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Photograph by Chris Samuels

Can So! Local women protest Sutter Maternity's proposal to discontinue a procedure known as VBAC, or Vaginal Birth After Cesarean.


The Vaginal Birth

With barely three weeks till Christmas, the question of the Virgin Birth remains a matter of faith. Still, it seems certain that MARY, whom legend has living to a ripe old age, didn't have a cesarean, since the procedure, whose name is believed to be derived from the surgical birth of Julius Caesar, would only have been performed on a dead or dying mother.

(Nüz notes that some of the earliest successful C-sections took place in remote rural areas, which, ironically enough, were less likely than hospitals to be bedeviled by infections and more likely to be populated by people well versed in animal husbandry, such as, er, shepherds. But we digress.)

Fast-forward 2004 years to Santa Cruz County, where the C-section rate is 23 percent, making it one of the highest in the nation--even though cesareans pose increased medical risks to mother and baby, and cost $4,000 more than vaginal births.

And now this C-section rate threatens to increase even more as Sutter Maternity deliberates whether to continue a procedure known as VBAC, which stands for Vaginal Birth After Cesarean and assists mothers who've had the procedure in the past but want to give birth without a cesarean.

Indeed, if Sutter does discontinue VBAC, it would become the 156th hospital nationwide, and the 39th in California, to cease offering the procedure.

So, why the increasingly anti-VBAC trend? Tari Neill of the county's International Cesarean Awareness Network blames the American College of Obstetrics and Gynecology, which in 1999 laid down what she claims are "overly stringent" guidelines that hospitals need to follow in the case of VBAC.

"Statistically, there are higher risks for a woman giving birth for the first time than one going from cesarean to vaginal delivery, so it comes down to malpractice and insurance concerns," Neill claims.

Sutter's chief administrator, Rick Nichols, says the VBAC policy review is about "medical quality and patient safety concerns" and that since Sutter's medical staff also have privileges at Dominican, "we're not saying we're not going to do VBAC at all, but when and where and by what criteria."

And Sutter obstetrician Dr. Howard Salvay notes that a few years ago insurance companies wanted everyone to have VBAC because they didn't want to pay for cesareans.

"But now the pendulum has swung, and national standards have been set that require every hospital to look at being immediately available to do cesareans," says Salvay, noting that what makes VBAC "a little more problematic" is the possibility of uterine rupture.

"The chance of rupture increases in VBAC because the uterus has been cut and has a scar on it from the first cesarean tear," he explains, adding that uterine rupture is rare, "but it still happens and is very serious for the baby when it does, so we want to find a way to prevent ruptures--and deal with them when they do occur."

Asked if he thinks the VBAC guidelines are too stringent, Salvay, who describes himself as a "very pro-VBAC person," says, "No comment."

"These births need to be done in a safe way and these guidelines describe one safe way to do it," he says. "And if guidelines are perceived to be too restrictive, then efforts need to be made nationally to change them. That's the value of a group like ICAN. And it comes down to the expectations of patients and their acceptance of risk. If hospitals assume 100 percent of the risk, then hospitals have to do what hospitals have to do."

As for Neill, she says women need to stand up for their VBAC right.

"We live in a culture of immediate gratification, but we are gypping women if don't give them the opportunity to feel the amazing glory of vaginal birth ... and women need to spend more time on births than on weddings."

Haunting questions

Is black the new green?

That's the question members of the recently formed Keep the Greenbelt Green citizens group must be asking as pressure mounts to build an "eastern-access roadway" through the Pogonip, the 640 acres of greenbelt between the San Lorenzo River and the UCSC campus that provides an unbroken connection from the city's edge to the wilder part of the county.

According to a 1907 American Indian handbook, Pogonip is a Shoshone word for a "peculiar icy fog," and though an equally romantic anecdote claims the name stands for polo, golf and cocktails--which is what went on at the Pogonip Country Club during its heyday--a definitely peculiar and distinctly icy political fog is descending on the city as it considers whether the land, bought with $15 million of state funds, is protected in perpetuity.

The issue has reared its head again in part due to heavy traffic on High Street, a problem which has so far triggered two petitions. One demands that the "eastern-access roadway along with other transportation options be investigated immediately," while the other, the Keep the Greenbelt Green petition, urges the UCSC chancellor and the City Council to reject a roadway and to implement the Master Transportation Study proposals, instead.

Environmental lawyer and former Mayor Celia Scott says she feels both petitions are "on the same side, because both are saying do something about the traffic impact in High Street," and that the sense of mysticism that pervades the Pogonip, not to mention the bobcats, coyotes, deer and mountain lions, is what inspired people to save it in 1978 when talk of annexing and developing it first arose.

"The story of Pogonip, so far, is a story of what didn't happen," says Scott, noting that it's not accurate to say that the Pogonip is not legally protected, since any attempt to urbanize it could invalidate the terms of the state Park Bonds act.

Meanwhile, the city Parks Supe Steve Hammack notes that the greenbelt was purchased because the citizenry wanted it.

"The fact that we're currently having difficulty with the stewardship is because of the budget, but in the long term we'll be good stewards," he says.

Noting that "a majority of the greenbelt was purchased with grants that specifically funded the preservation of open space," Hammack says that until those grants have been properly researched he can't make a statement, but that conditions probably make road building impossible.

"But we do know the citizens of this town place great value on parks and open space. And I don't think those values have changed."

The City Council will consider the Master Transportation Study on Dec. 9 at 3pm.

Nüz just loves juicy tips: Drop a line to 115 Cooper St, Santa Cruz, 95060, email us at , or call our hotline at 457.9000, ext 214.

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From the December 3-10, 2003 issue of Metro Santa Cruz.

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