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Fort Myers, Florida (News-Press) -- Sabrina Hall had an emergency cesarean section six months ago, an experience that gave her a healthy baby boy but left her emotionally distraught.

Medical staff whisked away her son after the surgery — a common practice with C-section deliveries — depriving her of those first moments with her first child. It made her determined to never have another C-section, assuming she can ever find a doctor to help her avoid one.

"I feel like the birth of my son, there was a lot of disconnect, which shouldn't be there when you have a baby — it's the most joyous experience in the world," said Hall, 20, of Naples. "My son was removed from me like a tumor."

The old medical rule of thumb went something like this: "Once a C-section, always a C-section."

But improvements in how those surgeries are done has increasingly meant it's safe — safer in many cases — for women who have undergone cesareans to have natural deliveries afterward.

Despite that, such "VBACs" (vaginal births after cesareans), remain a rarity in Southwest Florida. The four-hospital Lee Memorial Health System, which oversees the majority of births in Lee County, does about 30 VBACS a year. By comparison, it performed more than 2,500 C-sections last year.

The situation has been made worse for women seeking VBACs by the potentially long-term hiatus of one of the region's few physicians who specialize in such deliveries. That doctor is on medical leave from his Cape Coral practice and did not respond to an interview request .

Advocacy groups are pressuring the local medical community to step up to fill the gap.

Protocols, stats

Generally speaking, vaginal deliveries are preferable to cesareans. C-sections, after all, are surgeries. Aside from the longer recovery times, C-sections are more likely to cause blood clots, strokes, hemorrhaging, death to mother and child, than vaginal births. The more C-sections a woman has, the greater the risk of complications.

C-section rates here are considered high. Thirty-eight percent of Lee County deliveries were by cesarean last year, compared with the national rate of 33 percent. More than 41 percent of Collier County's deliveries were C-sections, according to state records.

VBAC success rates are between 60-80 percent nationally, experts say. But many doctors remain cautious about helping women get them, particularly if they have had more than one C-section. Complications from VBACs may include uterine rupture, dangerous bleeding and, potentially, death of the mother and baby.

"There are no do-overs when it comes to the birth of a baby," said Dr. Dirk Peterson, chairman of the obstetrics and gynecology department Cape Coral Hospital, noting: "The greatest impediment to offering more VBACs is the fact that, although the risk is low of a horrible outcome, when that outcome does occur there's no do-over. There's no way to reverse it. It's final."

Hospital rules also have meant those doctors were required to monitor those patients when they start labor, a time-consuming process that keeps them away from their practices.

Lee Memorial Health System recently changed its hospital delivery policy to make it easier for women to get such deliveries.

The old rule required women wanting such deliveries to have their VBAC physician inside the hospital during a woman's labor. The new rule, based on American College of Obstetricians and Gynecologists guidelines, would allow for some consenting women to try for a vaginal delivery even when their doctors are not immediately available.

"I think it's a great step in the right direction," said Megan Nickel-Martin, chapter leader of the International Cesarean Awareness Network. The group pushed for the change. "I'm very supportive of the policy change we worked out."

But, with so many physicians in the region reluctant to oversee such births, it remains to be seen if the policy will translate into more VBACs. Nickel-Martin's group is reaching out to local OB-GYNs, a process she described as "slow-going."

Hall said she has started looking for a doctor willing to help her deliver vaginally the next time around. No luck, so far.

"It's extremely hard to find anyone, in Lee or Collier County," Hall said. "I will not start to even plan for another child until I can find one."

Conflicts

But it's not always just a matter of tweaking rules and finding the right doctor. Sometimes patients and their health care providers are sharply at odds over what's best for the health of the baby and mother.

A Cape Coral woman's dispute with Bayfront Health Port Charlotte over her desire for a VBAC led to a complaint in federal court earlier this month.

Jennifer Goodall, a 29-year-old mother of three, asked the court on July 18 to intercede over Bayfront Health Port Charlotte's refusal to help her deliver vaginally. The hospital also threatened to contact the Florida Department of Children and Families over Goodall's refusal to agree to a C-section.

All three of her children were born by C-section, a fact her Port Charlotte doctors said would make a vaginal delivery particularly risky for her and her baby.

The hospital's ethics committee also reviewed the case.

"(W)hile we recognize that you have the right to consent to a (c)esarean section, you have elected to refuse this procedure despite the advice of your treating physicians," Bayfront Chief Financial Officer Cheryl Tibbett wrote in a July 10 letter to Goodall. "This decision places both you and your unborn child at risk for death or serious injury."

U.S. District Judge John Steele sided with the hospital in a decision handed down the same day Goodall filed her complaint.

Goodall, of Cape Coral, said she wanted to try to have a natural childbirth. She said she sought out Bayfront initially because she believed they would provide her with a VBAC.

"The way they handled it was completely inappropriate. It's just absurd," Goodall said. She noted she will consent to C-section if, once she's in labor, medical complications are evident. "I'm not playing Russian roulette with my baby's life," she said.

Goodall's due date was July 18 but, as of Friday, had not delivered. At the time, she said she did not know where she would go for delivery. She said it might be Cape Coral Hospital.

In the Cape

The Cape Coral health center performs, by far, the most VBACS in the health system. In the last two years it performed 43 of them, more than twice the number performed at HealthPark — home to the Golisano Children's Hospital of Southwest Florida.

It also has developed a "Gentle Cesarean" program, in which C-section newborns are placed on their mothers' chests immediately after delivery. This gives mothers and newborns a chance to physically bond and, in many cases, start breastfeeding, according to the hospital

The program has become popular since it started two years ago, said Nancy Travis, labor and delivery nursing director for Lee Memorial Health System.

"We've had women coming from as far away as Sarasota, the Naples area to come here to have a c-section," Travis said.

But, for now, C-section rates remain high in Lee. And their numbers have grown in recent years.

Nearly 40 percent of Lee Memorial Health System deliveries were C-sections the first three months of 2014, a rate slightly higher than last year. In 2012, barely a quarter of women delivered through c-section in Lee.

Peterson, the obstetrician and gynecologist, said the trend may be related to increasing obesity and drug-use rates in Southwest Florida. Part of it may be doctors doing them out of an abundance of caution, he said.

He said hospitals should instead concentrate on lowering rates of initial C-sections, something that would decrease the need for VBACS.

Lee Memorial has had some success with that. In 2011, nearly 34 percent of births at Cape Coral Hospital were first-time cesareans, records show. Last year, 26.7 percent of deliveries at Cape Coral Hospital were those kinds of deliveries.

"If a patient doesn't have a C-section in the first place, you're never confronted with them having to have a VBAC in the second place," Peterson said.

Connect with this reporter: @FrankGluck

High C-section rates

• Thirty-eight percent of Lee County deliveries were by cesarean last year.

• More than 41 percent of Collier County's deliveries were C-sections

• The national rate was 33 percent.

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