When she felt that pain, she knew immediately,"This was my last opportunity to have some control over how this delivery was gonna go."
Weiss' midwife, Jessica Johnson, was at the hospital that night and confirmed her client's account. She said the experience wasn't good health care. To her, it just illustrated the underpinnings of blanket bans of vaginal birth after cesarean across California:"Absolute ludicrousness." Johnson watched helplessly as her patient came to the brink of being forced into a plainly unnecessary surgery she said repeatedly she did not want.
Some of that stems from genuine concern for an individual's well-being. A bad labor outcome becomes more likely if the prior surgery was less than two years ago and the wound hasn't had enough time to heal; if the C-section was in response to a situation likely to arise again; if the original incision was atypical; if the person has undergone multiple uterine surgeries.
ACOG explicitly tells providers in a separate recommendation that"pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment." And data show that in the same five-year span, the average VBAC rate across all California counties—the rate of people who, having had a C-section, are able to have a subsequent vaginal birth—was just under 12%. That left a vast majority undergoing multiple cesareans: Nearly nine times out of 10, people having a baby after a C-section were going right back into surgery.
When she served on the California Pregnancy-Associated Mortality Review committee, she looked into some of these deaths. Stanislaus County, where Weiss gave birth, is in many respects a typical California county when it comes to VBACs. More of those are repeat cesareans because Black women are more likely to have a possibly unnecessary C-section for a first-time birth of a non-twin, head-down baby at 37 weeks or beyond, which in most cases is a low-risk birth. The California Department of Public Health said that in 2018, 28% of Black women in California giving birth under those conditions had a C-section; 23% of white women giving birth under the same conditions had a C-section.