so frustrated....WWYD?

[jenninjapan]

I live in an area of Japan which has an almost total VBAC ban.  I decided NOT to spend the majority of my pregnancy fighting and spending time looking for a hospital that would allow me, maybe possibly to labour.  Instead I have hired a traveling midwife.  But until she arrives, of course I need to find a dr that will agree to a few basic prenatal tests - blood work essentially at 28 weeks and then once again before birth.  But so far NO dr will take me on as a patient. (I have seen two dr.s so far - both of whom I have seen before for my previous pg).   They refuse to call my visits prenatal visits and will not write anything down in my prenatal handbook.  (Which means of course that if something were to happen during my homebirth and I needed hospital transfer the hospital would mostly likely refuse all treatment because it would seem that I had refused proper prenatal care.)

So what would you do?  My options are find a dr and lie through my teeth - which would probably mean going so far as scheduling my mandatory 38 week section (without any intention of going through with it). Not mention anything about the home birth, traveling midwife or previous reasons why other dr.s refused me and just kinda drop of the face of the earth until the baby is born and needs a 1 month check up

Continue with an unassisted pregnancy and trust that all will go well with the birth

Or go home to Canada.  I could still have the midwife come and at least I know the hospital wouldnt turn me away, but cost, spending two months away from home and finding a home to birth in....

I just dont know which is going to be more of a headache.  So would you lie to your dr?  Has anybody done this before?

[Caitlin0919]

I've never been in this situation, although we're planning to UC with our next pregnancy so I might be sooner rather than later. I plan to just go to prenatal appointments and act like we're going to birth in the hospital and then just say "oops". I live in South Dakota where midwives are legally banned from attending home births and we're in a smallish town where there are no CNMs in the hospital so I don't expect to find a doctor here who is supportive of homebirth, let alone UC. If I were you, I honestly would have started out lying so I could get the proper tests and documentation before a HBAC. Maybe just tell the next doctor that you didn't like the previous caregivers you saw or something? I think lying, scheduling the c-section with no intention of going and staying put will be the least stressful plan for you. It sounds like you're pretty uncomfortable with lying, but I honestly think that's your best option and in the end, you're doing it for the benefit of your baby and that would be worth it in my book. Good luck!

[MegBoz]

Originally Posted by jenninjapan 

They refuse to call my visits prenatal visits and will not write anything down in my prenatal handbook.  (Which means of course that if something were to happen during my homebirth and I needed hospital transfer the hospital would mostly likely refuse all treatment because it would seem that I had refused proper prenatal care.)

Wow!! Really? You could show up in labor & they'd REFUSE to treat you? Is that really possible? If that's the case, that alone might make me most likely to come home to Canada. If they are 'strict' like that, could they also force you into a section even if you just transferred say for IV fluids or an epidural or something? That is not to say that women haven't been bullied into CS here in the US, but at least on paper our laws protect our patient autonomy to make our own decisions about our care. If no such laws exist in Japan AND they have VBAC bans, I might be uncomfortable even attempting HB there.

Otherwise, I totally with the PP that you should just lie. Definitely the easiest thing. Heck, I'm even sorta conspiring to tell a degree of lies too. I'm seeing hospital-CNMs for a little back up care to ease transfer just in case. I see only 2 of the 6 in the practice- they are totally, completely supportive of my HB plans & personally know my MW, a CPM. BUT- they can't write it down in my file since some of the OBs in their practice might give them a hard time, potentially even insisting they fire me as a patient. I also have to lie to the receptionists about why I'm not doing all the prenatal apts there that I ought to be.

When the maternity care systems are broken & warped, and don't put women & children first, I don't think it is wrong, in any way, to lie -- since we HAVE TO LIE in order to get the care we need -- & I feel absolutely no guilt for doing so.

[jenninjapan]

Thank you so much for your replies!

Caitlin - if I could go back and do my 2 'prenatal' visits from the beginning I would have def started out telling a selective truth.  Hindsight I suppose, but it sounds like the best course of action when you KNOW you are not going to be listened or paid attention to. 

MegBoz - thank you for putting it so clearly as well.  I feel like I am def left no choice but to lie and will feel no guilt for it (anger and frustration are another thing though....) Really my first instinct was to go with an UBAC because of all the possibilities.  I just don't know enough and trust the system enough NOT to do any of those things - let me labour in the parking lot, force me into a section.....But hospitals here will refuse ambulances and patients because 'they dont have the proper facilities' or dr.s to treat a patient.

I emailed my midwife and she agrees that I should find another dr I have never seen before and just keep my mouth shut - not lie per se, but definitely NOT offer any info on my birth plans or total refusal of a  repeat section.  The most important thing is to get the prenatal care so that way if I were to go into labour before she arrived at least then I know a dr that will see me or can show up with at a hospital with some proof of prenatal care.  what a nightmare this is turning out to be....

