VBAC should not be a woman’s right

VBAC activists are clinging to their resentment and aggressively ignoring reality.

Amy Romano at Science & Sensibility asks the bizarre question: Do women need to know the uterine rupture rate to make informed choices about VBAC? It’s bizarre because she implies that this is a medical question and that the answer is unknown. However, this is a legal question and the answer has been clearly established by the courts. Not only is knowing the rupture rate required, it isn’t even enough. Women must “understand” the rupture rate and many women have successfully argued that they are incapable of understanding.

Don’t believe me? Consider what the Syracuse NY Birth Injury Lawyers have to say on the subject:

For an expectant mother to give meaningful and informed consent she must be specifically told and understand that “IF HER UTERUS RUPTURES DURING HER VBAC, THERE MAY NOT BE SUFFICIENT TIME TO OPERATE AND TO PREVENT THE DEATH OF, OR PERMANENT BRAIN INJURY TO, HER BABY.” (emphasis in the original)

Courtroom Mama, writing on The Unnecesarean, helpfully illustrates how VBAC activists desperately cling to their resentment. In her post NIH VBAC Consensus Development Conference: Gift Horse or Trojan Horse? she is most excited about the fact that an activist aggressively challenged a panel member, presumably “speaking truth to power.” Courtroom Mama (a self described “law geek”) utterly ignores the medico-legal issues that restrict availability of VBAC.

Most egregious, though, is the penchant of VBAC activists to invent rights that don’t exist. Henci Goer’s bemoans the “[f]ailure to recognize that VBAC is a right.” Yet there is no legal right to VBAC. Indeed, there is no legal right to healthcare of any kind, let alone a right to a specific procedure. A “right” to VBAC implies an obligation on the part of doctors and hospitals to preside over VBACs, justifying resentment of obstetricians for depriving women of their “rights.” However, since there is no “right” to VBAC, doctors and hospitals cannot be accused of violating anyone’s rights.

Asserting a non-existent right is worse than pointless. It demonstrates an inability to understand and frame the real situation in favor of a make-believe world where evil obstetricians control everything. In the real world, women have only the right to refuse medical treatment, not a right to demand a specific treatment. Moreover, doctors and hospitals have no legal obligation to comply with patients who refuse medical advice or demand procedures that the doctors or hospitals do not provide.

And speaking of “procedures,” activists who attended the conference impressed themselves with their clever observations on semantics. According to Goer, “VBAC … is not a procedure. Labor is what inevitably happens at the end of pregnancy.”

That point, currently bouncing its way around the Twitter universe, is simultaneously inane and irrelevant. Are doctors supposed to bang themselves upside the head and suddenly realize that VBACs don’t pose additional risks because they aren’t “procedures”? Are lawyers supposed to have a sudden epiphany that detailed consents aren’t required for VBACs because they aren’t “procedures”? Why don’t VBAC activists notice that no one beside themselves is impressed with their “cleverness”?

VBACs have been dramatically restricted because of legal and insurance concerns. There’s no one to “blame” because everyone involved is doing their job within medical and legal constraints that we all must acknowledge. Unfortunately, being deprived of the opportunity to blame obstetricians appears to be insupportable to VBAC activists. They demonstrate a greater commitment to made up reasons for resentment than to practical solutions for making VBAC more widely available. Indeed, they are so committed to resentment that they appear incapable of addressing reality.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

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