This article is a joint reporting venture by Edhat and the Santa Barbara Independent and is part of an ongoing series of stories on maternal health in Santa Barbara. Read our last collaborative story here.
By Lauren Bray
The Cabrillo Pavilion was filled with nearly two hundred moms, parents, caregivers, and healthcare workers on the evening of September 15th. The fifth annual Maternal Healthcare Panel hosted by ICAN, the Santa Barbara chapter of the International Cesarean Awareness Network, offered a free public event for the community to directly communicate with medical providers specializing in pregnancy and childbirth.
Six maternal health experts sat in front of the crowd and candidly answered questions, discussed successes and shortcomings in their field, and suggested available care options in Santa Barbara. Noticeably absent from the panel was a representative from Cottage Health System, the only hospital with an obstetrics unit capable of delivering babies on the South Coast.
ICAN chapter leaders Anastasia Stone and Kimberly Summer Zuleger informed the audience that Cottage Hospital was asked to participate, but instead chose to respond to a handful of questions. The bulk of the statement centered around the hospital’s July announcement to reverse its ban on VBACs (vaginal birth after cesarean) and TOLAC (trial of labor after cesarean) this Fall, a decades-long request by local birth workers and women.
“We are working to identify the best specialists to support [VBAC] service at Cottage, upholding our standards for quality and safety,” wrote Cottage Hospital spokesperson Maria Zate, “We are planning for an obstetric hospitalist and a dedicated anesthesiologist to be onboard before we begin offering the option of VBAC/TOLAC this fall. The timing will be based on securing this staffing coverage of emergency specialists onsite 24/7 to provide immediate support for VBAC/TOLAC care.”
The majority of the panelists responded to Cottage’s statement by questioning the need for additional specialists. Cottage Hospital is a Level 1 Trauma Center, the only one between San Jose and Los Angeles, equipped to handle even the most complex of cases, obstetrics included.
Dr. Emiliano Chavira, a Los Angeles-based OB/GYN with subspecialty training and certification in Maternal-Fetal Medicine for high risk pregnancies, stated that every obstetrician, labor and delivery nurse, and anesthesiologist should already be trained in how to handle a VBAC.
“Are they suggesting there is going to be a VBAC team or one VBAC provider? That doesn’t make sense to me,” he said, “An obstetric unit has a responsibility to prepare for emergencies of all types. That can be a hemorrhage, uterine prolapse, seizure, amniotic fluid embolism. People are supposed to be doing drills and figuring out how to respond to these emergencies. I don’t really understand how VBACs are any different.”
Local private practice OB/GYN Dr. Melissa Drake echoed Dr. Chavira’s sentiments.
“You don’t need experts to do a VBAC, you need people to be very well trained in emergencies, and not simply for VBACs, but for everything because VBAC is not the most dangerous thing we do and it’s not the common emergency that will arise,” she said.
Flor Cruz, a Southern California-based activist and birth educator, questioned if the hospital’s statement means the facility lacks proper emergency care for its patients and speculated why they’d give such a response. “What they’re mostly afraid of is litigation, let’s be honest. They don’t care about the person who is giving birth. What they care about is that the baby comes out alive, however that has to happen. And they think that a c-section is the only way for that to happen,” Cruz said.
Dr. Jennifer Dunatov, a clinical ethicist from Orange County who studies morals and values related to the practice of medicine, agreed with Cruz and stated that 98% of her ethics consultations are clinicians asking what could cause a lawsuit and how to mitigate it from happening. “It’s a common question and the fear coming from providers, the fear of being sued, is so tangible… it drives a lot of decision making,” she said.
Attendees of the 5th Annual Maternal Healthcare Panel (Photo by Aurielle Whitmore)
During the event a group of women were asked to come to the stage and share their experiences giving birth in Santa Barbara, most of which centered around having a VBAC. Leandra stated she would have loved to have her child at Cottage Hospital but her local OB/GYN wouldn’t discuss the possibility of attempting a VBAC so she chose to travel to UCLA Medical Center, while in labor, to have her child.
Raquel discussed having a conversation with her provider in Ventura who was “tolerant” of a VBAC but said if they were to be successful, they would have to lie when Raquel was in labor. The doctor said they would have to say she was going against their medical advice and is being really stubborn. She chose a home birth instead.
Vicky, who was seated in the audience with her 8-month-old, said the entire event is empowering. She, too, attempted to get support for a VBAC in town and was told “we don’t do those here” by a local doctor. She met with a different Santa Barbara doctor who supported her wish but couldn’t help due to fear of backlash from the hospital. She chose the Santa Barbara Birth Center instead and cried at her first appointment when the staff took the time to answer all her questions and support her journey with kindness and empathy, she said.
Cottage Hospital was contacted directly for follow-up questions for this article. The hospital declined to answer why a representative did not participate in the forum and also declined to comment on the panelist responses, but instead re-sent the same statement provided for the event. This included a mention of Cottage Hospital being listed on the 2022 California Maternity Honor Roll recognizing 108 hospitals for reducing C-section deliveries, a partnership with the Santa Barbara County Public Health Department to assess community health needs, and a separate Maternal Health Needs Assessment conducted by Cottage Center for Population Health.
Maternal Healthcare Panel (Photo: Ellie Stone)
The panel of experts also tackled the topic of collaborative care, where hospitals and clinics work side by side with physicians, nurses, midwives, and doulas to support families in their birth process.
“Statistically it’s better outcomes for mom and baby when there is collaboration and we can transport to the hospital without feeling like we’re going to be shamed or reported, or our clients are not going to be cared for,” said midwife and educator Blyss Young.
Santa Barbara-based midwife Alissa Herbert detailed a recent experience of working with Dr. Drake in a twin delivery. She expressed how important it was to be respected and acknowledged by a physician for their patient’s birth process.
“It’s unique to find the kind of respect and professionalism that we can have with each other and I think it is only detrimental to people who choose out of hospital birth who need to have some sort of medical care or any kind of referral to not have that [collaborative] conversation… but we do not do that here and Santa Barbara is not special in that way,” said Herbert.
“It’s better for safety, and it’s better for patient outcomes, and it’s a better use of resources,” Dr. Drake added.
While many families may look for support to have vaginal births outside of Cottage Hospital, the majority of health insurance companies won’t reimburse for care, costing thousands of dollars in out of pocket fees.
The Victoria Project aims to help with that. Founded in Santa Barbara in 2020 by Deja Rabb, Jenelle Green, and Haize Hawke, the organization is dedicated to increasing access to home birth and holistic maternity care in Southern California. Rabb and Green shared their success with attendees stating they offer funding support ranging from $250 – $10,000 with payments made directly to practitioners on the client’s behalf. They have so far dispersed $1.8 million and funded 340 births.
At the end of the event, the panelists discussed the future of inclusive birth choices. A general consensus of hope was expressed in that the culture of maternal health is shifting, due in large part to patients advocating for their own health and creating their own teams of professionals to support their journey.
More information on upcoming ICAN events can be found here.