I'm under the impression that I can say no way to c section

[Simonsez2u]

Little background here.  I'm almost 37 weeks and due January 31st.  My ob and I have had a good relationship so far and he is the ONLY doc in this city who will "let" me VBAC.  At my appointment yesterday he said he was comfortable with letting me go to 41 weeks.  My reply was "No Way! My son was 41 weeks 1 day past my due date."  He said 41 weeks was what he was comfortable with but my response was let's get to 41 weeks and then discuss it and he said okay.

I am so ticked off at the whole notion that my babies entry into the world is set on a time limit.  Give me a break.  It's ridiculous to think that I would want to undergo major surgery because my baby does not show up on a due date that is just a "somewhere around there date."  I'm not agreeing to that even if we get to 41 weeks.  I am comfortable with 42 weeks.  I am a consumer paying him for a service and I should dictate what I am willing to do or feel comfortable with (I hate that I have that view of my hospital/obgyn birth but there it is).  The hospital has no ban on VBAC but he is the only doc that will do them.  I guess my question is can he make me have a c section at 41 weeks.  What are the scenarios if I refuse?

[starrlamia]

They cannot force any medical procedures on you, you absolutely have the right to refuse. To be able to make any case against you in regards to it, they would have to have solid evidence saying that there is an actual medical reason that would indicate what they want to do. Going post date is not a medical reason!

Im sorry you have to go through this :(

[NaturalMama311]

My MW kind of said the same thing to me, but it's their over seeing OB's policy.  My old MW required me to have a c-section scheduled for the 42 week mark, but she also said its my choice if I show up for that appointment;)  We've since moved and I had to switch providers and the new MW said at 41 weeks they won't require me to have a c-section but they want to induce me at that point.  They think it is too risky to let me go beyond 41 weeks because the baby will be too big and my chances for needing a c-section will only increase exponentially at that point.  I go in for my 37 week appt today so I'm going to discuss it more with them and see how flexible they are with their dates. 

What really worries me is that I just had an ultrasound last week and they decided to change my due date based on the baby's measurements - they moved it up from Jan 26th to the 23rd.  So if they do require induction at 41 weeks I now have 3 less days just because the sonographer did some measurements.  And I don't think her measurements were all that accurate - I was 36 weeks and baby's head was measuring 38 weeks, legs 34 weeks and stomach 36 weeks.  When she re- measured the head she said, ok maybe 37 weeks like she wasn't really sure. 

[jenniro]

He CANNOT make you have a c-section.  You absolutely have the right to refuse any procedure.  Even if they had evidence that there is a medical reason to do the c-section, (which they don't), as long as you understand the risks of the decision you've made, you can refuse any procedure.   If someone has cancer and doesn't want to treat it, they can't make them, right?  Also, I don't remember the exact week, but past a certain point in your pregnancy, your doctor cannot drop you as a patient or it is patient abandonment.  It sounds like you have a decent relationship with this doctor and the plan right now is to talk about this at 41 weeks.  I know that is past the timeline for patient abandonment, so talk about it then and continue to refuse.  He may ask that you do NST past 41 weeks to check babe, or he may try to scare you into doing what he wants.  Know your rights!  He can present to you what he thinks is the best option for you, and if you disagree and refuse any aspect of his treatment plan, then he legally and ethically has to continue to care for you while repecting your decisions . 

[Pirogi]

OP - I think the only way you (as a non-military member, but that is a different rant) could be "forced" to have a c-section is if the doctor were to go to a judge and make a case that you were medically endangering the life of your baby and get a court order.  Even then, what if you disappeared for a few days?  They could fire you, but they have to give you a certain amount of time to find another provider or else they are abandoning you.  If it were me, I would just humor him.  Don't agree to anything, continue with the "wait and see" attitude.  If it comes down to it, and he is putting lots and lots of pressure on you, go ahead and schedule, then don't show up and reschedule.  Continue to have small emergencies that prevent you and your healthy baby from going in for surgery.  Delay.

NaturalMama - Eeek.  Sorry to say it, but your new MWs don't sound very VBAC friendly.  Adjusting a due date this late in the game based on a sonogram is NOT good science.  And did they really say that your risks go up "exponentially" after 41 weeks based on baby's size alone?  Maybe it's the math nerd coming out in me, but that is just not accurate.  Your baby likely won't gain more than a half pound in the week between 41 and 42 weeks.  Good luck, I hope they are a bit lenient on this.

[NaturalMama311]

Originally Posted by Pirogi 

NaturalMama - Eeek.  Sorry to say it, but your new MWs don't sound very VBAC friendly.  Adjusting a due date this late in the game based on a sonogram is NOT good science.  And did they really say that your risks go up "exponentially" after 41 weeks based on baby's size alone?  Maybe it's the math nerd coming out in me, but that is just not accurate.  Your baby likely won't gain more than a half pound in the week between 41 and 42 weeks.  Good luck, I hope they are a bit lenient on this.

