http://www.cesareanrates.com/pennsylvania/

WHERE DO VBACS OCCUR IN THIS STATE?There is no indication as to whether these VBACs were planned or unplanned. While it can be assumed that hospitals with higher numbers "allow" VBAC in their facility, it is best to speak with both your doctor and an administrator at the hospital for information on their VBAC policy.

(Excuse the formatting below, I haven't figured out how to tidy it up yet. But you can scroll, all hospitals are listed alphabetically. Paoli, Lankenau, and Bryn Mawr are all listed under Main Line Health Hospitals.)

2011

Facility

Total Repeat CS

Total VBAC

VBAC Rate

Abington Memorial Hospital

744

95

11.3%

Albert Einstein Medical Center

351

129

26.9%

Altoona Regional Health System

96

14

12.7%

Armstrong County Memorial Hospital

97

11

10.2%

Berwick Hospital Center

9

1

10.0%

Bloomsburg Hospital

31

5

13.9%

Bradford Regional Medical Center

48

0

0.0%

Butler Memorial Hospital

46

6

11.5%

Carlisle Regional Medical Center

60

2

3.2%

Chambersburg Hospital

167

22

11.6%

Charles Cole Memorial Hospital

28

0

0.0%

Chester County Hospital

273

52

16.0%

Childrens Hospital of Philadelphia

36

0

0.0%

Clarion Hospital

37

0

0.0%

Clearfield Hospital

22

2

8.3%

Conemaugh Valley Memorial Hospital

136

31

18.6%

Crozer Chester Medical Center

269

32

10.6%

Delaware County Memorial Hospital

184

52

22.0%

Doylestown Hospital

205

8

3.8%

Dubois Regional Medical Center

118

7

5.6%

Easton Hospital

60

2

3.2%

Elk Regional Health Center

27

1

3.6%

Ellwood City Hospital

31

4

11.4%

Ephrata Community Hospital

81

22

21.4%

Evangelical Community Hospital

142

27

16.0%

Excela Health Westmoreland Reg Hospital

197

20

9.2%

Geisinger Medical Ctr

211

34

13.9%

Geisinger Wyoming Valley Medical Ctr

220

26

10.6%

Gettysburg Hospital

72

1

1.4%

Good Samaritan Hospital

114

9

7.3%

Grand View Hospital

189

8

4.1%

Grove City Medical Center

27

1

3.6%

Hahnemann University Hospital

74

52

41.3%

Hamot Medical Center

343

61

15.1%

Hanover Hospital

71

1

1.4%

Hazleton General Hospital

117

5

4.1%

Heart of Lancaster Reg Medical Center

90

24

21.1%

Heritage Valley Beaver

87

19

17.9%

Heritage Valley Sewickley

147

14

8.7%

Holy Redeemer Hospital & Medical Center

424

29

6.4%

Holy Spirit Hospital

113

67

37.2%

Hospital of The University of PA

411

131

24.2%

Indiana Regional Medical Center

61

6

9.0%

J C Blair Memorial Hospital

28

2

6.7%

Jameson Memorial Hospital

66

4

5.7%

Jennersville Regional Hospital

52

21

28.8%

Lancaster General Hospital

624

101

13.9%

Lehigh Valley Hospital

324

75

18.8%

Lewistown Hospital

64

13

16.9%

Lock Haven Hospital

18

2

10.0%

Lower Bucks Hospital

207

8

3.7%

Magee Womens Hospital of UPMC Health Sys

852

182

17.6%

Main Line Hospital Bryn Mawr

190

17

8.2%

Main Line Hospital Lankenau

439

25

5.4%

Main Line Hospital Paoli

389

16

4.0%

Meadville Medical Center

44

0

0.0%

Memorial Hospital Inc Towanda

32

0

0.0%

Memorial Hospital York

66

4

5.7%

Millcreek Community Hospital

23

1

4.2%

Milton S Hershey Medical Center

273

43

13.6%

Montgomery Hospital

154

40

20.6%

Moses Taylor Hospital

289

38

11.6%

Mount Nittany Medical Center

143

25

14.9%

Nason Hospital

52

13

20.0%

Nesbitt Memorial Hospital

155

18

10.4%

PA Hospital of the Univer of PA Health Sys

684

119

14.8%

Phoenixville Hospital Company LLC

111

20

15.3%

Pinnacle Health Hospitals

468

22

4.5%

Pocono Medical Center

106

10

8.6%

Pottstown Memorial Medical Center

98

5

4.9%

Punxsutawney Area Hospital

20

0

0.0%

Reading Hospital & Medical Center

384

82

17.6%

Riddle Memorial Hospital

160

4

2.4%

Robert Packer Hospital

