VBAC3 after t cut incision and refusal of doctors plans...

[memphrika]

Hello there. I'm new here and very curious what other women would do in my situation.

My first child was an emergency C section at 24 1/2 weeks, that was extremely unnecessary and (i'll spare you all the details) inhumane.

That C section ended in a T cut incision. I was 18 at the time.

My next child was 12 months later, c section also because of the recent t cut. (This was a bikini cut incision)

My third child was a c section, 19 months after the 2nd one. (also bikini cut incision)

I am now 25 years old, and it has been 4  years since i've given birth. My mate and I have decided to begin getting pregnant again. I would really like to have a VBAC and I know I could do it.  My main issue in this is the fact that i'm SURE I cannot find a doctor willing to allow me to do this. Allow is the key word here. Vanderbilt University hospital is very close to my house and is where I will be going. They have awesome doctors who are competent enough to  handle any uterine ruptures or any other complications which may arise.

This brings me to my questions. If I cannot find a doctor willing to allow me to do this VBAC , what will happen if I refuse to consent for a c section and insist on a natural birth? Will they have to let me? I am  not going to use any labor inducers. I usually go into labor at around 36 weeks and have babies under 7 lbs. So I know that makes my chances of rupture go down.

I just basically want to know, in you ladies' experience, what will happen when I refuse to consent to a c section. can they kick me out of the hospital?

how long does one have after rupture before death of baby and mother? is there any website where I can find research on cases like mine?

Thanks ahead of time for your answers.

[CrunchyChristianMama]

I've never had a c/s, but I can answer a few of your questions.

A doctor can drop you as a patient, but they have to give you 30 days to find another care provider.  So if they know from the beginning that you are going to refuse a repeat c/s, then they may just not take you on or will tell you to find another provider. 

There are cases out there of c/s being performed without consent, so I would be really hard pressed to pick a provider that wasn't on board with your plan.  I think it would be safer for everyone to be on the same page.  Are you completely opposed to home birth?  You may have better luck finding a home birth midwife who would take you on than an OB.

Best of luck to you as you figure out what is best for you and your baby.

[memphrika]

I don't see how they could perform a cs on someone without consent! couldn't I sue?

I am not opposed to home birth, although that would be more risky and harder to find a midwife who takes state health insurance. also, the time it would take to get to the hospital from my house is over an hour.  last time I went into labor I was 7 centimeters dialated before I got to the hospital, and not in much discomfort at all. This is what leads me to believe I could have a natural birth with no issues.

Well, I guess I have a new question also. Does anyone know of any doctors who are willing to do this kind of thing in the Middle Tennessee area??

[jenniro]

It is very rare, but there have been cases of hospitals and doctors getting court orders to force women into c-sections.  Really rare, but has happened.  You are not pregant yet, right?  So, you have some time.  Check out ICAN in your area.  They would be able to point you in the direction of supportive providers.  It is probably going to be a challenge to find a truly supportive provider, but women in your situation have.  Also, make sure you research and understand the risks.  The risk of uterine rupture is higher with incisions that extend into the upper portion of the uterus.  There is a great site for women with scars other than low transverse.  http://specialscars.org/

I hope you find a supportive, informed provider.  GL!

[memphrika]

Thanks! I have looked on ICAN, and the providers listed for my area say that their limit on VBACs is 2! I called them all yesterday and spoke with nurses. The only one I'm waiting on an answer are the Vanderbilt University Medical Center actual Doctors. The midwives won't see me.

I was 6 cm dialated when I showed up to the hospital with my 2nd Csection, and 8 cm when I showed up for my third! They had the nerve to tell me I am not even a candidate for a trial of labor. I tried to tell them I had a trial of labor with both of my children. I don't know what to do other than just go to a doctor, let them know I am interested in this VBA3C situation, and very insistent about it. Then maybe drop the bomb 10 days before my due date?

[jenniro]

I understand not being able to find a supportive provider.  I live in a rural area and I am not sure what I will do when I get pregnant, but I will tell you what I am planning.  I want a HBA2C, so my ideal situation will be to find a midwife.  Unassisted childbirth is outside my comfort zone, so if I have to see my local OB this is my plan.  I am going to lie about my LMP by about 5 days so I can buy myself some more  time.  I will ask the doc how he feels about VBA2C and let him know I want to do it.  If he is supportive, great.  If not, then I will drop the subject.  When it comes time to schedule the section, I will schedule as late as possible.  If the date comes, and still no baby, then my "grandma will die" and I will be unavailable and have to reschedule.  I will continue avoiding until I go into labor and show up pushing. 

All this being said, I understand the risks of a VBA2C.  I have read every study I can, and while the risk of uterine rupture is low (I've had 2 low transverse incisions) it can happen.  However, I also understand the risks of a 3rd c-section.  Although I have never given birth vaginally, I believe I can do it and I am very motivated.  I think that I should be allowed to make informed decisions about my birth, for my safety and the safety of my baby.  It is unfortunate that I have to lie to my healthcare provider, but they sometimes have to make decisions based on insurance and legal reasons.  That is unacceptable to me. 

