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Hospital policy pains expectant mom

Posted: Wednesday, Sep 30th, 2009

Photo by Mary Forney/Lake Powell Chronicle Joy Szabo, pregnant with her fourth child, stands beside the message she wrote protesting Page Hospital’s recent general ruling that will prohibit her from giving birth naturally.

PAGE – A pregnant woman’s pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital’s general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.

Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

“Page Hospital is, as many small communities are, challenged with resources,” said Chief Executive Officer Sandy Haryasz. “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.”

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women’s care clinic in Phoenix or have unassisted home delivery.

While the hospital’s new policy not to do VBACs is unwritten, Haryasz said the decision is not based on money, but on there not being enough “volume” to warrant hiring another physician or emergency anesthesiologist.

“This is about providing quality safe care to all our patients,” Haryasz said. “The hospital would have to cancel surgeries or any other procedure because that doctor or anesthesiologist would have to be available to her while she’s in labor, which could take hours or days.”

Joy’s husband, Jeff, 44, is supporting what he thinks is his wife’s right to choose.

“I have talked with Banner Health officials who have said it’s just their policy,” Jeff said. “It’s a legal decision – not a medical decision. My wife’s plight is indicative of the health-care system in the U.S. They make money off of people’s suffering.

“Consequently, medical care is dictated by cost and insurance companies and not by what’s best for the patient.”

Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.

“I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order,” Joy said. “They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency.

“I wish her luck explaining to a judge that she is insisting I have a medically unnecessary surgery.”

ACOG currently supports VBAC deliveries, citing on their Web site at www.acog.org, that the benefits include the avoidance of abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss, and less need for blood transfusions.

The risks include a rupture of the previous cesarean scar during delivery, or in rare circumstances, rupture of the uterus.

Haryasz said that despite ACOG’s recommendations and the favorability of success with VBACs, Page Hospital is sticking by its decision to no longer perform natural deliveries after cesareans.

“We respect our patient’s wishes should they choose VBAC, however the medical staff and administration have determined that deviating from national standards and performing this procedure here is a risk that is unwarranted and too great for our mothers and babies,” Haryasz said.

The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

“My doctor doesn’t have a problem with me having natural delivery, but said that the hospital does,” Joy said. “The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn’t matter since the hospital has decided that all VBACs have to have an ‘elective c-section.’ I think my definition of ‘elective’ differs from theirs because I don’t want this.”

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