30

5

14.3%

Sacred Heart Hospital

49

13

21.0%

Saint Vincent Health Center

158

31

16.4%

Schuylkill Medical Ctr-S Jackson St

111

14

11.2%

Sharon Regional Health System

24

8

25.0%

Shenango Valley Medical Center

50

14

21.9%

Soldiers & Sailors Memorial Hospital

28

0

0.0%

Somerset Hospital

30

3

9.1%

St Clair Memorial Hospital

166

5

2.9%

St Joseph Medical Center Reading

85

13

13.3%

St Lukes Hospital Allentown

208

39

15.8%

St Lukes Hospital Bethlehem

346

69

16.6%

St Mary Medical Center

255

17

6.3%

Temple University Hospital

471

76

13.9%

Thomas Jefferson University Hospital

232

63

21.4%

Titusville Area Hospital

16

3

15.8%

Uniontown Hospital

125

6

4.6%

UPMC Bedford

46

1

2.1%

UPMC Mercy

167

29

14.8%

UPMC Northwest Seneca

76

5

6.2%

Warren General Hospital

49

8

14.0%

Washington Hospital

74

11

12.9%

Wayne Memorial Hospital

25

4

13.8%

Waynesboro Hospital

32

13

28.9%

Western PA Hospital Forbes Regional Campus

76

12

13.6%

Western Pennsylvania Hospital

491

76

13.4%

Williamsport Hospital & Medical Center

160

13

7.5%

Windber Hospital

28

0

0.0%

York Hospital

421

52

11.0%

Freestanding Birthing Center

23

N/A

Other

102

N/A

For a quick peek without the commentary, scroll down to the Table below. 

As it seems half of my clients over the next 6 mos are hopeful VBAC mamas, I am constantly reminded that we have to keep these intervention conversations going not just for them but for our first time moms! Let's please get the word out however we can - PREVENT the PRIMARY CESAREAN! You can do this by informing yourself and other pregnant women of these common maternity practices in the US and how they can change a labor, birth, baby, and woman. The biggie - unnecessary inductions. A woman is not OVERdue just because she has passed her due date. Post term pregnancy begins after the 42nd week, and induction is NOT supported before that date, especially for first time moms, because of the risk of cesarean. Spontaneous labor is your friend! A friend worth the wait! 

Below is a table created by Rebecca Dekker from Evidence Based Birth. Citations are available by visiting her post which she also shared on Improving Birth.Org : 
http://www.improvingbirth.org/2012/11/state-of-maternity-care/

I 



Encourage anyone hoping to avoid a cesarean birth to choose their birth location and provider CAREFULLY and hire a doula! It's great to take an out of hospital childbirth prep class, too, but going into the hospital with professional labor support is invaluable in helping women avoid routine interventions that lead to cesarean birth without improving mom and baby safety, according to evidence. So many women don't know! Believe me, I hear the stories from moms during their second pregnancies all the time at consultations. There are way too many women who just don't ever come across this info and don't know what to expect at the hospital during labor and how it can affect their birth, baby, and future! They trust their doctors and that the hospitals wouldn't do anything unnecessary or that could possibly be risky. And while those of us immersed in helping to change things don't believe that many care providers are ill-intentioned, we do know this - standard and routine practices being used in hospital labor and delivery care are not supported by evidence, not even recommended by ACOG! And yet they are still used on women everyday and leading to UNNECESSARY CESAREANS. Take a look at the chart - for you, your sisters, your friends, your daughters. And while you may be uncomfortable offering unsolicited advice, how would you feel wondering if you had gently passed on this information and it having prevented a woman and baby you love from unnecessary harm. 

