mom won't be forced to have C-section
•One woman plans to travel 350 miles to another city in order to avoid a C-section

•Hometown hospital says it can't meet doctor group's guidelines for VBACs

•Group issued guidelines in 2004; since then fewer hospitals willing to do VBACs

•In other cases, patients can ask providers questions to get the birth they want
updated 9:30 a.m. EDT, Thu October 15, 2009Next Article in Health »
By Elizabeth Cohen
CNN Senior Medical Correspondent
(CNN) -- Jeff Szabo was by his wife's side when she gave birth to their son Gabriel seven years ago, and he was right there holding Joy's hand when their younger sons Michael and Daniel were born, too.

Jeff Szabo was there when Joy gave birth to (from left) Gabriel, Michael and Daniel, but will probably miss No. 4.
Joy is now eight months pregnant, but when this baby is born, her husband will most likely be more than 300 miles away.

The reason: Their local hospital in Page, Arizona, won't deliver the Szabos' baby vaginally as the Szabos wish, so a week or so before her November 21 due date, Joy will drive 350 miles to be near a hospital in Phoenix that will.

Their local hospital says they'll only deliver the Szabos' baby, another boy, via Caesarean section. Joy had her second son, Michael, by C-section. Page Hospital says it won't do a vaginal birth after a woman has had a C-section -- known as a VBAC -- because it has a higher than usual risk for complications.

So Joy plans to move to Phoenix in November, while Jeff stays in Page, in far northern Arizona, to take care of their three children and run the family computer business.

"I'm so upset about this," Jeff says. "I've been there in the delivery room for all the other boys and I won't be there for this baby, and I won't be there for Joy."

The Szabos and a growing number of other families are facing the choice of Mom having a surgery she doesn't want or attempting a vaginal birth at a hospital that, in most cases, would be far away.

A mother's choice

The Szabos' story began in 2004 when she was in labor with Michael. Complications arose and doctors at Page Hospital feared the baby wasn't getting enough oxygen, and so they performed an emergency Caesarean section.

"I'm grateful for that C-section," Joy says. "It saved Michael's life."

Two years later, Szabo had a successful, uncomplicated vaginal delivery with son Daniel at the same hospital. She assumed she could have a vaginal birth this time too, but, she says, a month ago her doctor told her Page Hospital had changed its policy and she'd have to have a C-section.

Studies have shown VBACs carry with them an increased risk of a uterine rupture compared with births in women who've never had a C-section, but the risk is less than 1 percent, according to the American College of Obstetrics and Gynecologists.
The results of a uterine rupture can be devastating: The baby could die or have permanent brain damage.

"I know there's a risk with a VBAC, but we think the risks of surgery are worse," Joy Szabo says. C-section risks include breathing problems for the baby and infections and bleeding for the mother, according to the Mayo Clinic.

"And I don't want to have to recover from surgery when I'll have four children at home, at least not voluntarily," says Joy.

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital's CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

"I was a bit flabbergasted, because that seemed rather extreme," Joy says. "I'd already had a VBAC at Page and it went fine. And if something happened, I know they can do an emergency C-section, because they did one for Michael."

Conflict over guidelines

Michele Grim, a spokeswoman for the hospital, said Haryasz could not comment on her discussion with the Szabos because of patient confidentiality laws.

Banner Health, which owns Page Hospital, says it decided to stop performing VBACs at Page when ACOG, the obstetricians' group, established guidelines for hospitals that Page Hospital was not adequately staffed to satisfy.

The ACOG guidelines recommend "24/7 coverage of both physician and anesthesiologist," and that "two physicians be immediately available during the entire period of labor," Banner Health said in a statement.

But ACOG spokesman Gregory Phillips says that's not what the guidelines say. "These appear to be Banner's interpretations of the stated recommendation," says Gregory Phillips.

The ACOG guidelines recommend that doctors consider several factors when determining if a VBAC is possible. For example, two criteria that can be considered are whether there's physician availability throughout active labor, and whether anesthesia and staff can be available for an emergency C-section.

Since the ACOG guidelines came out in 2004, more and more hospitals have refused to do VBACs. Today, nearly half of hospitals won't do VBACs, either because the hospital has banned them or because doctors won't do them, according to a survey of nearly 3,000 hospitals by the International Cesarean Awareness Network, a grassroots group that has fought against VBAC bans.

Missing his son's birth

To get around the ban, Joy Szabo plans on moving to an apartment in Phoenix in the middle of November. They have no friends or family there, but a doula, or childbirth assistant, will drive her to the hospital when she goes into labor.

The Szabos have no option but to separate to get the birth they want, but in other situations, women don't have to go to such extremes.

For example, some women don't want to be induced into labor, or don't want an episiotomy.


The key is to look around for a doctor or midwife who shares your philosophy by asking questions about their induction rate, or whether they perform episiotomies routinely, according to Carol Sakala, director of programs for the Childbirth Connection, a nonprofit advocacy and education group.

