If you made the trek down the hill to Main Street the morning of Saturday, Sept. 10, you may have noticed a small coalition of women on the edge of Union Green, across the street from Mondo and Rite-Aid. They held up signs that read “Evidence-Based Care” and “Informed Consent and Refusal,” and passed out business cards for local midwives, OB/GYNs, and birth doulas.

The gathering was part of a national movement organized by ImprovingBirth.org, which hosts rallies across the country every year, typically around Labor Day. This year, the focus of the rallies was on the widespread refusal of licensed practitioners to allow women to have vaginal births after a Cesarean section (VBAC). While many doctors claim that women who attempt vaginal birth after having a C-section for a previous child risk rupturing the walls of the uterus, childbirth advocates argue that it is actually safer for a woman to go through with natural birth as opposed to having surgery.

“When someone has a C-section, as with any surgery, there’s going to be scar tissue left behind,” said Maura Jo Lynch, a birth doula and childbirth educator who was present at the rally. “Multiple surgeries are going to cause there to be more and more scar tissue…and the risk of hemorrhage for people who have surgical birth is higher than those who have vaginal birth.”

In particular, the organizers in Middletown hoped to bring attention to how Middlesex Hospital handles its decisions to provide VBACs. Up until recently, one provider out of the 11 at Middlesex allowed for women to go through with VBACs. But after that provider retired at the beginning of 2016, there was a significant change in Middlesex’s policy on VBACs, according to Melissa Duenas, a birth doula and the newly elected leader of ImprovingBirth.org’s Connecticut chapter. Duenas’ job includes accompanying women to prenatal visits with their doctors at Middlesex, and she recalled hearing the option of a C-section being continuously brought up despite there being no complications with the pregnancy.

“Even [at one mother’s appointment] two days prior to delivering, they offered her a C-section,” Duenas said. “And they told her that they were only giving her five more days to go into labor on her own, which would have been only two days past her due date.”

According to the American College of Obstetricians and Gynecologists (ACOG), only five percent of women who give birth naturally do so on their due dates.

“[The providers are] setting up themselves to have people come in who are trusting them to allow them to have a VBAC,” Duenas said. “And then when it gets into the end of their third trimester, [the providers are] taking away that opportunity, or scaring women into believing that they’re having some type of complication that will not allow it.”

Since 1985, the ideal rate of Cesarean sections, meaning the percentage of births in which a surgical procedure is medically necessary, has been considered to be between 10 and 15 percent, according to the World Health Organization (WHO). Since the 1980s, however, the national rate of C-section births in the U.S. has hovered around 35 percent; in the most recent statistical findings, Connecticut’s rate has been slightly lower at about 30 percent.

“In the 80s, if you had had a C-section [in the United States], a repeat C-section was basically your only option [for giving birth],” Duenas said. “At the time, doctors believed that if they had cut into your uterus once, your uterus was too thin in order to continue to have more children vaginally, that your uterus would rupture because of the scar tissue that was there. And so they just started scheduling women for C-sections.”

A 2010 study from the American College of Obstetricians and Gynecologists concluded that VBAC is a “safe and appropriate choice for most women” with one prior C-section and for “some women” with two prior C-sections. Yet heath care providers remain hesitant to allow VBACs for their patients.

“[Some physicians] ban VBACs under the guise of patient safety,” said Dr. Stuart Fischbein, a Southern California obstetrician who is a VBAC supporter, in an article for improvingbirth.org. “But patient safety is a euphemism for, ‘We don’t have a good evidence-based reason to do it, other than we don’t want to get sued, it’s more expedient, and we make more money from C-sections’—the hospital does, not necessarily the physician, but the hospital does—‘so we’re going to ban it because it’s easier for us.’”

This leads to misinformation and even the coercion of patients into receiving C-sections when they are medically unnecessary, which can then lead to traumatic birth complications, Fischbein explained.

Indeed, Duenas said that many childbirth advocates, herself included, began demanding informed consent in surgical birth practices because of their own negative experiences.

“It’s unfortunate that that’s really how most people end up here,” she added. “It’s that their first birth, or their first child-bearing experience, was dramatic or traumatic in some way.”

Duenas herself was given an episiotomy procedure against her will during her first birth, causing her to need 34 stitches.

Middlesex Hospital did not respond to requests for comment from The Argus. In July 2001, the hospital was sued by Kathleen Duffy in April of that year for negligence that led to the death of her child during a VBAC birth, according to a Middletown Press article. Lynch has stated that currently, several practitioners at Middlesex are “VBAC tolerant,” meaning that while they do not ban the practice outright, they encourage their patients to schedule a C-section if they have had a previous birth through Cesarean.

Not all hospitals in the greater New Haven-Hartford area share these policies regarding VBACs. All of the licensed practitioners at both Manchester Memorial Hospital and Yale New Haven Hospital’s Vidone Birth Center are supportive of VBACs for pregnancies without complications, according to Duenas. While statistics for VBAC success rates are still relatively few, given how recently the practice has been adopted in the United States, different studies claim between a 77 and 83 percent success rate.

In comparison to other reproductive health issues, such as the debate around abortions and Planned Parenthood services, informed consent around surgical childbirth is not a hot topic on college campuses. But as the main provider of reproductive services in Middletown, Middlesex Hospital does have an impact on University students. Moreover, Lynch believes it is vital for young people to get educated on these issues around childbirth so that they can plan for the future.

“One of the problems is that a lot of people who go into surgical birth are given consent forms that really don’t detail all the risks that are involved in the surgery,” she said. “In order to provide full consent, you need to know what you’re getting into….Students should start talking to their OB/GYN provider, like, ‘Hey, I’m not in a position right now where this is my issue, but I know there are people out there who are concerned about access to VBAC, and I want you to know that I’m one of those people.’”