I know we all find ourselves asking...but why? Why do hospitals practice this way? Why would our OB's do these things if not based in evidence? If not backed by their own professional organization? I think the simple answer is that this is just how they are trained.  "Managing" every step of the labor process is how they've experienced birth in the hospital setting. Ultimately, it's easier to manage a bunch of women's labors using these routine practices coupled with it being more in their comfort zone. Taking spontaneous labor off the table in the majority of their patients really puts a lot more control in their hands, too, which I believe is a good match for most of their personalities ;) ...and schedules, dare I say. That is, of course, all my opinion. Not based on evidence. ;) 

And for local information and support for managing interventions in a "trial of labor after a cesarean" (TOLAC) as a hopeful VBAC mom, please attend the ICAN meeting this Saturday at 10 am at Ohm Chiropractic in Media. It will be a roundtable discussion featuring tips from local doulas, ICAN leaders, and experienced moms! https://www.facebook.com/events/598029813590109/

Our son joyously arrived at 10:08pm on Monday, April 29th.  He came on his due date, which happily is the first of my expectations he decided not to fulfill.  I had told people for months that we would have a May baby, but he had other ideas.  My husband and I were lounging on the couch in the afternoon of the 28th when I felt a sudden desire to rush to the bathroom.  I knew immediately that my water had broken and remembered to note the color, smell, etc. like Lori had told us.  Water continued to seep from me for the next eight hours or so, in varying amounts.  The amount of water surprised me!  Good thing I had a bag of sanitary napkins on hand.  

Dan (the husband, not the baby!) and I frantically packed our bags and called The Birth Center in Wilmington, which is where we were planning on giving birth.  Because I am Group B Strep positive, the midwife (Durenda) requested we come in and start an antibiotic.  I felt high and expectant on the ride to Delaware.  I had not had any contractions yet.   When we arrived  Durenda confirmed that I had experienced premature rupture of membranes (PROM).  I was about 2cm dilated and 60% or so effaced. She suggested that we take a walk and get something to eat at a local restaurant, which we did feeling anxious and gleeful.  After dinner, we considered getting a hotel, which would have meant that we would have to come back to TBC every four hours during the night so the antibiotic could be readministered.  Durenda suggested we sleep there, saving us the hassle.  Very nice!  

During dinner and the walk, I had several slight contractions that felt more like the Braxton-Hicks  variety with little pain.  Things were going slowly so we were reminded that if active labor had not begun within 24 hours of PROM we would be transferred to Christiana Hospital. After we returned to TBC, Durenda suggested taking some homeopathic tablets to help speed the process of labor.  She also presented castor oil as an alternative.  After consulting with Lori, I decided to try to castor oil immediately and try the homeopathy in the morning if it was needed. In hindsight, I should have done everything suggested immediately, but at the time I wanted to sleep a little and thought contractions would begin very soon.  I slept on my left side that night with my belly hanging over the edge of the bed to try to help Baby Danny position himself in the ideal position, with the knowledge that he had been on my right side for the majority of my pregnancy.  The castor oil did not kick in until early the next morning, and I had mild contractions through the night and was able to sleep pretty well.  