Also, choosing the right hospital or birthing center makes a big difference. "The institution you walk into profoundly affects you," Sakala says. "A really good thing is to ask doulas for their recommendations, because they've worked at multiple hospitals and have a good feel for what happens in each of them."

For more information on getting the birth you want, see these recommendations from Lamaze International.

The Szabos know there's little chance Jeff will make it in time for the birth. "With our other sons, her labor only lasted three hours. It'll take me five hours to get to Phoenix," Jeff says, noting that with three little kids along for the ride, it will take even longer.

"Of course I'm scared that I won't be there," he adds. "It's my job as the dad to make sure the baby's OK after the birth, to follow him around and make sure he has 10 fingers and 10 toes. Now the chances of that happening are slim to none."
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CNN's Sharisse Scineaux contributed to this report.

All About Pregnancy and Childbirth

The Hospital can set procedures any way they like...I applaud the Hospital for not bowing to a patients demands.

Seems pretty bizarre to me - after having a c-section; an uncomplicated vaginal delivery; now the hospital has changed it's policy and would only perform another c-section whether it's medically necessary or not.

I would not deliver my child there (jmo)

I can understand where the mother is coming from, but the hospital does have to look out for themselves against a lawsuit.

What would happen if they decided to allow a vaginal birth and something went wrong? Most likely the hospital would be looking at a lawsuit. I cannot blame the hospital at all in this. If any organization knows all too well about lawsuits they surely are the hospitals.

She needs to do what she needs to do as well as the hospital.

i know that if you have 2 c-cections they dont require you to get pg again, at least here any how.
but a old bf sister had 3 c-cections and her 3rd she had some problems.


a friend of mine has 6kids
her first she had a c-cection and her last child was a c-cection
she didnt have any problems with the others

If something went wrong during the vaginal delivery, heck I'd figure since we are in a hospital, let's perform an emergency c-section, let's fix it, is what I would assume they'd do.

Haha great point.

I just think that if something were to go wrong, that she should not be able to sue the hospital. Make her sign a waiver, but then that opens up another possible mess. Organizations have to be careful. In our society they can get sued in the drop of a hat.

No matter what, I wish that family the best.

Are you serious? Whatever happened to freedom of choice here? I understand that the hospital has to cover itself, but couldn't they do that by making sure the risks are known by the family before going through with such an event, instead of making a stressful situation even more so on them? I think the hospital is totally out of line to be forcing a pregnant woman to have to travel across the country just to have a vaginal birth. They should be ashamed.

AAAAAAAhh I keep forgetting the sue them it's their fault mentality.

What the hospital should do is respect the patient's wishes, and have a surgical team ready to perform a c-section should the need to do so arise. I find it absolutely ridiculous that hospital policy supercedes a patient's wishes.

This is a touchy subject for both sides. Taking devils advocate side, I can see both sides being equally right. The mother should have the choice to deliver how she wants to, and in this case is exercising that right; I find it odd that she has to go three hundred (?) miles away in order to do so, instead of choosing a different option like say having a midwife deliver the baby at home?

However, the hospital also has the legal obligation to protect it's patients as much as possible, and some insurances, yes we are getting into the insurance issue again, will not insure a hospital UNLESS they do exactly what the insurance agency tells them to, even if it means crossing an I and dotting a T.

I personally think a fair compromise would be that the hospital require, say a one hour class giving information on the facts of ALL kinds of birthing options (or longer if neccesary), and that if the mother chooses to go what is considered a more dangerous route, such as having a vacs, that the mother be required to waive in writing any legal rights she has, also releasing the hospital from being able to be sued from anyone else, to suing the hospital if a complication does arrive DIRECTLY RELATED TO HER CHOICE OF HAVING THE MORE DANGEROUS PROCEDURE. Now, if the hospital screws up and it is not because of the vacs (in this case) then the hospital is still legally liable; for example say the doctor accidentally tears the mothers vaginal lining to where she hemmorages, then yes the hospital would be at fault. Or if they have to have an emergency c-section and the doctor sews an instrument up insed of the mother, then the hospital is at fault.

BUT, so long as the mother is given all the information possible to make an informed decision, then it should still be her choice to have it done any way she chooses, as long as she is willing to waive legal action if something happens due to HER choice and not the hospital staff.

tons of women have a VBAC. much smoother recovery, and less risk for both mother and baby.

the chance of a uterine rupture is fairly small...the problem is that if it happens, it's severe. so they give a procedure that they KNOW is harmful to prevent the reaaaally harmful one.

many doctors feel that a VBAC is safer than a cesarean, especially when internal fetal monitoring and such is used to keep the baby and mother safe. success rate can be between 70-90%.

i didn't see if said that she'd had a vertical or horizontal incision, which can directly impact the safety of a VBAC. in the old days, everyone was cut up and down. that incision is more likely to come apart than the bikini-line procedure.

i think i'd wait it out until the last second and then check into the hospital. can they even send you away if you're in labor? they can't force you to sign for surgery...so what if you just deliver? are they going to take the chance of tossing the pregnant lady out on the street?