[Banana731]

Yeah, bummer, I would just get the prenatal care until 38 weeks and then stop going.

 I had dd2 in Okinawa. I went to a US military hospital for prenatal care, but had a UC (illegal for the local hb midwives to take me as a vbac, as I'm sure you know) I did not let the hospital know my plans. FWIW, it was super easy to get all the birth registration stuff taken care of with the city, even though it was an unattended birth. I'm sure with a mw to sign the report of live birth, it will be that much easier.

[gravida]

   I didn't lie but I let them believe something that wasn't totally true. I told the doctors here when they asked where I was going to have the baby that I was having him/her at home. They assumed that meant Canada and I never corrected them. Then I kept me mouth shut to everyone else. If people asked what hospital I was going to I told them the name of my back up hospital. It was just easier sadly to lie than tell the truth. My doctor did an exam on DS when he was 2 days old (I wanted him in ASAP for the paperwork needed to get him a birth certificate) and spilled the beans then. Good luck! 

[Meganlove]

With my last I left my CNM at 37 weeks because she said somethings that I didn't agree with and was called that "crazy Love women" Yeah I got a homebirth MW  but she couldn't give me my rogham shot so I called my CNM and told her I was laboring at home and the baby came. All true I just didn't tell her that was the plan :) This time I am seeing a different CNM group but am planing a homebirth again. I am just using them as back up and US. This is how I have to get the birth I want and so I am doing what I have to. Good Luck!

[catherine1981]

Hi JenninJapan,

I find myself in a slightly similar predicament and wanted to bounce ideas off here. First though,

Quote:

(Which means of course that if something were to happen during my homebirth and I needed hospital transfer the hospital would mostly likely refuse all treatment because it would seem that I had refused proper prenatal care.)

How do you know this? My husband is also afraid of this (or if not of being refused treatment, then receiving substandard care) and to me it seems ludicrous. Yes, eye-rolling, yes "tsk...tsk...shame on you...you should have known better", maybe even verbal rudeness (but what would I care if I was going there for an emergency c-section?), but I just cannot comprehend a hospital risking a maternal death to make a point. When the WHO stats come out and they have a higher maternal death rate, they don't get to put a little asterisk next to the number and say that some of them were planned HB and so they deserved it!

I can't help but think of my Peace Corps experience as a health volunteer in a small village in northern Peru. There, if there is a maternal mortality, the nurses and doctors responsible for the community will be put under investigation and possibly lose their jobs. If a "rogue" (that's what we considered her) woman where to hide her pregnancy and avoid all prenatal visits and then send someone in the middle of the night to the health center because there was an emergency, the nurse and OB (in the district capital) would HAVE to go to the woman's home (even if it were a 2 hour hike up over a mountain). They would be irritated, maybe even angry, and probably scold the husband and grandmother for waiting so long or for not contacting the health post earlier for assistance, but it would be unthinkable for them to do nothing and let a woman/baby die.  

I'm in the Philippines and am just 21 wks with my first pregnancy and have been seeing an OB at a hospital in Manila (which is 6-8 hours away). I have only begun to learn about HB and to investigate my options and so I've not asked any OB doctors about being a back-up (in Manila or in the city where I'm located). 

In initial conversations with my husband, I assured him that I would make sure that I found a doctor who I thought was competent and who was supportive of the idea of HB who would agree to be the back-up before fully deciding on a HB. The more I read though, the more that seems totally out of reach.

My options as I see them:

1.) Meet with one or two OBs in town who work at the best hospital and have come highly recommended as friendly to natural birth (here that means they have heard of Lamaze and allow the husband to accompany the woman), ask them if they would be my back-up for a planned HB, pray that they say yes. This would be ideal because then I could even call the OB when I was in active labor and even pay for her to be on-call for me so that I wouldn't end up with just anybody giving me a C-section. Husband would also be allowed to be with me in this case.

2.) Meet with the above OBs and tell them that I am planning to have the baby in Manila (at big hospital) but want to have a local OB for emergency. Then I go ahead with HB and call OB if there is emergency and just act like it was a sudden emergency when I show up at the hospital ER. Husband should be allowed to be with me in this case if that OB is able to meet me at hospital.

3.) Meet with above OBs, have them say "no way, José!", forgo the back-up idea, and then risk having a bad transfer experience in case of emergency and a (worst case scenario) botched C-section. Husband most likely not allowed to be with me in this case.

I just reread your original post and the fact that they are insisting on a scheduled 38 week C-section does throw a wrench in the whole, "oops, it was an accident" plan. I guess I would just plan to have a successful HB and if there is a life and death emergency, you will go to the ER and know that they will treat you.

Good luck with your decision.