The next morning, midwife Sarah gave me the homeopathic herbs and Lori arrived with breakfast foods from Wawa. I was still only about 3 cm dilated and a little more effaced, but satisfactory progress wasn't being made.  I started to feel slightly desperate with the thought that we would be transferred, so after some more castor oil I tried nipple stimulation in the shower, which brought some better contractions.  After about thirty minutes in the shower, we tried taking a walk and doing some pelvis-opening stretches, but another exam revealed that I still wasn't 4cm dilated, which had been our indication that active labor had begun.  Sarah told me that we would need to be transferred, which was heartbreaking to me because I saw a C-section at the end of the ordeal.  I had a good cry, then we packed up and went to the hospital.   

As soon as we arrived, my contractions became more painful.  I was incredibly frustrated with the paperwork in triage, including seemingly irrelevant questions like the name of the county in which I was born.  Apparently, my husband, who took over after I showed clear frustration with the questioning, was also asked three times, "Are you sure she has no Spanish heritage?"  Not sure why this was of interest to them.  Finally, Sarah spoke up and asked if I could go to our room and we were told we could. We arrived in the room about 2:00pm.  As soon as we arrived an IV was started and I was given Pitocin to induce more contractions. The nurses were kind to all of us; I didn't feel any animosity about our wanting to do things as naturally as possible.  The nurses even seemed to respect Sarah and Lori's perspective and knowledge. I think they would agree.   

I found not being able to walk, squat, or move in general very difficult.  I turned to my left and waited between contractions. I experienced very little sensation in the front of my body, but the pain in my back was sharp.  Luckily, Dan never left my side and massaged both sides of my spine during each contraction.  Lori or Sarah stayed in front of my face, while the other stroked my leg or applied pressure on pressure points to help the contractions speed along.  

A habit I developed that Lori later said was unique: during contractions I sang or repeated phrases.  In the beginning, I said things like: "OPEN" in a firm, calm voice; "somos juntos" ("we are together"), a phrase that resonates with me after a trip to Mexico a couple of years ago; "ganbare!" ("go for it!" in Japanese); "there is no bliss like this" (a favorite affirmation from yoga practice); and simply "YES!"  I also told myself to be calm and that what I was feeling was a pain that creates, not that destroys.  As the contractions increased in duration and frequency, I sang long high notes or scales and didn't repeat phrases.   Lori told me I also sang "Somewhere Over the Rainbow." I could not have made it through without this comfort measure, which made me feel powerful and as though I was still in control of something.  At one point, the nurses explained that they were concerned about the baby's heart beat, so they wanted to use an internal monitor.  This device sticks into the baby's head using a piece of wire that looks like a screw.  Lori and Sarah said it was a good idea, and with the idea that a healthy baby was the goal I agreed.  

Around 9:00pm someone asked if I was feeling pressure in my bowel, which I said was true. The pressure increased with each contraction, and Lori was coaching me not to push but to use puff breaths during each contraction to avoid the urge.  During the puff breaths, I began to push uncontrollably.  The pushing felt like a sort of muscle reaction that I could not control, similar to what I imagine a seizure might feel like.  Someone (a doctor?  I never saw her again) said that I was fully effaced and dilated, so everyone agreed with smiles that I could start pushing.  A bar was used across the bed for me to put my feet on and the OBGYN on call arrived.  He said the pushing was going very quickly.  I commented to Lori and Sarah that this part was very satisfying and almost pleasurable because it was empowering to feel I was getting things accomplished.  Several other nurses joined us and everyone was shouting "Go, Sara! Push!" which really helped me stay motivated.  The hospital nurses commented that it was unusual for me to be smiling and seemingly enjoying myself. I think around this time I said to Lori, "I am a warrior" and she heartily agreed with an encouraging smile.  

I expected to be shocked by my baby, so had done a lot of visualizing during pregnancy of the moment when he emerged.  There was no shock involved, he felt like mine and someone I already knew. I don't think the visualizations had anything to do with this feeling; I just think it was the first hormonal reaction of motherhood to know that this creature is mine and no one else's, not even my husband's in the same way as he is mine.  

