Cutting Laws

(Part 2 of Politics, Poltics...)

A brief history of EMTALA: It stands for the Emergency Medical Treatment and Active Labor Act. It was enacted in 1986 with the purpose of requiring hospitals to accept patients in active labor regardless of their insurance coverage, lack thereof, or ability to pay.

EMTALA today: The use of this anti-discrimination law has since been expanded beyond its original intent to include protection from discrimination on any grounds.

"Forced" Cesaraens: In many parts of the country, and sadly and ashamedly, in many parts of Oregon outside the metro area, practitioners and hospitals are refusing to perform VBACs (Vaginal Birth After Cesaraen). This is mostly driven by malpractice insurance, but regardless of the causes, the end result is women are being forced to have surgeries they do not want. A surgery that has even made the list of Consumer Reports' "12 Surgeries You May Be Better Off Without".

Refusal of Forced Cesaraen: If you live in a place where Cesaraens are forced and you would like to have the opportunity to have a VBAC, consider taking up temporary residence in a place that will allow them for your last months of pregnancy, such as the Portland metro area. If that is not an option for you, you do have the right to refuse a Cesaraen, regardless of what any doctor or hospital says. What you say is: "I am refusing consent for a Cesaraen Section under EMTALA and it is a violation of these rights to perform any proceedure on me without my explicit permission." Not exactly the best low-stress environment for a natural birth, but it is a right that you have.

Want to learn more about VBAC and EMTALA? Check out ICAN, the International Cesaraen Awareness Network or Birth Policy, a consumer group devoted to protecting patients and midwives legal rights.

Now my own rant: Episiotomies - why are they still so prevalent? Since the early 1990's, publications as out-there and radical as the New York Times, the Journal of the American Medical Association, and the New England Journal of Medicine have declared this proceedure to rarely be needed, and its routine use to worsen the extent of laceration. This recent JAMA study still found the same thing: Episiotomy increases the need for stitches, increases pain, increases the healing period, increases bowel incontinence, and increases pain with sex.

If some yahoo on the street came up to a woman and sliced her perineum, it would be the top news story of the night. NO ONE would consider it anything other than sexual assault. Why is it different when the assailant is wearing a white coat?

On rare, rare occasions, an episiotomy can be a life-saving proceedure on the part of the baby. Or it can be the only option other than a Cesaraen. But there is no way those situations account for the nearly half of all births that include an episiotomy.

Here's my crazy plan: Women should start asking their care provider what their episiotomy rate is. If the number is above 2 or 3%, or if their answer is "only when needed" (which translates into "at least 50%"), they should issue the following statement to their provider: If you perform an episiotomy on me without asking for and obtaining my permission, I will have my records reviewed by another provider. If the baby is not found to be in time-critical fetal distress at the time of the incision, I will press criminal charges against you for sexual assault."

Methinks it would not take long for the number of "needed" episiotomies to drop, drop, drop...