Oh sorry, it was the sonographer that changed the EDD, I haven't seen my MW since so I'm not sure what date they are going by yet.  I guess I'll find otu this afternoon.  As for the "exposnentially" comment, that was actually made by the overseeing OB for the MW's office.  It's their policy that I had to have a VBAC discussion with one of their OB's to discuss the risks and benefits.  The OB was actually really supportive and said I'm the perfect candidate for a VBAC (DD was breech and I had very low fluid levels).  But it's their policy that I have an induction at 41 weeks.  I'm going to talk to the MW today and try to feel them out on that policy since it was the OB that stated that to me.  If I get to be 40 weeks I will certainly try my own natural methods before going in for medically induction.

[GOPLawyer]

Assuming that you're in the US....the only way a c/s can be forced is via court order and that's a really rare thing after the Angela Carder case.  If you do not consent, they cannot forcibly perform a c/s.  Just stick with "No".

[onyxravnos]

he can only MAKE you do ANYTHING if he has a court order. 

Personally I opted for a UBAC so i didn't have to deal with similar doctors but had i transferred i had little cards printed that i would then give to every single person who entered my room that said:

'if you touch me in anyway without my permission i will sue you. try me.' 

it seems harsh and silly and over dramatic but i don't want to have to fight with doctors while I'm trying to have a baby.

[MsFortune]

No one can force you to have any medical procedure that you do not want to have.  

But the flipside is, no one can force your OB to participate in your birth, either.

I suggest a different approach - ask the doctor to explain why he is so adamant about the 41 week date.  Ask him if his 41 week rule is just for VBAC or for all births.  Ask him what is the danger of going postdate and why does he think this would be dangerous for you.  I would not dismiss his concern completely - I'd ask him to explain it, and try to reach common ground.  

[LisaSedai]

Might be his malpractice insurance company says he can't let women go past 41 weeks. In that case, just don't show up for the 41 week induction/ERCS appointment (family emergency prevents you)

[khaoskat]

FYI - I VBAC'd an 11 lb 1 oz baby back in May 2010.  I refused all later term US's.  I also fudged my edd a bit, because I have a long history of going over to 42 weeks (DS1 - 42+5; DS2 - 42 DD1 - 40+2; DD2 - 40+3).

This baby was technically by my original dates 42+1; by OB dates 40+2.

[neveraim]

Originally Posted by MsFortune 

I suggest a different approach - ask the doctor to explain why he is so adamant about the 41 week date.  Ask him if his 41 week rule is just for VBAC or for all births.  Ask him what is the danger of going postdate and why does he think this would be dangerous for you.  I would not dismiss his concern completely - I'd ask him to explain it, and try to reach common ground.  

I totally agree.  You don't want to ruin your relationship with this OB just yet...after all, the situation is still only hypothetical.  Try and dialogue with him and find out why he has this policy.  Ask him what you would need to do to make him comfortable waiting a few more days.  Non-stress test?  Maybe you could tell him that you'll try some natural methods of induction at 41 weeks (nipple stim, sex, etc.) Whether you actually do or not is up to you, but he could think you are.  It was smart of you to say, lets' wait and then we'll discuss it.  Let him know how much you appreciate him and reassure him that if there are any signs of problems you will be the first person to do what needs to be done to protect your baby and yourself.  Be confident, stand your ground but don't be hostile and just refuse...he'll see you as uncooperative and noncompliant.  Make him think that you respect his opinion and advice (even if you don't).  You'll get further that way.  GL!!!

[tonttu]

If you fell comfortable with your doctor otherwise , I would try to strike a deal with him first .

Agree to have the baby monitored regularly (like every 2 days for example)until you go into labor , and don´t put a date on . If you and the LO are fine , even after 42+ weeks , then there is no medically justifiable need for a cs .

And if he gets pushy , just tell him "no" . After all , he cannot force you and like you said , he is here for you , not the other way around !

I hate , when doctors say "it´s too dangerous for vbac after 41 weeks " That is soooo stupid , seems like they are clinging to every reason , they can , to talk us into cs .

But , if you like him , try the diplomatic approach first ,

[Pirogi]

Originally Posted by neveraim 

Let him know how much you appreciate him and reassure him that if there are any signs of problems you will be the first person to do what needs to be done to protect your baby and yourself.  Be confident, stand your ground but don't be hostile and just refuse...he'll see you as uncooperative and noncompliant.  Make him think that you respect his opinion and advice (even if you don't).  You'll get further that way.  GL!!!

Not arguing, but just, urgh.  Mothering/partnering the OB.  Blech.

[neveraim]

Originally Posted by Pirogi 

Not arguing, but just, urgh.  Mothering/partnering the OB.  Blech.

I know and I agree...but when you feel like this person is your only option, better to try and keep the peace than go around making demands.  I've seen it go really badly too many times.  That's why I say...be confident...don't cow down, but don't be agressive either.  There's a fine line between assertive and agressive.  Do what you need to do, but it's best not to labor in a hostile environment if you can at all help it. What's that saying...you win more flies with honey than vinegar?

