A North Platte woman is at odds with local hospital officials over the approaching birth of her sixth child. Barb Roebuck delivered each of her first four children, Jacob, 15, Cassie, 12, Seriah, 10, and Patience, 4, naturally. Vanessa, now 2, was in the breech position at birth, and was surgically delivered with a cesarean section surgery.

Now Roebuck is due to have her sixth child June 26, and she wants a natural birth, but Great Plains Regional Medical Center officials will not allow it. GPRMC President Cindy Bradley said research shows that a vaginal birth after a C-section, called a VBAC, has a higher risk of the uterus rupturing, which can result in the deaths of both the mother and the child. She said the American College of Obstetrics and Gynecology recommends that hospitals not offer a VBAC unless physicians and anesthesiologists are present during the entire birth. "That's not something we can do, something so intensive," Bradley said. "Physicians would be tied up in-house 25 to 36 hours."

Roebuck said the risks are minimal. According to the International Cesarean Awareness Network Web site, there is a 7 in 1,000 chance of a uterine rupture after a low transverse C-section, which she had. The Web site also warns of dangers of the surgery, which may increase the risk of maternal death, hysterectomy, hemorrhage, infection, blood clots, damage to blood vessels, urinary bladder and other organs, postpartum depression, post-traumatic stress syndrome, and re-hospitalization for complications. Complications from scar-tissue adhesions can include chronic pelvic pain, bowel problems and pain during sexual intercourse.

The Web site reports that the U.S. C-section rate of 27.6 percent in 2003, the most recent year of report, was much higher than the 15 percent rate recommended by the World Health Organization. The W.H.O. estimates that only half of C-sections performed in the United States are necessary. Roebuck said after her last C-section, she suffered postpartum depression, with a significant recovery period. "It was a year and a half before I felt back to my normal self," she said. "I still have days that I feel my scars."

She said two GPRMC physicians have said she is a perfect candidate for a VBAC, that there is no reason for her to have a C-section, except for hospital policy.
"If it's not necessary, I don't care to have my body cut open and go through that pain and stress just because it's someone's policy," she said. She said she has offered to sign a form releasing hospital physicians from liability, in case of uterine rupture. Obstetric Gynecologist Michael Trierweiler of North Platte Obstetrics and Gynecology said such a form would likely not hold up in court. "Attorneys burn those up in court, saying the patient didn't realize what she was signing," he said. Medical malpractice insurers often will not cover physicians who offer procedures outside the accepted standard of care.
"We'd like to do (VBACs)," he said. "We did them for years. Unfortunately liability colors much of what we do anymore. If we can't provide that care, we shouldn't be offering the service."
Bradley said Roebuck has two options: To schedule a C-section at GPRMC or relocate to a larger hospital in Denver or Omaha for a VBAC. Roebuck with said that would be difficult with her family obligations. Bradley said hospital policy is in place for a reason.
"It's just too risky to attempt to do VBACs," she said. "We want what's safest for her and the baby. Maybe in years to come, ACOG will change its position, but for now, we're going to abide by that."

Update on Barb Roebuck: She delivered a healthy baby at home with no complications in July. She had labor support, but no midwife. She decided she would be better off going it alone at home rather than consenting to medically unnecessary surgery.