What should I do? Very Long

[ZinniaGarden]

Hi Ladies. I am in a real mess here and I guess I am just needing support, encouragement and if anybody has suggestions, they will be more than welcome. I am only 7 weeks so I have a while to sort it out, sort of.

I live in Louisiana where the vbac rate is 2.5%. There is a hospital 1 hr and 15 min from me that allows and maybe supports vbac. Great! But you have to have a provider that supports your vbac as well. There is a practice in the same city with 2 doctors (at least) that support vbac. My problems is that due to a car crash 3 years ago, I have several physical issues - fibromyalgia, arthritis in my hips, a couple of ruptured disks. I am also going to be 37 soon, have fibroids and my last birth was a c-section due to baby being stubbornly transverse. I am not able to work and am using Medicaid. All the practices in town pool their Medicaid patients into a group and take care of them through a program called “Healthy Moms.” So if you want Dr. X and they use the Healthy Moms program, you must get accepted into Healthy Moms for them to take you. Apparently “Healthy Moms” is called that because you have to be healthy to get in. They won’t take me. The VBAC doctors won’t take me because I am not in the program.

I found a doctor that will take me but he practices out of a hospital with a total VBAC ban and he refuses VBACs. Once I choose a doctor through Medicaid, it is difficult to change doctors. If I walk into the hospital with a ban and refuse a c-section or if I walk into the hospital that supports VBAC but a doctor that does not support it is on call and I refuse a c-section, I will likely get sent to a third hospital - our state hospital.

I WILL NOT go to the state hospital. Oh, I would be able to VBAC (I think) there BUT - baby is taken away immediately, must be under close observation for 12 hrs and mom or other family is not allowed to see baby during this time. Blood sugar is automatically monitored and if it is not high, an IV is started immediately. Baby MUST be taking formula well before he can go see momma, even if momma intends to BF. After baby is released from observation, mom must room in. Great but rooms are not private so you share a room with another momma and her family. You must stay for at least 24 hrs after birth.

And that is not going into the horrors of their birthing practice. Automatic IV, no eating or drinking. Women are almost always given an epidural and pitocin to speed up the process. As it is a teaching hospital, you must be willing for as many people observing as want to. I have no problem with students normally but I observed a delivery that had at least 20 students watching. Mom had twins, the first baby was born, second did not come down. Mom was hemorrhaging. They brought the ultrasound in and the student doctors (at least 2) took turns reaching inside mom to try to pull the baby out. Mom was screaming and the student doctors were all laughing at how cool it was to see the “doctor’s” hand on the ultrasound. Granted, mom was Medicaid, no prenatal care and high on cocaine (most of the patients that go there fit this profile) but they treated her as an absolute non-being. The women going through labor and delivery there are not seen as real people - they are sheep to be dealt with as quickly and coldly as possible. Possibly these practices have changed since I was a nursing student and observing there - about 10 yrs ago -but I SERIOUSLY doubt it. Needless to say, this hospital is NOT an option.

So I have found a midwife that will take me - 3 hrs away and out of state. I am ecstatic about it but DH is really dragging his feet. He does not like doctors but it seems he would rather I have an automatic scheduled c-section than go with a midwife - because they are not doctors. He is refusing to drive me to another state. I am so frustrated. Apparently my options are going to be automatic c-section or keep my mouth shut when I go into labor and deliver at home UC.

[mrsberman]

Originally Posted by ZinniaGarden 

I WILL NOT go to the state hospital. Oh, I would be able to VBAC (I think) there BUT - baby is taken away immediately, must be under close observation for 12 hrs and mom or other family is not allowed to see baby during this time. Blood sugar is automatically monitored and if it is not high, an IV is started immediately. Baby MUST be taking formula well before he can go see momma, even if momma intends to BF. After baby is released from observation, mom must room in. Great but rooms are not private so you share a room with another momma and her family. You must stay for at least 24 hrs after birth.

This would definitely keep me from going to the hospital, but are you sure this is done in every situation? I find it hard to believe that in modern day practices hospitals are keeping the baby from the mother for over 12 hours.

Also, I've always been told you can refuse students in the room in a teaching hospital. You are supposed to be asked if it is okay to have them there. It is optional, not mandatory. Again, this is what I've always been told.

I'm sorry I can't offer much for encouragement. Is it possible to see if the VBAC doctors will make a special case for you to be with them? I'm not sure if I understand the whole Healthy Moms concept. Also, have you contacted your local ICAN chapter to see what area specific help you can get for your situation?

Good luck and congrats on your new pregnancy.

[ZinniaGarden]

Thanks for your reply, MrsBerman. As of 10 years ago, every single case was treated the same. This is a hospital that is seen as for the poor and uninsured. The ob care is for walk in, no prenatal care patients who are often hooked on drugs, for the most part. I did my nursing school OB/Nursery rotation through the hospital and was horrified. I questioned the practices, asked about BF moms. No. Every mom and baby had to follow the same routine. I did not exaggerate at all in my post. It is possible that it has changed but I HIGHLY doubt it. I know, from a family member's recent experience, that the rest of the hospital and ER are still exactly the same. Every baby is considered at high risk due to the low socio-economical situation of the mom and so the observation is justified. And the moms were not asked if they would accept "student" doctors because technically, they are already doctors - they have the written part of their schooling done and so are not considered students even if they have never seen a birth in their life. They are "residents" and called doctor. I am sure you could turn down the student nurses but frankly, we were the only ones who saw the patients as women having babies rather than as a job.

I don't get the healthy moms concept either. All I understand is that you have to be in the healthy moms program. The doctors do not accept Medicaid patients in their regular practices, at least in that city. I am going to be on the phone begging on Monday but I have been told no twice already. Our closest ICAN chapter is 3 hrs away in another state but I may contact them anyway.

[ariatrance]

Here are some thinking, random questions/statements from off the top of my head:

1 - Call the ICAN chapter. The women there will likely have more up-to-date information on the local hospitals (and state one) as well as doctor recommendations.

2 - Did you apply for the Healthy Moms program and were turned down?

3 - Has the local Medicaid office been able to help you find a physician/apply for the Healthy Moms program?

4 - Will any OB take you regardless of the VBAC issue? You might want to go ahead and start your prenatal care knowing you can change at any point to another person.

5 - Is the midwife willing to drive 3 hours to deliver your baby or would you have to drive 3 hours in labor to deliver at her facility?

6 - If the midwife is really and truly your only option for a VBAC and your husband is refusing to drive you, add a temporary fund in your budget for a taxi, if it is really and truly that important to have a VBAC to you (and only you can decide that).

It is a great thing that you are starting so early in your research! Remember that absolutely nothing is set in stone. There is always another choice, though sometimes our choices may not be great or what we want.

[lexiejk4]

What city do you live in?  I had similar issues when I was trying for a VBAC in Alexandria.  Unfortunately I lost the baby, but maybe if you live near there I can offer you some insight.