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OB recommends repeat c/s for breech B?!?!! X-Post VBAC - Page 2

post #21 of 42
Honestly, I think if a mother refuses a cesarean at the time of birth, the doctor cannot be held liable anymore. I mean, he TRIED to get her to do it, right? And although I could see a desperate OB going for a court order, most wouldn't. You might have to sign an AMA form or something along that line, but its not like the hospital can kick you out.

I'd definately try to find out what he'd do in different senarios though. I mean, at the very least he should let you deliver baby A vaginally. The labor is good for both baby's and being delivered vaginally would be better for baby A's lungs. Thats a known fact. If he wont even say ok to that, I dont know what I'd do....I definately wouldnt just sign up for a cesarean regardless though.

*hugs* If I was already a midwife, I'd come help you out!
post #22 of 42
[QUOTE=labortrials;14160177]Intertwined, you KNOW these US OBs don't give a rat's patootie what Canadian docs have decided. "Well that's Canada for ya!"


But, actually they do. It was the Canadian breech study years back that started the whole cesarean for breech all the time with insurance/hospitals/ and docs. That study is how the US Obstetrical community justified changing the policies.



I walked in to a hosp. with preterm twins (planned homebirth) and refused epidural, cesarean, pushing in the OR and a few other things. Did they make it easy- no - but I just kept saying "I refuse consent for that, I am happy to sign a waiver to relieve you of liability." I got everything I wanted. And I did sign some big scary waivers, but I did not care in the least.
post #23 of 42
Quote:
Originally Posted by rhiandmoi View Post
But I would tell my doctor that I'm sorry he couldn't be my doctor anymore vs. force him to take on a risk he's not comfortable with.
That's all great - when there are other choices available. When I was pregnant with our twins, I phoned and phoned, and asked and asked. I was suggested names of one (perhaps two) doctors who might "allow" the sort of natural birth I was looking for. That was with me willing to travel up to 300 km in one direction and 375 km in the other direction! Certainly, many women in the US live in more populated areas than I do, but current obstetrical conventions can leave the plain just as barren - lots of doctors, but not lots of choice.

Doctors are in service to others. This is just like many other jobs - including any that I've had in my career. Part of that deal means that sometimes your job involves doing things you aren't comfortable with or don't agree with, because it complies with the wishes of the person you are serving.

Quote:
Originally Posted by homewithtwinsmama View Post
. . .but I just kept saying "I refuse consent for that, I am happy to sign a waiver to relieve you of liability." I got everything I wanted. And I did sign some big scary waivers, but I did not care in the least.
(Bolding mine). Thank you for that! The extra sentence about the "big L-word" is a good recommendation.
post #24 of 42
Show me the evidence.


You can birth your baby butt first or head first. And Aile was breech at 39 weeks and came out head first at 40. I would make sure that you DON'T have a version after the first is born. Let the second baby find the way...whether that is butt first or head first.

He needs to present you with solid evidence that shows that having selective MAJOR ABDOMINAL SURGERY is less traumatic and invasive then catching (and not going after) a second baby, with a complete mother.

I am sorry, but that is just crap medicine.
post #25 of 42
Quote:
Originally Posted by Novella View Post
Doctors are in service to others. This is just like many other jobs - including any that I've had in my career. Part of that deal means that sometimes your job involves doing things you aren't comfortable with or don't agree with, because it complies with the wishes of the person you are serving.
I disagree. I work in a service industry, and I also have a lot of professional liability. When my customers ask me to risk my neck to provide them with a service that they want that I don't offer, I politely tell them I won't do that, but I can offer them XYZ alternative. It is up to them to decide what is more important, what they want or having me provide them service. I have to consider myself, and the people that depend on me, first and foremost. Sometimes that means disappointing the customers, but I won't risk my ability to provide for my own people because a customer disagrees with me about my professional risk.
post #26 of 42
Quote:
Originally Posted by homebirthing View Post


You can birth your baby butt first or head first.
yeah this. there is so much fear around breech. it is tiresome, disturbing and restricting.
post #27 of 42
Thread Starter 
[QUOTE=homewithtwinsmama;14166114]
Quote:
Originally Posted by labortrials View Post
Intertwined, you KNOW these US OBs don't give a rat's patootie what Canadian docs have decided. "Well that's Canada for ya!"