The placenta came away quickly, though I think the doctor had something to do with that as his arm was somewhere inside me just before it emerged.  The stitching process was not pleasant; I had a third degree tear because our baby was on the larger side (9lbs, 14 ounces) and came out with his arm wrapped around his head. I am disappointed with doctor's performance; he was by far the least caring member of the team and did nothing to keep me informed of what he was doing.  He almost seemed annoyed by my questions.  Our baby spent the next 3 and a half days in the NICU, which is another long story!  If anyone is interested I'd be happy to share.  The end result of all of this is currently asleep on my lap.    :)

Last thing for all you first timers who might come across this: a short list of recommendations.
1.  Hire a doula.  I VERY HIGHLY recommend Lori.  If possible, also have another support person plus your partner for a total of three.  I know that these people's presence there meant that the interventions were kept to an absolute minimum.
2.  Pack a bag in advance and pack as though you'll be gone for several days.  Better to have to much than too little.
3.  Get in shape NOW.  Even if you're already pregnant, find something to do that will keep you fit.
4. I hate to say this, but expect to be disappointed in the doctors you meet.  Find others to trust.   

THE END! Ah, but also a huge beginning for our family!  

Lamaze International lists the TOP 5 Barriers to Breastfeeding. And while everyone who experiences these things when having a baby assumes they must be necessary, they are SO OFTEN NOT. Get the word out - moms have to know that they can ask for alternatives and while the practices may be 'normal' for that hospital, they are NOT normal for babies or getting breastfeeding off to a good start. Remember, the staff only sees moms through day 2 or 3 usually! What they don't see is the struggle afterwards that moms often encounter because of these barriers, and all too much without support. This is why our initial rate of 77% breastfeeding when discharged drops so drastically each week following.

Below is copied from their website: http://www.lamazeinternational.org/p/cm/ld/fid=324

In honor of breastfeeding awareness, Lamaze calls out the following top five breastfeeding barriers within the first 24 hours of birth to help expecting moms prepare for the best breastfeeding experience:

1. Unnecessary birth interventions:  While there are many unknowns during the birthing process, women can seek maternity care practices backed by science that can make birth safer and healthier. Fetal monitors, confinement to bed, artificially starting or speeding up labor and cesarean surgery can make birth more difficult and lead to a harder start for breastfeeding. For example, women whose babies are delivered by cesarean surgery can face a delay before the mature milk comes in. Pregnant women can find more information about reducing these and other challenges in childbirth by visiting Lamaze’s Push for Your Baby resources at: www.lamaze.org/ChildbirthChallenges. 
2. Separating mom and baby: Abundant evidence shows that mother-baby, skin-to-skin care beginning right after birth and continuing uninterrupted, for at least one hour, or until after the first feeding for breastfeeding women, helps mothers, babies and breastfeeding. Skin-to-skin care helps a mom feel more confident, respond more quickly to her baby’s needs, reduces stress and makes breastfeeding easier. There are also clear benefits for babies: they breastfeed sooner, longer and more easily, they cry less, have more stable temperatures and blood sugar levels, have lower levels of stress hormones, and adjust more easily to life outside of the womb.[i]
3. Use of pacifiers or other artificial nipples before breastfeeding is well established: Does the hospital nursery use pacifiers or bottle-feed babies without need? It’s an important question for expecting parents to ask. Studies show that early pacifier use may interfere with breastfeeding, and could decrease mom’s ability to exclusively breastfeed and reduce the duration of breastfeeding. Artificial nipples should be avoided until breastfeeding is well established (after about four weeks).
4. Supplementing breastmilk with formula: Breastmilk is best for babies. Formula simply does not provide the added nutritional and health benefits of breastmilk that’s naturally packed with antibodies, and should not replace formula unless there is a compelling medical reason to do so. Even the few days following birth are vitally important. The breasts produce a vital substance called colostrum, which protects the baby from illnesses and provides important nutrients
5. Lack of postpartum breastfeeding support: Many new moms need breastfeeding support after hospital or birth center discharge. Support may include: a home visit or hospital postpartum visit, referral to local community resources, follow-up telephone contact, a breastfeeding support group, or an outpatient clinic. This is a good time for a mom to talk about any challenges she may be having, and get the help she needs to give her baby the healthiest start.

