Karin Finley had a Caesarean section with her first baby in 1999. She didn't know it at the time, but that procedure would have a big impact on her later decisions on childbirth.

Recently, Helena's St. Peter's Hospital instituted a policy preventing women from having vaginal births after Caesarean section, commonly known as "VBAC."

The decision was in response to a bulletin from the American College of Obstetricians and Gynecologists. The bulletin stated that when hospitals perform VBACs, they should have a number of safety precautions in place as a precaution against ruptured uterus in labor -- precautions the hospital administration feels it cannot currently implement.

St. Peter's is one of hundreds of hospitals across the country that have instituted policies against VBACs in response to that bulletin.

But many women, including Finley, feel it is unfair to tell a significant segment of the population they must undergo surgery to deliver their babies.

According to St. Peter's physician Dr. David Lechner, a ruptured uterus is about 1 percent more likely to occur in labor for a woman who has had the most common type of C-section. After classical C-sections -- a procedure now rarely used except in very premature birth, in which a vertical incision is cut -- a ruptured uterus is about 5 percent more likely.

The ACOG guidelines for hospitals performing VBACs include immediate access to an operating room dedicated to the patient, an anesthesiologist dedicated to the patient and an obstetrician at the bedside for the entire time the patient is in the hospital.

"That sort of resource allocation is hard to accomplish in a small hospital -- even in a large hospital," Lechner said.

"The standards changed in the last couple years ... and this is something that's not unique to Helena," said Lechner. "This is something every hospital in the nation's had to struggle with. At this point we're not able to meet the letter of those standards for VBACs, so we're not offering them now.

"That's not to say we won't be offering them for the future, but we need to put together some resources to make sure we get them done to the letter of the recommendations."

Finley's second and third children were born naturally at the hospital -- one in her previous home in Overland Park, Kan., and one in Helena -- without incident.

But she became pregnant with her fourth child after the new policy at St. Peter's was enacted.

When she heard of the policy, she told her doctor she was considering having a home birth. She later received a letter from the doctor's office informing her that if she was having a home birth they wouldn't provide her care.

"I was told, 'We can't be your provider, you're considered to be a liability.' "

Finley eventually decided to have her baby at home with a midwife, once again without incident.

Other women in the same position are considering going to other nearby cities, such as Great Falls, where the hospitals allow VBACs.

Kimberly James, head of the Greater Missoula Chapter of the International Cesarean Awareness Network, encourages women to look at all their options.

"There are resources for how to fight a VBAC ban," she said. "ICAN is a great resource for that."

Finley feels it is ironic that a policy put in place for the stated purpose of improving safety resulted in her having her baby outside of the hospital, separated from the support of the hospital.

She rejects the argument that the increased risk of uterine rupture is justification for a blanket ban on VBACs. She said there are many reasons women can need emergency C-sections and that the policy is discriminatory.

"What if other real (labor) emergencies happen?" Finley asked. "Why is it different? Why are we labeled? Why do we have a big C on our forehead?"

Another factor in the controversy is that C-sections themselves pose risks, such as infection. Each C-section increases the likelihood of future placental abnormalities that can be life threatening to mothers and babies. And babies born by C-section are more likely to develop lung problems than those born naturally.

According to James, many hospitals across the country have reversed policies against VBACs after public outcry, including one in her native Houston.

"You can't tell someone they have to have surgery," she said. "It's a violation of rights. If someone told you you needed major back surgery, you'd get a second opinion. What I'm hoping to do is help educate people about their choices. We have to be empowering women to make these decisions. It's her body and her decision and her child that's at stake here."

Lechner said he understands the frustration, because he has delivered VBACs many times without incident. He said a 1 percent risk may not seem like much. But, he added, this isn't a 1 percent risk of a minor side effect.

"If you have a 1 percent risk of a uterus rupturing and killing the mother and baby, that's a whole different way of looking at that 1 percent," he said. "That's what got ACOG's attention."

Finley said she is not likely to have any more children, but she is not giving up her battle. She has started an online petition to try to convince St. Peter's to reverse its policy. She also plans on starting a Helena chapter of ICAN, which opposes the overall increase in Caesarean sections in the United States -- from 21.7 percent in 1996 to 31.1 percent in 2006, according to the Centers for Disease Control.

"I have to stay involved and keep fighting for these women," she said.

Reporter Joe Menden: 447-4087 or joe.menden@helenair.com