Serving Whitman County since 1877
Serving Whitman County since 1877
The question of providing vaginal birth after cesarean service was discussed in a special meeting of the hospital board Monday night. While doctors at the hospital have provided the service in the past, there is no set hospital policy. Two are scheduled for June and have prompted “significant” discussion said Whitman Hospital and Medical Center CEO Hank Hanigan at the start of the meeting. A panel from different hospital departments participated in the meeting in person and via Zoom.
Before hearing from attendees, Hanigan said the question was not if vaginal birth after cesarean (VBAC) can be done, but what are the benefits and risks and does it make sense to offer the service.
Dr. Pete Edminster spoke first. He stated that VBAC is a “hot button issue for small hospitals.” He explained to the hospital board that a VBAC is when a woman wants to deliver naturally after have a cesarean section. There is a slight possibly that the pressure of vaginal labor can cause the uterus to rupture along the scar of the c-section. Doctors can assess the risk of the mother to decide if VBAC is advisable or not. Those who are the right candidate for VBAC do better after delivery than if they had another c-section.
“It’s actually safer to offer this than eliminate from our bag of services,” said Dr. Edminster. He added that if the hospital loses this service, it creates a domino effect resulting in the loss of other hospital services.
It behooves us to continue to offer this service, he said, pointing out he and other doctors use a risk calculator to determine if the individual patient is a good choice.
Dr. Mark Parsons and Dr. Kim Mellor agreed with Dr. Edminster.
“We don’t take very many VBACs,” said Dr. Mellor. In his more than 30 years of OB care, he had seen two uterine ruptures, neither of which were VBAC patients.
Dr. Mellor also said that Dr. Edminster’s voice was the most relevant as he represents the future of care at the hospital. Dr. Christin Reisenauer also spoke in favor of continuing to provide VBAC service.
Charlene Morgan, chief nursing officer, spoke against providing the service due to concerns of lack of back up surgery staff should the worst case scenario occur.
Members of the anesthesia department also expressed concerns about lack of resources and staff in the rare event of a uterine rupture, including the store of blood available at the hospital. CRNA Nikki Riley said she was “nervous” that in a worst case scenario they would not have the resources.
The last professional input came from Cristi Shindler, Family Birth Center manger. She told the board the OB nurses provide as much information as they can to patients and feel the rights of the patients need to be upheld.
After a break for executive session, the board voted four to one in favor of providing VBAC service for the two already scheduled for June with further action awaiting more discussion. The dissenting vote was cast by Martin Marler who then made a motion to allow VBAC service at the hospital now and into the future. The motion died for lack of a second. More discussion on the matter is expected in the future.
In cases, VBAC care has been linked to the attending physician, not the hospital as a whole. The service is not available at Pullman Regional Hospital.
“I felt the Board considered all input provided from the various disciplines and acted in the best interest of the patient in order to provide them with a high quality and safe experience at our hospital,” said Hanigan after the meeting.
Jana Mathia is a reporter at the Whitman County Gazette.
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