"While breastfeeding decision-making can spark controversy among moms, improving breastfeeding awareness is not about passing judgment,” said Deck. “It’s about considering the scientific evidence and giving women the support they need to achieve their breastfeeding goals."

Some women find that they get to a certain point in pregnancy and realize they are not totally comfortable with either their care providers or their place of birth, yet do not know what to do about it.  Some women see red flags during an office visit or while asking questions during a hospital tour and they decide to make a change that they become forever happy about.  Some women just completely follow their intuition and go along their journey how they are comfortable.  If you trust where you are and who you are with, that's great! But it's important to Choose Carefully, and here are some stories of women who did.
______________________________________________________________________________________________________

Changing Care Providers

1) Mayumi's story 

2) Rupal's story  

3) Angie's story

4) Jess' story 

Care provider matters. Location of birth matters. Choose very carefully. Do not choose based on location's proximity to you, an appealing renaming of a facility, it's where your mother or sister gave birth, where your GYN is, or new beautiful renovations. Choose because you FULLY trust your care provider and the location where he or she delivers. Be sure you are getting personalized CARE and not just the routine. Ask specifics of nurses who work there, find out if the nurses and doctors have THEIR babies there, talk to doulas who have been to births there, take a PRIVATE childbirth class and ASK them, ask your provider how they like to work with doulas, what they will do in a stalled labor, when you're past due, how detailed and valued their nutritional education is, etc.  Do your research on statistics for each location, and do not stop until you are totally satisfied with your options.  Find out how often they see normal.  If they don't see it except for moms who come in pushing, then they also don't know how to react or support normal without trying to medically mange it. Recognize red flags and act on them.  Change is good in this case. Changing again is sometimes even better.  Often, it is not ever too late.  As a friend and mentor once said to me "You cannot go into Taco Bell and expect a Pizza."   And...I must add to her metaphor just a bit.  If you do go into Taco Bell wanting a Pizza and are ultimately talked into a taco being just as good, just know that you may never have an opportunity to eat a pizza ever again.  And maybe that taco will be just as good for you again and again and you'll only slightly desire a pizza in the future, but for some - it will become much more than just satisfying the need to eat, it will affect you in every part of your life more than you could have imagined.  Your birth depends on your choices more than anything else. You and your baby's birth deserve more research than your house, car, major appliance.  Maybe even as much consideration as when you chose your partner. Do not settle.  But, if you do - be ready to accept whatever outcome you get, knowing you had control to look into options and make choices about them.  Do not rule out anything because it scares you or because you don't know enough about it.  Learn.  Ask tons of questions.  If you don't know what to ask, find out.  Ask a doula.  Ask a childbirth educator.  Go to a birth friendly website to find out. Information eases fears.  Evidence based research cannot be manipulated as some people's words and opinions CAN be.  Also, a hospital is not the only place to give birth.  Feeling a certain loss of control at some point prenatally should tell you something about what to expect when you walk into the L & D room.  There really are care providers out there who will work with you and your individual situation as a respectful partnership and not impose strict protocols just because you have to go into a certain box.  And as much as I advocate for hiring a doula, there is really only so much a doula can help with at certain locations, up against a staff who finds us very counterproductive to their agenda. Sometimes our presence and mere suggestions alone are seen as interfering with 'the way they do things', no matter how safe, helpful, or important it may be to the birthing woman. And, yes...in the end, what we all need to have is a healthy baby and healthy mom.  In addition to that, though, as women...we desire to feel respected and supported and loved through the birth process.  It is important to our beings whether or not we realize before our first birth or after.  PEACE.

To read stories of women who've changed care providers and were glad for it, read here.