Please speak up
The public, particularly pregnant women, of the Roaring Fork Valley need to be made aware of a decision by Aspen Valley Hospital that significantly, and negatively, impacts your labor and delivery care management options.The decision is not to allow women who have had a Caesarean delivery the opportunity to try and deliver vaginally. These are called VBAC’s – vaginal births after Caesarean section deliveries.Why? Because:The hospital-employed pediatricians refuse to participate in the stand-by in hospital care precautions because of safety implications for the baby.Fear of litigation if an adverse outcome occurred.Now women who have had a Caesarean delivery, and are a candidate for attempting to deliver vaginally, will have to have a repeat Caesarean delivery, or temporarily move to Denver where the care option is available and await spontaneous labor, or consider home delivery without the security benefits of in-hospital labor care.All labors have risks; the select risk of VBAC’s is the unlikely occurrence of the uterine Caesarean scar opening during labor which can assuredly jeopardize the baby’s safety and life, and can necessitate emergency Caesarean intervention. Hence, the need for in-hospital, stand-by care which the obstetricians, anesthesia personnel and operating room personnel have committed to – except for the pediatric department staff and now the administration has dissented as well.VBAC’s have been done for over 10 years at Aspen Valley Hospital with a 65 to 70 percent success rate of delivering vaginally, and NO adverse outcomes for mothers or babies. Now these VBAC care options have been sadly rescinded. I implore the community to share your concerns loudly and vociferously with the hospital administration and the hospital board. Our practice will continue to offer obstetrical care, but Dr. Nagle and I are extremely saddened and chagrined by the impact of this decision on our patients, and the loss of ability to offer full service obstetrical care without patients having to go elsewhere. I feel horrible about the decision, and can only imagine how badly I will feel operating on a patient coerced into a Caesarean delivery without the opportunity to try and deliver normally.We will attempt to form an alliance with Presbyterian St. Lukes in Denver to transfer candidates for VBAC management if they wish to do so. Dr. Richard Porreco’s group of obstetricians pioneered VBAC safety and efficacy beginning in the late 1970s.One additional political aspect of this negative decision is that the election issue of 1994 supporting a mill levy subsidy for Aspen Valley Hospital was predicated on maintaining availability of obstetrical services in the community. With the pediatric staff declining to participate because of safety liability apprehensions, one solution I proposed to provide the added margin of safety for the baby was to employ neonatal nurse practitioners, one of whom would be in the hospital continuously to provide stand-by availability for any compromised newborn, born vaginally, or by Caesarean. Certainly this would be an appropriate use of mill levy subsidy funds that continue to be funneled to the hospital.The pediatricians contend that we cannot offer VBAC’s here because of their concerns for the newborn’s safety. Aspen prides itself on being uniquely innovative and we need to try and find a solution that allows us to continue VBAC obstetrical care management services and not “throw out the baby with the bath water.”The upcoming board election is an opportunity to voice your concerns, particularly with regard to this latest care management infringement.I fear this infringement on care-management options is the beginning of a slippery slope that could result in the loss of obstetrical care availability at Aspen Valley Hospital. My voice has not been heard – perhaps yours will be. Please, please, speak up.M.T. Harling, M.D.Aspen
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