But, actually they do. It was the Canadian breech study years back that started the whole cesarean for breech all the time with insurance/hospitals/ and docs. That study is how the US Obstetrical community justified changing the policies.



I walked in to a hosp. with preterm twins (planned homebirth) and refused epidural, cesarean, pushing in the OR and a few other things. Did they make it easy- no - but I just kept saying "I refuse consent for that, I am happy to sign a waiver to relieve you of liability." I got everything I wanted. And I did sign some big scary waivers, but I did not care in the least.
Ah, had forgotten that the initial study came from Canada. I'll definitely mention all of this in case he's "forgotten." Good to know that you were able to get what you want even though it was tough.

Quote:
Originally Posted by rhiandmoi View Post
I disagree. I work in a service industry, and I also have a lot of professional liability. When my customers ask me to risk my neck to provide them with a service that they want that I don't offer, I politely tell them I won't do that, but I can offer them XYZ alternative.
Ok, sure I gotcha, but my OB can't provide me with the alternative, not in this town and certainly not at my "advanced" stage of pregnancy. This is an example of UNDUE BURDEN, an actual legal term, that women are consistently subjected to during pregnancy and childbirth.
post #28 of 42
Thread Starter 
Oh, and just because you sign a waiver doesn't mean that you can't still sue for iatrogenic damage to mom or baby.
post #29 of 42
I'm sorry I haven't had time to read through the whole thread.

I thought I would share my birth anecdote, although I don't think there were any insurance coverage issues (it's that his malpractice insurance won't cover breech, right?) in my situation.

My twin B had been pretty insistantly breech for the third trimester. He was the larger twin, too, and according to the u/s techs baby A was pretty spread out (even though he was smaller.) I went for some Webster chiropractic sessions (this very successfully turned my first child, who was breech at term) but for whatever reason it just didn't seem likely to work this time around, with a different chiropractor and the particular positioning/space situation.

If twin B was breech when I went into labor, my OB was planning to attempt an external version after baby A's birth.

I went into labor at night on the weekend, and the on-call doctor was not my regular OB. The on-call physician came into the room after we arrived, introduced himself, and recommended a cesarean delivery for the second twin, because he was breech.

At this point, I spoke to him about what my doctor had intended to do, and also said that none of the perinatologists we'd worked with (at a different hospital an hour away) had seemed to think planning a vaginal birth with a breech twin B was outrageous or a bad idea. (I think the policy at that particular hospital would be a breech extraction for the second twin.)

I had a big problem with consenting to an automatic c-section. I said that I wanted to see what happened after the first baby was born....maybe the second twin would turn vertex, given opportunity. If not, maybe assisting him with an internal version would work. Why plan a pre-emptive c-section when we didn't even know what would happen?

The doctor said he wouldn't consider an external version at all (I forget his reasons, but he seemed to think it was a really bad route, despite the fact that his colleague had been planning to attempt one -- I don't disagree with that, actually, and hadn't really wanted my OB to attempt one right off the bat), and he responded to "the perinatologists at the other hospital" bit by sort of poo-pooing their practices (without actually doing so. It was the vibe. Sort of an, "I'm from a little town called Los Angeles, and around there, we think...." wink-wink kind of minimizing of whatever standards were governing protocol in the upstate NY hospital with the perinatologists I'd referenced. Obviously, they weren't as current or up-to-date as those in the little town called Los Angeles....ugh.

In the end, he basically said since I was refusing the c-section, he would do a breech extraction. I don't think we actually got to the point of stating that clearly (I'm pretty sure he was going to return to the discussion with me), because they suddenly realized I was complete and ready to start pushing and all conversation halted. I remember wondering where we stood, but after the first twin was born I heard him tell someone he'd agreed to a breech extraction.

