VBAC as choice, Drs telling me medicaid will not cover

I am 19 weeks pregnant with child 3. I've been talking to my Dr's office about having a VBAC for the last 8 weeks at least and this week they dropped the bomb on me that NC Medicaid does not cover VBAC. I got laid off 1 month before getting pregnant and lost my insurance. So basically they are forcing me to have a c-section on grounds that I can't pay for a VBAC. I have called medicaid and they say they cover both vaginal and c-section births; what is different about a VBAC? I have been told that they call in a team of anesthesiologist who basically sit and wait for you to labor and have an OR on standby of which all of these have to be paid for their time. The anesthesia could cost $10000 or more!? My first question is why is this any different from any other emergency that may come in. I have never heard of anyone in our area not getting emergency care because there was no staff already in place to cover it. My c-section was nearly 7 years ago and very traumatic for me. I have pain from the spinal and lots of stomach pain from the scars, my stomach was cut vertical and my uterus was cut horizontal. I have a friend who had Medicaid pay for her delivery and it was after a c-section though i don't know what codes were used. I have called hospitals, anesthesiologists, medicaid office, case workers, etc and can get no answers. One even acted like I had no right to ask the questions. Does anyone have any information to help me. I do not want to be cut again. Thanks

[LosingMyMindInGA]

You may also want to check with the head nurse in L & D and find out what the hospitals stand on VBACS is, some hospitals have bans on them, some don't

[mychel7]

Thank you for your comments. It's not an easy place to be in, laid off and pregnant. I have considered laboring outside of the hospital and going in at the last minute. At least that way I would be close in the event of an emergency. The problem is the VBAC code and Medicaid does not recognize it so therefore when the Dr. office files it, no one gets paid is what I'm being told. I am getting told so many things and they conflict with each other. I am currently checking out ICAN and hope to get some answers. I love my Dr. and don't want to switch but I don't want to be forced into an unnecessary surgery.

[RockRose]

mychel,  don't do that.  

You are putting your baby and yourself in grave danger by not at least laboring in a hospital,  where on a moments notice they can administer general anesthesia and save your baby and your life if your uterus bursts.

There's a reason the hospitals insist on having a standby staff in preparation for a true emergency with a VBAC - because it's quite likely to result in an emergency.

I've had three c-sections - one that was difficult,  two that were fairly easy.  Maybe you've already had your difficult one and will have an easy one next time.  ;D

It is hard not to have all the choices available due to money issues,  but please don't take the drastic step of laboring outside a hospital.   You can't get there quick enough to save lives if you rupture.

[LosingMyMindInGA]

DO NOT LET THEM FORCE YOU INTO IT.  I don't believe ANYONE Should be forced into something.  If you have no other risk factors like complications with your pregnancy and your previous c-section was a low-transverse incision, there is no medical necessity at this point to force you into a planned c-section.  I've been looking at the NC medicaid website and I see NOTHING that specifically says they will not pay.  If anything, it would be more beneficial for medicaid to allow you to do a VBAC becuase the chance of complications is low (though higher than for someone who has not had a prior c-section) and a vaginal birth is about half as much as a c-section depending on the area, doctor and hospital.  If you can not get a straight answer from anyone at medicaid....call your state rep or your governors office and tell them what is going on, see if they can help get you some answers.  I was looking at the ob codes for NC medicaid and I don't SEE one for VBAC.  I see variations of vaginal with and without anasthesia and variations of c-section, but none that say VBAC.  This is what i was looking at :

http://www. dhhs.state.nc. us/dma/mp/1E5.pdf
(I had to put spaces in the web address so it would show, be sure to take those out before you copy and paste)

http://www. dhhs.state.nc. us/dma/bulletin/OBGYNSpecBull.pdf

[LosingMyMindInGA]

That was supposed to read they DID not have an ob at the hospital.  Trying to type faster than I can think so I can take DD6 to Baton practice.