I don't know what I would have done without my precious dr. who doesn't even require an I.V. for anyone...loves natural birth...won't induce...attends vaginal births of all kinds...VBAMC, special scars, twins, and breech.  He wholeheartedly supports homebirth and is back up OB to a whole slew of midwives.  (We call him the midwife disquised as an OB)  He truely is one of my favorite people in the whole world and there is a special place in heaven for him.  ok, ok...sorry to rant, but I know how lucky I was to have him and I feel bad for women going through this without the option of having someone like him.

You have to work with what you have...You might just win him over and make him rethink his 'policy'!

[HappyMommy2]

Sometimes you can agree to the appointment, and then call the day of (or the day before) with some reason you have to cancel. (car broke down, hubby out of town, etc)  Reschedule for 2-3 days away.  Repeat until baby wants to join the world on his own!!

[neveraim]

Originally Posted by HappyMommy2 

Sometimes you can agree to the appointment, and then call the day of (or the day before) with some reason you have to cancel. (car broke down, hubby out of town, etc)  Reschedule for 2-3 days away.  Repeat until baby wants to join the world on his own!!

Yes you can!!  :-)

[DMG8]

Originally Posted by Pirogi 

OP - I think the only way you (as a non-military member, but that is a different rant) could be "forced" to have a c-section is if the doctor were to go to a judge and make a case that you were medically endangering the life of your baby and get a court order. 

 Correct.  And legal precedent is not on the side of the doctors.  Courts are very reluctant to get involved unless there are extreme circumstances.  

 

Originally Posted by MsFortune 

No one can force you to have any medical procedure that you do not want to have.  

But the flipside is, no one can force your OB to participate in your birth, either.

Well, technically a doctor who just doesn't show up to the birth could be charged with patient abandonment!  They have a duty to continue care of a patient unless they give proper notice and find a provider who can provide comparable care.  

My doctor said something similar about 41 weeks and scheduling a c-section.  I will let them schedule it but I won't show up.  There's little they can do if I'm not there and I live over an hour away.  When I show up in labor I know it's my right to say no to a c-section, especially if their only reason is because I'm 41+ weeks pregnant.  The medical literature says there is a slightly increased risk after 41 weeks weeks but it's really quite small and hardly justifies the need for a planned c-section.  

[stik]

The doctor's obligation to continue care has been much discussed on MDC, but I'm not sure how real it is.  If you go to a hospital in labor, the hospital has to provide care until 24 hours after you deliver the placenta (unless they don't do deliveries, in which case they have to transport you somewhere that does).  It's my understanding that the availability of care from a doctor based at the hospital covers a doctor's obligation not to abandon their patients.  You still have access to care.  

Further, I'm not sure that obligation actually exists.  The US freed the slaves during Reconstruction - no one can be forced to work.  If your doc dropped dead, or was incapacitated or ill, obviously, they wouldn't come to your birth.  They can also duck out when alive and healthy - my OB wasn't at my birth because she was on vacation.  There's no reason the doctor you identify as your personal doctor actually has to provide care for you personally except that they are getting paid to do so.  If they forfeit payment, their obligation to you ends.  I looked hard for a law defining a doctor's obligations to a pregnant patient when I was having concerns about my OB during my second pregnancy - I couldn't find any law that defined any such obligations, and it's clear from my experience (both giving birth and having a friend of the family who was an OB) that providing a substitute or leaving the patient to the MD attending at the hospital is a widely accepted practice.  

If the doc is willing to wait until 41 weeks and then discuss a section, I'd rest with it for now.  It's possible that, should you reach 41 weeks, your situation will have changed - high blood pressure, signs of fetal distress, obviously transverse baby not responding to version, any of a variety of things could happen and while one hopes they don't, at 41 weeks it's conceivable that there would be a reason c-section is indicated.  You don't have to agree to have a c-section at 41 weeks to agree that it could, conceivably, be worth having a conversation about at that point.  That keeps your doc happy until 41 weeks.  

At that point, you can re-evaluate or stall.  But there really is no point in arguing with your OB (who is otherwise supportive) before the point where conflict actually exists.  Save your energy for when it's needed.  If your doc is willing to let the matter rest until you're 41 weeks, you can probably negotiate for a NST and another few days.  

[DMG8]

Sure, you can't force a doctor to work.  However, he still has a duty to his patients to follow through with care.  It's not a specific statute per se, more of a public policy that as a society we don't want our doctors abandoning patients in need.  Case law has supported this public policy in many states, in OB and other medical cases.  You can file a complaint against your doctor (with the state that licenses him) if he does not break your relationship in a professional and ethical manner (giving the patient adequate written notice of the termination, help the patient find another doc).  And in a worse case scenario, if you are harmed by his "abandonment" you could potentially file a lawsuit.  Ideally it would never come to that.