So he was preparing for the breech extraction but the baby turned, instead. (I was upright when the first twin was born, so I took a good bit of time turning around, getting down, and getting into position for the extraction. All the while, I was telling my baby A how to turn, which I'd been doing for weeks at the end of the pregnancy, too. But at that point, it was "Now's the time, baby! Head down, facing back, chin to chest.") There was very little the OB had to do to turn him, though I think he reached in and helped in some way (I didn't feel anything at all, but I asked when I saw the doc a few days later and he said, "I turned him." But he also mentioned that the baby was turning, and he "reached in and turned him" so I think whatever happened was not heavy-duty wrangling.)

Anyway, I'm sharing this because I had an ostensibly "current" doctor (in town, he's considered the "young, up-to-date OB who is very competent but not always the best with his bedside manner") who spewed all sorts of studies findings contraindicating versions & extractions, and was recommending automatic c-section for the second breech twin.

I don't think your doctor is necessarily coming from nowhere with this.

As far as hospital policy, they don't do breech deliveries. With multiples, if the first twin is vertex, the "vaginal attempt" is "allowed" but I think the second vaginal birth only will happen IF the second baby turns. (Unlike the other hospital I mentioned, where breech extraction is standard.) With my regular doctor, though, if the second twin could not be turned, she would have opted for a c-section (she never offered me a breech extraction or any kind of breech birth.)

I had gone into it believing my baby would turn when he had the chance (I honestly didn't believe the external version was going to be needed and I think I'd have asked her to wait, though not sure how that would have all gone down), and not thinking that I would end up with a c-section. But I guess I knew if things went wrong or he just didn't turn, or if he got into a stubborn transverse presentation or something, c-section would be the result. In the end, I think the on-call OB was assuming breech extraction as the default, probably because I had refused a c-section (at least, a planned one) and it was so late in labor that maybe they could claim a breech extraction was unplanned? Or that it was done only because I refused the other procedure?

I'm sorry I'm rambling so much.

I wonder if your doctor would consider making the decision after the birth of the first twin, when he can see what happens with the second twin's positioning. You may not be able to push him to deliver the breech twin, and he may not reconsider his misgivings about external version or internal version, but maybe you could clarify that rather than an elective repeat c-section, you would like the decision made in the moment because of necessity ("necessity" in this situation, of course, being debatable) rather than planned from the start. Perhaps the baby won't need a lot of manipulation, or any manipulation. You understand his policy against breech delivery, but is he willing to consider any alternatives or allow that there are possible scenarios that would make a c-section completely unnecessary?

(Sorry if you've already gotten past this point and are no longer dealing with him. Like I said, I didn't read to the end of the thread.)

BEST WISHES!!!
post #30 of 42
Thread Starter 
Thanks Amy (and everyone!). I appreciated reading your story. I see my OB again tomorrow and will ask him where we go from here if B is breech. My preference is to take a wait and see approach. At this point I see little point in switching providers. I'm not even assured to have my doc (or a doc supportive of vaginal twin or VBAC) staring into my yoni when it comes time. :

I know he's not coming from "nowhere" on this breech stuff, but ACOG's resistance to breech birth is based on a faulty study from Canada in 2000. Luckily Canada is reversing its position on breech birth. Yes there are studies that claim that versions (internal or external) are contraindicated, but really a LOT of this stuff is in that murky controversial state.

My chiro thinks B's butt is up in the top of my uterus. Hope that turns out to be the case. I'll be meeting with my OB tomorrow - wish me luck!
post #31 of 42
Hugs! It is so frustrating to not know how things are going to happen and to feel like big decisions are out of your hands. My B was breech, too, all the last trimester. My OB knew from day 1 that c-sec was a life or death deal for me, and we talked about a lot of senarios. You really cannot tell what B will do after A is out. My B turned himself sideways and stuck his hand out. My OB had been willing to deliver breech, but when that happened I had the lovely internal version (to keep cord from slipping out), and B came out headfirst! They are 27 (I think) minutes apart, and I am SOOO happy the way things turned out. I don't think I could have gotten any better. Good Luck, sending you some TURN BABY vibes!
post #32 of 42
Quote:
Originally Posted by rhiandmoi View Post
If the standard of care for breech B is ECS, and he does not follow that standard of care, he has practically no legs to stand on if there is a bad outcome.
But if ECS for baby B is the "standard of care," then the standard of care is not supported by mounds of research suggesting that baby B can safely be born breech as long as A was vertex. I tend to be more trusting of my providers when their practices line up with the research in the medical journals.
post #33 of 42
Just FYI- going in as late as possible (with A already crowning) is no promise of no section. Your doc could chose to deliver A vaginally and then B by c-section.

