Decision Maker Response

Julie Cann-Taylor’s response

Julie Cann-Taylor
Chief Operating Officer & Senior Vice President of Patient Care Services, Wyoming Medical Center

Jun 4, 2013 — Wyoming Medical Center has become aware of a petition urging us to reconsider our policy against performing VBAC – vaginal birth after cesarean.

We sympathize with a mother’s desire to experience natural child birth. But VBAC is considered a high-risk obstetrical service for both mothers and babies.

A cesarean birth requires the uterine wall to be surgically opened, weakening it for future births. Natural birth in a woman who has had a prior cesarean can rupture the old scar of the uterine wall.

A ruptured uterus can be catastrophic for both the baby and the mother. In such cases, medical response must be extremely rapid. The American College of Obstetricians and Gynecologists recommends the “immediate availability” of an obstetrician, an anesthesiologist, a surgical suite and an operating team to provide an emergent cesarean delivery. The position of our insurance carrier is that “immediately available” in these guidelines means these services would have to be available at any time a patient presented for a trial of labor after cesarean.

In addition to being very costly, our insurance carrier does not allow us to provide this service due to the risk involved. We realize other hospitals in Wyoming may offer VBAC, but they may not have the same insurance carrier. We and our insurance carrier have taken a conservative position in the belief that this best protects the health of the mother and the baby.

WMC is continuously engaged in improving the care we offer patients. We will use the input from this petition to engage the stakeholders in reassessing our position.