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Friday, March 28, 2014

Buffalo offers nation's first abortion clinic/birth center in one facility

By now you've probably heard about the nation's first abortion clinic and birthing facility all rolled into one, located in Buffalo, New York. Not surprisingly, it hasn't been without controversy.

At first, the idea of it did bother me. But I began to realize that to me, at least, that's not even the issue.

When talking about this groundbreaking facility, many people - both those who are pro-choice and pro-life - focus primarily on the abortion aspect. The fact that it's opening a door, albeit a small one, to women who want to 'birth outside the box' has pretty much gotten lost in the discussion.

Some articles, like this one, do touch on the birth aspect but in a very general sense. Of course the writers at Cosmo probably have no idea what it's like to give birth here. But this area, which comprises an eleven-county region, has, according to the Yellow Pages, at least six facilities that offer abortion, which no doubt translates into dozens of care providers. How many freestanding birth centers do we have in the area? One. How many in the entire state? Three.

Three freestanding birth centers in the entire state. 

Image: Fernando Audibert/stock.xchng
I'm sure there are other states that have zero birth centers in them. But I bet even those states offer abortions, even those that "set limits" on doing them. But they're still doing them. Where are those places that have tons of freestanding birth centers? Or hospitals that are truly, instead of just on paper, designated as 'mother and baby friendly?' Why is the outrage over lack of access to home births, birth centers and non-traditional birth in general seemingly boxed into a very small corner and only discussed by relatively few people in comparison?

I'm sure it wouldn't be hard to find a number of pro-choice people who think home birth is dangerous, VBACs are reckless, and that hospital birth is the safest option for pregnant women. The sheer volume of abortion facilities tells me that even with limitations, there is probably more access to abortion than there's ever been.

However, if you're giving birth in Western New York, you may have obstacles depending on what kind of birth you want. While Buffalo is indeed a major city, there are also outlying rural areas that are up to an hour away from the city. One hospital has gone on record as saying they'd "get a court order at 2 a.m." if they had to, to prevent you from having a VBAC, but it's hard to say if that's true or just a scare tactic. If you're giving birth in that hostile environment, you may not be emotionally strong enough to take that chance.

Other options include a home birth, which not everyone is totally comfortable with. I know some who've birthed in their midwife's home close to the hospital, but again, the midwife can only see so many patients.

I've heard people say they labored in the parking lot outside the hospital, knowing they'd be hooked up to monitors if they went in too early. Others willingly drive an additional 45 minutes to an hour away in another county to give birth at a "friendlier" hospital with a lower cesarean rate (but a much higher rate of births attended by midwives). Judging from the data, it's quite clear in a number of areas that evidence-based practices are not being performed.

So far several of our hospitals still allow VBAC, but in my experience it was hard to find overwhelming support from doctors (and even midwives) when choosing one (and the numbers speak for themselves). Many women, I'm sure, are easily swayed not to even bother attempting one if their doctor isn't enthusiastic about it. Besides myself, I know only a handful of women who've VBACed. The rest just look at you like you're crazy.

It saddens me deeply that among my friends and acquaintances, most of us have had cesareans, some multiple times. I myself have had two. Among the three women I've talked to recently, I realized that between us, we had ten cesareans total. If I widen that scope, it racks up pretty quickly - to the point where vaginal birth seems to be somewhat of an anomaly.

Why? One reason is likely because of inductions. That one act - inducing labor - can trigger a domino effect that can make your chances of vaginal birth slim, at least around here. I've known women who were induced simply because of their geographical distance from the hospital, with the doctor joking, "You don't want to give birth on the New York Thruway."

Here's how a few facilities in the Western New York region (which comprises eleven counties) stack up: (For the sake of boredom we'll look at two counties.)
Data is from 2012. Note the rate of induction, 
which is substantially higher than both state and local averages 
(down only slightly since 2011).  This hospital serves a number of rural
women in outlying areas surrounding the city. VBAC rates are much lower
than the already predictably low state average. The cesarean
rate actually increased slightly in that time period. 
When I first gave birth, it was at this hospital, and not a very happy experience. Maybe things have improved a little since then?

Across town, induction rates are just as bad, as compared to
state averages. Relatively few births (22 in all) were
attended by a midwife. Episiotomy rates dropped only slightly
from 2011, as did the cesarean rate. 
Located in a fairly remote area, your choices are
further limited in neighboring Niagara County. We can
reasonably assume the VBACs (and probably all breech
births in this entire data set) were unintentional. Still higher than
state average episiotomy rates persist, more than half of
women have labor augmented (which increased from 2011),
cesarean rates are high (which also increased, from 35.5%) and for
some odd reason, they had a relatively high rate of
cesareans performed under general anesthesia. No births
were attended by midwives. 
The c-section rate went up from 51.4% in 2011. There
were no births attended by midwives in both 2011 or 2012.
According to the ICAN VBAC policy database,
VBACs are banned at this facility, and they have one
of the highest cesarean rates in the state.  
A rather alarming episiotomy rate (that was 42.9% in 2011).
"We don't often deliver babies, but when we do,
they're mostly by c-section." 

It's such a hurdle, to essentially change the birth climate of an entire city, and even more so, the entire region - and like anything else, when change finally happens, it's often painstakingly slow. I bet most women in need of an abortion would know where to find one, but for a normal, let alone natural birth, they'd probably have to search, maybe even fight for it. With the overwhelming number of clinics throughout the state (New York City alone has dozens) that serve those who wish to have an abortion, it still seems clear that that is their primary focus, not how to have a happy childbirth. If we're going to recognize reproductive rights, we can't ignore the needs of the laboring mother.