Kimberly! I think you do need to think about the stress factor as well of having to fight for your vaginal birth vs. going ahead with the c-section. It is all relative, of course. For some women the latter would be too much and they'd rather fight it out with others it's visa versa. I know with me after my last birth the prospect of another fight makes me want to vomit. Frankly a vaginal birth is just not as important to me as NOT having horrible PTSD, not being able to bond with my baby, etc because of the stress and harassment. Sometimes healthy mamas and babies come about in different ways. I am just talking about ME here not saying you have to sign up for the c-section. I'm just hoping for the best physical and emotional outcome for you and your baby and I know YOU know what that is. You need to have the birth you need.

post #34 of 42
I say push push push until you get what you and your babies deserve. If that means changing drs at the VERY end, so be it. I had a breech baby A and a vertex baby b and I STILL found someone willing to attend even with the risk of twin lock. I got all hell from everyone about it but I would not back down. I was 32 weeks when I transfered my care. I did end up with a c-section because in the end I had additional issues but they were respectful and let me make the final call. If this Dr won't budge keep shopping, it's not too late until baby a is out!
post #35 of 42
What is involved in a breech extraction?
post #36 of 42
Quote:
Originally Posted by Toolip View Post
What is involved in a breech extraction?
In my understanding, a breech extraction is when the doctor goes in, grabs hold of the babies feet and basically assists (pulls) the baby out.

So...can anyone share the studies/research on breech extractions and internal versions? I was all set to go ahead with that plan, which my ob would follow, then he kinda scared me with talk about the increased risk of birth injury. Something like a 12 to 1 chance. Ugh. Anyway, if I could educate myself more before the next appointment, it would help.

Kimberly - I really hope it works out as you wish. Come on baby, turn! Update when you hear back.
post #37 of 42
Thread Starter 
Well, I was amazed that my OB suggested the "wait and see" approach before I had to even mention it. I think he's given my *situation* some thought and talked with a couple of folks about it. He sees no reason to NOT proceed with planning for a vaginal birth and also thinks it's very possible that B will turn during labor.

So, big sigh of relief.

I have gone ahead and drafted a cesarean birth plan in addition to my vaginal birth plan.

magstphil, I get where you are coming from. In my case, I've suffered from secondary infertility and had to have a myomectomy to remove adenomyosis likely CAUSED by the previous cesarean. And since adenomyomas don't have regular boundaries like fibroids, the surgeon wasn't able to get all of it. I feel that every c/s increases the potential for future reproductive and women's health problems. I've had MORE than my share, thank you. So, in my case, it's quite important that I only consent to a necessary cesarean.

It's very important to me to have my provider "on board" with my birth plan, and I have altered it somewhat for his benefit too. I just figure that I have more "power" if I end up with someone else actually attending the birth if it's well-documented that my OB is aware of and on board with my birth plans.
post #38 of 42
Thread Starter 
Quote:
Originally Posted by christyc View Post
But if ECS for baby B is the "standard of care," then the standard of care is not supported by mounds of research suggesting that baby B can safely be born breech as long as A was vertex. I tend to be more trusting of my providers when their practices line up with the research in the medical journals.
Yup. This is a frustrating time to be pregnant in the US.
post #39 of 42
Quote:
Originally Posted by labortrials View Post
Well, I was amazed that my OB suggested the "wait and see" approach before I had to even mention it. I think he's given my *situation* some thought and talked with a couple of folks about it. He sees no reason to NOT proceed with planning for a vaginal birth and also thinks it's very possible that B will turn during labor.

So, big sigh of relief.
Oh, that is good news.

So I guess the chiro was wrong about positioning.....?
post #40 of 42
Yeah for your ob taking the "wait and see" approach. May it all go smoothly. I totally understand what you mean about having your provider on board. I too am not the personality to want a real fight at that time, hence the discussion about labor starting at 20 weeks. Tee hee hee.
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