It is NOT illegal for a Licensed Midwife to attend a VBAC (Vaginal Birth After a Cesarean) in South Carolina.
Why would I say that?
There are rumors that it's illegal for midwives to attend VBACs, but they are only rumors.
While it is true that a midwife might not feel comfortable attending to a women who has had a previous cesarean or that some hospital policies prevent their staff midwives from attending VBACs, there are no laws forbidding a midwife from attending a VBAC. As a
matter of fact, the regulation for Birth Centers for Attendance by Midwives (reg. # 64-102) is clear that as long as a woma n has not had a classical cesarean section (midline vertical incision), she may be considered low risk for delivery.
So where did this "VBAC illegal" rumor come from? Ahhh, that's the question!
Remember that lovely organization that we have grown to 'love' formerly named DHEC?
Here's the BACKSTORY:
In the early 2000's, one of the hospitals got upset about a planned home VBAC that transferred to the hospital for extended services. Transfers are never fun, but the outcome was good and mother and baby did well.
When there was a complaint, DHEC wanted to forbid VBACs by midwives. The regulation for Licensed Midwives attending home births does not mention VBACs, but it does say that a midwife can attend to women who are deemed to be low risk by a physician.
Even the American College of Obstetrics and Gynecology has a position statement that most VBACs should be given a "Trial of Labor" (TOL). So the task of 'educating' DHEC began. There were many meetings where Licensed Midwives presented an exhaustive number of studies and information. Even the Midwifery Advisory Committee (MAC) to DHEC voted that many VBACs were low risk. Yet despite all of this information and the decision of MAC, in 2006 DHEC issued a MEMO declaring that VBACs were high risk and could not be attended by Licensed Midwives. Soon after, DHEC issued a Position Statement also forbidding VBACs at Birthing Centers (a position that directly contradicted their own regulation).
Fortunately, when DHEC tried to update the MEMO by placing the VBAC ban permanently in the Licensed Midwife regulations, the consumers protested. VBAC moms, midwives and their healthy children filled the conference rooms of the Medical Committee at the South Carolina statehouse and the VBAC restrictions were prohibited from being a part of the updated 2014 Licensed Midwife regulations.
Once a regulation is renewed, any former provider-wide-exceptions, position statements or MEMOs are no longer valid; therefore the short-lived VBAC restrictions ended over 10 years ago.
So why is the VBAC ban STILL a rumor in 2024? The answer to that one will make you angry.
The VBAC rumor continues to circulate because DHEC has refused to remove the MEMO from their website. That's right, they are wrongfully informing women that their rights are being denied, despite the knowledge that Licensed Midwives can attend to VBAC families.
With the updated compartmentalizing of DHEC, they may change their website soon, but here is the current link to the outdated MEMO: https://scdhec.gov/sites/default/files/docs/Health/docs/BCVBACMEMO20101214.pdf
So can you hire a Licensed Midwife to attend your home or birth center VBAC?
Yes and No
There are a good handful of home VBAC providers. Some are even doctors or Advanced Practicing Nurses. But very few of these providers advertise that they will consider attending a VBAC because they are fearful of retaliation from DHEC. Just this year a newly licensed midwife advertised that she attended VBACs on her website and was threatened with citations from The Department.
For midwives it's a catch-22. We know that we can legally attend VBACs and many of us want to help the women who are considered low risk, but we can't afford the cost, time or stress of a DHEC investigation.
So what can you do if you want a VBAC? Ask for referrals from your friends or local Natural Mommy groups, then call the midwives personally. Even if the midwife doesn't attend VBACs herself, she is likely to know someone who does. Or email us. CWB would love to attend many, many VBAC births but we don't have the resources to fight DHEC either. However, when you email us with your story, we'll be happy to recommend a friendly provider in your area.
Be prepared for your VBAC:
Try to plan at least 2 years between your cesarean and your VBAC.
Take lots of classes. Attend in person and take some online. Make sure the classes not only natural birth classes but that they are also realistic. I tell my moms to prepare for a long and tiring birth, expect it to last for days. Most births aren't that long, but be mentally and physically ready for a marathon.
Prepare financially. Unfortunately, most VBAC out-of-hospital births aren't covered by your insurance.
Remember that the next birth will be a VBAVB (Vaginal Birth After Vaginal Birth) and it's a lot easier to find a provider willing to offer a Trial of Labor once you have a "proven pelvis" (Isn't that a horrible OB term? But that's what they call it, ugh).
I say this often, "BIRTH IS NOT FAIR." Some women seem to experience very little pain and deliver chubby babies without effort. Others struggle and push for hours to welcome a tiny 5 pound baby. If your birth experiences are on one of these two opposite ends of the spectrum, it's difficult to even imagine the other woman's perspective. But that's ok. Yours and your baby's experience together is unique. The ONLY thing that we can do is to be prepared and make the best out of our situation.
Good Birthing and phooey on DHEC (Just Kidding. They know how much I love them.)
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