[Victoria01]

Back to your original post :) I know you tried talking to a case worker, but maybe you should speak to a supervisor and NOT give up. Someone needs to speak to you. I cannot see why they would deny a VBAC as, in most cases, it is just as safe and better. I wouldn't give up without a fight.

[mychel7]

To clarify, I was considering sitting in my car in the parking lot of the hospital until it was time to have the baby. That way I was close in case of an emergency. Also, from all the facts about VBAC I have researched, and I have done my homework, they have about 15 - 18 minutes to get the baby out with a good outcome in the instance of rupture. The sooner the better but that is plenty of time. My prior c-section was not an emergency and I was in the OR within 15 minutes and it could have been done quicker. Also, rupture is not as likely as many think. The current statistics are less than 1 in 100 will have a rupture, babies are highly unlikely to die being 1.4 in every 10000. My point is, my hospital does have staff on call for emergencies anyways, this should not be any different than any other emergency situation and I don't see why I or Medicaid should have to pay for all the extras when its part of services that are already in place.

[RockRose]

That's not enough time,  Mychal.  You can't get in the hospital doors in 15 minutes if you have ruptured your uterus.  I realize your first C section was not an emergency also - you had an epidural it sounds like.  That means it was not an emergency.  

The reason VBAC ruptures are so low is because it's not done very often.  Women with any risk at all are encouraged not to attempt a VBAC.  In generations past,  VBACS were simply not done at all.

If you rupture and you are laboring in a car in the hospital,  your baby will be dead before you are on the operating table.  I'm not trying to be rude and cruel,  just honest.  From experience of having seen misguided women think they can labor outside a hospital and come in if something goes horrifically wrong.

Medicaid is trying to cut corners and not spend any extra than is necessary to ensure a healthy outcome.  In allowing you to labor after a c-section,  they do have to have a standby emergency crew ready at a moment's notice.

From my own experience,  there isn't always one of those available.  My anesthesiologist administered medication to me without a shirt on.  He was called out of sleep STAT.  

I wish you well with this,  and totally understand your desire to have a vaginal vs. c-section.  It's all about the risk.

[mum2beagain]

I may be wrong but, certainly where I am, if you had a vertical incision down you abdomen (as you described) with your last delivery that makes VBAC even more risky. No doctor in my area will allow VBAC after a vertical incision under any circumstances.
I have had both a natural birth and a c sect. I was terrified of having my c/s, (and  I really wanted another vaginal birth), also due to previous back injuries had to have a general rather than a spinal for the delivery, despite my fears the recovery wasn't any thing like as bad as I expected.
By all means take it further; if you are able find some way to go VBAC then that is great but also prepare yourself for the fact it may not happen. If that is the way it has to be please, please don't take any risks with yours or your babies health.
I wish you all the very best.

[melimeli]

if you induce with a vbac your risk of a rupture goes wayyy up...  most wont induce with a vbac

[mychel7]

My Dr. said he would prefer to induce because he can monitor the whole time. That threw a red flag for me b/c I know that increases the risk of rupture. He also said, when I asked when i needed to come to the hospital since its "so risky" and the need for constant monitoring is so high that I could come when contractions were steady and close together or when my water broke. Is that not a contradiction?

[Victoria01]

It sounds to me like he is saying that he would prefer to induce you but you should go to the hospital IF you contractions were steady or your water broke before then - but I could be wrong. Since you are only 18 weeks, he will probably give you an induction date later, if that's what he is planning to do.

[melimeli]

umm check your dr.. risk of rupture goes way up with induction..  

[pertykitty]

no induction with vbac.  that is it.  he is just trying to tell you he will do it but when you arrive that c section will be waiting for you.  find another dr, midwife anyone that doesnt use the word induction.  

[tam2girls]

From my understanding the vertical incision is better for the ab muscles than horizontal because you don't have to cut through the muscle and as long as they did horizontal in the uterus it should be ok. Vertical is no longer done for asthetic (?) reasons so that the scar is not visable nothing else.

