It was just an awful, awful situation where they were super supportive of VBAC with this mom for the first 32 weeks of pregnancy. I thought she found a real gem of a hospital!!! I was so excited to learn about Newton. Then they told her no going past 40 weeks. At 36 weeks, they told her the baby looked too big and she had to schedule a c-section around 39 weeks or she would not be able to continue seeing them (completely unethical). At her next appointment, they told her that at her age (which was about 30!!!), her risk of fetal demise with this VBAC was significantly increased.
The problem is that it was a bait and switch. There was no way to know until almost the end of her pregnancy. Like I said, I am THRILLED that you got a VBAC there!!! Maybe you got the 1 good doctor there (which is really what you need). Unfortunately, another situation just played out again last night. Doctors were super supportive of VBAC up until close to the end. Mom fought really hard for her VBAC as she approached 24 hours PROM but had to endure the doctor calling her selfish and complaining that he was missing his wife’s birthday party and pulling the dead baby card. Berating and belittling a mother in labor is not my idea of VBAC supportive.
I honestly don't know about Newton's vs Morristown's demographics but I work at a very suburban hospital that still gets it share of uninsured, drug users, etc. As a level III NICU, I have to believe that Morristown is getting it's fair share of these patients since many of them may need the NICU. But who knows!!! I’m a little wary when hospitals have excuses about their low VBAC rates. The real issue is whether women who WANT to VBAC, CAN have a VBAC. Pam and Louise attend at a true inner city hospital. The hospital has a clinic as well to serve the area. Yet, the hospital still maintains one of the lowest epidural rates, lowest c-section rates and highest VBAC rates in the state (those rates are all relative to the state, of course!!!!). Now that I've written that, I have to mention that one of the hospitals with the lowest c-section rates and highest VBAC rates is Cooper Hospital in Camden where I am quite willing to bet they get plenty of uninsured patients without prenatal care, proper nutrition, etc.
That's really a shame about the other women you knew hoping for VBACs with Avalon. This is the first time I've heard stories like that!!! Obviously, I can't comment without know what happened but I do know a woman whose VBAC turned into a CBAC with them but she had serious complications in labor so I believe her delivery was handled appropriately.
That's odd about your friends not knowing P & L's back up doctors. Up until about a year ago, they were backed up by 1 doctor whom all their patients met. He was very comfortable with P & L's running the show with their patients. They are now backed up by the on call physician group (actually the group has doctors and midwives) at the hospital but they are still running the show when it comes to their patients. My dh actually served in the military with one of the back up doctors so I am comfortable with them. Plus, that doctor was on call for my friend’s labor and I don't even think he ever stopped by the room for her VBAC. He just let Pam handle it (even with pitocin and well over 24 hours post-PROM). To me, that is a good doctor-midwife relationship.
Hopefully it doesn't change! I don't blame your friends for lying about when their water broke. I wouldn't want to lose my homebirth over that reason either!! The good thing is that they knew the "policy" up front and could "work around it" (so to speak!).
As far as induction goes, it is still not a good idea for VBAC. When I say induction, I am talking about the use of cervadil or cytotec. Those 2 drugs are typically coupled with pitocin to augment labor once contractions get going. This can increase the risk of rupture to 1.4% (according to the 2004 NEJM Landon study). A totally spontaneous labor has a 0.4% chance of rupture. So I guess it depends on the way you look at it. I would consider a castor oil induction or a foley induction before another c-section but I would NEVER agree to cytotec. A VBAC candidate is not without options when a medically indicated induction is necessary. A low dose of pitocin is considered safe for VBACs after labor has begun but in the past, providers would routinely increase the amount of pit at specific intervals (which is not safe).
My labor started and stopped for a week. P&L were quite aware of this! By the time I delivered I had been in labor for 41 continuous hours. We talked about pitocin but decided against it. Pam was more concerned that I would become exhausted than anything else. As long as I was okay to keep going, she was okay waiting.
Unfortunately, VBAC is not easy in this state!!! I totally agree that it is so important to know your midwife and her back up doctors. One of my old midwives was very encouraging of VBAC but she still had to adhere to the semi-strict policies of her back up doctors. There are a couple doctors in this state who are very supportive of VBACs and natural birth as well. In fact, I'd go with certain doctors before many midwife groups in this state (but that goes back to the fact that a midwife's scope of practice can be limited by her back up doctor). I really wish this state would recognize midwifery as an independent practice!!!