As a rural community, Kodiak doesn’t often offer the services and opportunities provided elsewhere, especially in terms of medical procedures. For instance, if a woman in Kodiak has ever had a cesarean or c-section, they are limited to that same procedure for future pregnancies, so long as they remain in Kodiak and choose to deliver at Providence Kodiak Island Medical Center, the island’s lone hospital. A cesarean birth is a surgical procedure that delivers babies by making incisions in a woman’s abdomen.
However, a group of folks in town are trying to open up the birthing options for women, and give them a choice in how they would like to deliver a child. Mariahs Yap is a member of Concerned Citizens for TOLAC, which stands for trial of labor after cesarean section. She said women aren’t even given the option to try a vaginal birth here in Kodiak if they’ve ever had a c-section.
“Which is very unfortunate because we actually have women on Kodiak who have taken their births to Anchorage, where a natural birth is an option, and they’ve had successful births, naturally – a birth other than abdominal surgery. Actually, some people have had two. And yet with another pregnancy they are not given the option at the hospital here to birth other than by cesarean section.”
Yap said many women in Kodiak don’t even know they don’t have a choice, especially if they moved here from somewhere else.
Most places do allow women to attempt natural births, even if they have had a c-section. What makes Kodiak different, according to Providence Kodiak Island Medical Center Spokeswoman Karen Leatherman, is its rural status.
“PKIMC and the medical staff determined this was not an appropriate in our rural setting because of our inability in this rural setting to consistently provide immediate cesarean section in an emergency, or offer immediate access to a neo-natal intensive care unit following delivery.”
Basically, the risks associated with having a vaginal birth following a c-section history are high, and include uterine ruptures, which can result in death.
“You have a very short response time, should something go wrong. It’s not like you might have any warning, something could be going wrong and it takes a little bit of time for us to – if this happened after hours, weekends, etc., you would need some time to assemble your surgical team and anesthesiologist to respond to this type of emergency. And we’re talking minutes – we’re not talking a lot of time.”
In another setting, where that 24/7 care is provided, Leatherman said vaginal births are options for women, even if they have a history of c-sections. In Anchorage, for instance, the option is provided to women at a number of medical facilities, including Providence.
Still, Yap says traveling isn’t always an option for expecting mothers.
“It usually is a plane ticket or a ferry ticket, time off of work, possibly long hotel stays – four week or five week hotel stays, renting a home or finding someone to stay with, meals. And what I hear most is women are leaving their support system on Kodiak to go have their baby somewhere else, because they want that natural birth, but what they don’t want is to leave their support system. Their husbands, their partners, their moms, dads, friends can’t always all come with them to the location where they’re going to birth.”
Yap acknowledged the risks involved with natural births following cesarean sections, but also noted that there are risks with c-sections, too.
Yap said her hope is that women in Kodiak can at least be given an option on the matter.
“That someone will tell you, here’s your rights, here’s the risks involved with having a cesarean section, here’s the risks in trying a trial labor after cesarean section, and you the woman, because it’s your body and your baby and your birth, you’re able to choose.”
Yap said the local TOLAC group is in the process of writing letters to Providence to help make this option available to women in Kodiak. The group has a letter template linked to their Facebook page, as well as on their blog, Kodiaktolac.blogspot.com.
Leatherman said she’s aware of the letters being circulated in the community, and said any decision Providence might make will be done according to patient safety.