I was told as long as the placenta has not implanted near the old scar then the risk of rupture is minimal either way you have the baby.

As for the increase of rupture with induction. I was induced for my VBAC because of my low lying placenta that was preventing the baby from engaging. 5 days overdue I had my waters broken and the drip put in and bub was born 10 hours later with no problems at all. The doc did not mention an increased risk and he has 40 years experience and I trust his advice.

I had no problems with my pregnancy in either case and the anethestist is always on call for an emergency.

If you have no other risk factors then I suggest you try for the VBAC. I know how bad a c section can be and I delivered twins vaginally one head first the other breech with no painkillers and I would do that 10 times over than have another c section.

If you go in for a proposed VBAC that turns into an emergency c section then the end bill should simply say emergency c section I would think. and if you go in for a VBAC and have a normal vaginal delivery then I would think that is what the doctor should bill for. Thats makes sense to me but I am in Australia and our sytem will bill for anything except elective surgery that is not considered medically necessary.

Good Luck just make sure you are happy with your final decision for what ever reason. I have had freinds that have been pushed into what others think they should do and have gotten quite bad PPD as a result of being bullied into not doing what they felt was right.

[mychel7]

I wanted to update. I got some answers today and Medicaid is not the problem. It's the hospital and their policies/charges. So I am going to a different hospital and changing Dr's. A VBAC is essentially a natural birth and should not be charged for more than such, especially when the hospital provides emergency services already. So for those that had a problem with my situation and having Medicaid pay for more, I am actually trying to save money and not have a more costly c-section. Beyond that, the benefits to my well being, both mentally and physically, and my child's well being should be reason enough for support. My husband and I paid (and continue to pay) taxes for years and this is what Medicaid was intended for; for those in need. Thank you to those that offered supportive comments.

[RockRose]

Good for you,  mychel.  It looks like you found the perfect solution - to be able to attempt a VBAC but under hospital care in case a true emergency arises.

[Victoria01]

I am glad you are able to get what you want in a safe environment.

[LosingMyMindInGA]

I'm glad you found a place.  I had a hard time this go around as well. I am only 8 weeks but I was already being told there was no way I was getting a VBAC under any circumstances around here.  I live in a small town and would have to go to another county to switch hospitals.  But I went backto my old ob who agreed that there is no reason i shouldn't be able to try for another VBAC.   I've read things both ways on this:  some places say it's best to have no medication that way you can feel the pain and alert the docs if your uterus starts to rupture.  Others say it's better to have an epidural becuase then they can administer the medicine easier if you end up requiring a c-section.  I know that last time the anasthesiologist told me that becuase i was going for a VBAC i would be on a lower dose of the epidural.


As for the inducing,...yes they do say that it can increase the risk of rupture becuase it makes the contracts stronger and more intense.  But there are other risk factors to consider as well such as success of a previous vaginal delivery, how long ago the c-section was etc.  As I said in one of my previous posts, my last child was induced and was a vbac.  I'm glad you are doing your research on the vbac statistics.

[mum2beagain]

Glad you found a safe and co operative hospital for your birth. Good luck with it all.

[tam2girls]

I am glad you will get to try for a VBAC and hope all goes well for you.

[mychel7]

Just an update for nay interested: I had my baby at home in a birth tub unassisted. We went to 2 different places after all that happened above and although Medicaid was no longer an issue the prospects of having a VBAC with these providers was slim, they claimed to be supportive but were not. One tried to tell me I have something wrong with my pelvis and I've already had 1 vaginally. The other practice came up with something new each visit about my weight. I was fine through the whole pregnancy but at 38 weeks they actually compared me to a heart attack patient coming to the hospital for treatment, all b/c I wanted a natural birth. So we stayed home and it was wonderful. I was relaxed, things progressed nicely, we listened to baby's heart rate and it never was abnormal. It was wonderful and I'll never go back to the hospital to have another baby.