Would You Say Something and What?

[Poodge]

I have a friend who had her first baby in December 2008. She was induced at 39.5 weeks due to elevated blood pressure. I have not idea how high.

Once they started the induction her baby went into distress and they could not remove the gel they had placed to ripen her cervix and she had a C/S.

She is now pregnant again and due in August. We only see each other in person every year and a half. We saw each other in January.

Her husband asked another friend of ours who is an OB/GYN resident what they typical C/S rate was and she told them 30%. He then went on to say that he thought their doctor was C/S happy because on the day their son was born 9/10 babies the doctor "delivered" were done by C/S. He wonders if the induction caused the need for the C/S!! He stated he does not like their doctor. My friend feels the induction was needed due to BP issues.

So I turned to my friend and asked - Have you considered switching doctors? She said no, he knows me, and how my pregnancy went last time. VBAC and its "risks" came up and my OB friend gave the typical "risk or rupture speech". My pregnant friend's doctor told her she would have a scheduled C/S at her very first appointment with this pregnancy and no discussion of VBAC.

My friend has said some things that tell me she mourns never experiencing labor. She has told me that my birth story "made her heart flutter and that is what birth should be like" (I had a vaginal birth, full of interventions) and that "I never got to feel labor". She just seems down about the whole thing.

Part of me feels like she wants the experience and if she did a little research and was a little more assertive she might want a VBAC. However I also think she is just grateful "the C/S saved her baby".

Would you say anything or not? If so what? I don't want to push my ideas on her (I tend to be the "odd" one of the group) and if she didn't seem down and had not said those comments and if her husband didn't seem so negative about the doctor I would keep my mouth shut.

[nashvillemidwife]

Why all the quotes? Do you not believe the c section saved her baby? Or that VBACs have risks?

Of course the induction likely caused the fetal distress, and what does it matter how high her BP got? BP issues don't get better, induction was an appropriate course of care. Maybe the doctor does have a higher than average c-section rate, but it does not sound like that had anything to do with her outcome. It's unfortunate that things went the way they did for her, but your post sounds as if you are second guessing the need for the induction that led to her c-section and I think that's inappropriate.re

She is at higher risk of uterine rupture because of the closely spaced pregnancies. It will only be 20 months between deliveries, is that correct?

Personally, I would encourage her to consider VBAC if that's what she wants, but you should be prepared to back down and support her if she decides to stay with her doctor and repeat c-section. Is that something you can do once you've opened the dialogue?

[Poodge]

I believe the c-section was needed in her case and that the induction caused it. I understand VBAC has risks but instead of a balance presentation of the risks of VBAC versus the risks of a repeat C-section our friend just told her don't do it it is too risky. Which was why I put that part in quotes. I am not trying to second guess the need for induction, her husband was second guessing it however.

I wouldn't even think to bring it up except she seemed so sad about the whole thing. I support her no matter her decision.

[kltroy]

I would probably offer her some very unbiased information - I particularly like the info that the Childbirth Connection has compiled - to help with decision making. It has good statistics about the risks associated with repeat c/s, VBAC, risks to mom AND baby. It also has good guidelines about how to choose a care provider etc. I would probably frame it like, "I found this website to be really helpful for things to consider during my pregnancies - you might enjoy it" if you think she will be annoyed at you being pushy. However, if she truly hasn't really considered VBAC, you might frame it by saying that you care about her and want to make sure she has good information to make her decisions.

I had a kind-of similar situation recently. My old HS sweetheart's wife had a c/s with baby #1 - can't remember why, probably induction/fetal distress. Had a repeat c/s with #2. "boy are we glad we did that - the doctor said her uterus was paper thin!" And now they are preg with baby #3 and have a repeat c/s scheduled for 37 weeks. 37 weeks?! I can't imagine why you'd do that, and I started to write him a note basically pointing him to a news article about risks of pulling babies out too early and how you should wait until 39 weeks unless there's a real problem. And then I stopped. I decided that it wasn't really my place.

Anyway, I would feel her out on the topic before intervening too much.

[mumkimum]

Making a comment to her or her dh to the effect of "you know, it doesn't really hurt to see another OB about your current pregnancy if you really would prefer a different delivery experience - a lot of people do that sort of thing, especially when they've had complicating issues with pregnancy, it doesn't mean you'd have to switch OB's unless you wanted to" might be a decent message to put out there, based on what they've mentioned.

I don't know that you really need to deal with any other specific issues, but it does sound like her doctor is either not listening to her feelings about it or is unaware of them, and someone else might be more sensitive to that (even if she still had another c/s and bp issues or whatever).

[MegBoz]

Is there a local ICAN chapter? The great thing about letting her know about the group (& maybe some yahoo groups) is that it's not an anti-CS thing, but rather another source of info & support.

[Girlprof]

Originally Posted by Poodge

I believe the c-section was needed in her case and that the induction caused it. I understand VBAC has risks but instead of a balance presentation of the risks of VBAC versus the risks of a repeat C-section our friend just told her don't do it it is too risky. Which was why I put that part in quotes. I am not trying to second guess the need for induction, her husband was second guessing it however.

I wouldn't even think to bring it up except she seemed so sad about the whole thing. I support her no matter her decision.

At least from what you've posted above, the husband wasn't second guessing the need for the induction - he was saying that the induction might have led to the c-section. But a very necessary induction can lead to a c-section, which is sort of what it sounds like happened here.

You've gotten some good advice here on how to approach her, if you decide to say anything at all.