So, that is what I am doing and maybe there are parts of it that can help you.  I don't know how I would feel doing a VBA3C with a special scar without a supportive provider.  That is a decision that only you can make.  I hope everything works out!

[memphrika]

that is a very inspiring story in my opinion. I'm thinking of doing kind of the same thing if it comes down to it. Vanderbilt is a great hospital, so I'm sure they can handle my medical situation if anything were to happen. that is good about the "misinformation" of the LMP.... hmm.. just a few days, but I'm usually in labor at 36 weeks anyway.

I understand the risks as well, but like i said, i was 8 cm dialated before i made it to the hospital with my last one!!! I was feeling great too. then they rushed me to the OR.....

Also, I live 30 minutes from Ina May Gaskin's "The Farm" so even if they won't see me. (havn't gotten a call back yet) I'm sure I can get some sound advice. I think they would be more willing to see me if I told them I am going to refuse hospital treatment anyway. maybe I can just sign some sort of release that relieves them of any liability, and that i know the risks...

we'll see. I'm sure everything will work out fine. I know my body and I would be the first one to accept it if I didn't think a natural birth was right for me.

[jenniro]

You'll do great.  You have such confidence in your body.  I am not quite there, but trying :) KUP!

[GOPLawyer]

WRT The Farm - it is my understanding they won't do VBACs w/o a prior vaginal birth. :-(

I would definitely ask about a HCP in the Tribe area.  Someone there might know of a MW or OB that is open to attending the birth.  If you can't find someone, I like jenniro's plan (and would do the same myself in the same situation).

I've had 2 c/s.  The last one ended up being a J incision.  The doctor who did the c/s said I should never labor and that I should never get pg again.  Went in one ear and out the other.  For my 3rd, I was able to find a MW who believed the decision was mine to make as the Mama (wish I could multiply her!) and thus agreed to take me on as a homebirth client.  Looong story short, I went into unstoppable labor at 30 weeks and thus had to go to the hospital for the birth.  The doctors lied and threw horrible stories at me and tried to bully me into constenting to a c/s that I knew was not necessary.  I knew that they could not kick me out (due to EMTALA...fabulous law that protects women from being kicked out of a hospital while in labor) and I knew they couldn't force a c/s w/o a court order (as previously mentioned *really* rare...courts/hospitals are reluctant to grant them after the Angela Carder case).  I refused and went on to have an amazing, natural VBA2C.

It can be done...even w/o a supportive hospital/OB.  I do recommend having a *very* strong backbone for both you and your support person(s).  I also recommend knowing your stats backwards and forwards.  When the OB tried to lie and say the rate of UR for a special scar was around 12%, I was able to quote the most current stats as well as why her stats were wrong/outdated.  It really made her back off and she basically left me alone after that (which was BLISS! lol).

[gingerbane]

I talked to the farm last summer about coming for a VBAC.  There was no "prior vaginal birth" rule so I doubt that has changed.  I don't know what their rules are regarding VBA2C and VBA3C however.

[GOPLawyer]

Originally Posted by gingerbane 

I talked to the farm last summer about coming for a VBAC.  There was no "prior vaginal birth" rule so I doubt that has changed.  I don't know what their rules are regarding VBA2C and VBA3C however.

What did they say?  At first, I heard they stopped doing VBACs (I remember several people calling the Farm and being told the same...no VBACs)...then I heard they were doing them w/ a prior vaginal birth.  If that's changed, I'd love to know.  It's good to keep up w/ current policies. :-)

[memphrika]

Does anyone know if the farm takes medicaid or is it just private insurance or direct payment? just curious in case anyone who sees this knows the answer.

Thank you ladies a lot for your input. I really appreciate the support from all of you. I have never even heard of a J incision, and just now did research on it. Wow momma, that is amazing that you had a vba2c! Congrats!!!!  That gives me a warm fuzzy feeling.

I have a VERY strong backbone. I own my own non-profit organization, and have 15 guys who work under me! i'm positive I can  handle a bully doctor! I know this is going to happen for me this time. Your support helps in ways I only imagined! i'm so glad I found this website, i've had a subscription to the magazine for years, but never realized there was a community!

[Kwgrlup]

There is a Mama on another VBAC board who has had a VBAC3 with a prior T-incision.  Here is the link to her birth story...http://community.babycenter.com/post/a13674885/successful_vba3c_after_inverted_t_incision_sergio_emanuel_is_here?   Goodluck, I hope you are able to get the birth you want! 

[memphrika]

Here is an UPDATE!!!  So, the regulations at "The Farm" on VBAC is as follows: they "allow" any VBA2C when double stitching was done on the uterus.

They discourage anyone with more than that from delivering vaginally. The midwives I spoke with yesterday said they have seen ruptures in their clinic before.

They will not let me birth in their center on the farm, but they do know of doctors in hospitals nearby who will let me labor and birth in their hospital...

AAAAND... for the awesome part. The midwives from the Farm will still come with me to the hospital while i'm in labor, to be my midwives, but we have to be in the hospital because of the risk of rupture.

I just told them my plans for laboring at home and showing up to the hospital late and they said as long as I paid them the amount for a VBAC, they would attend my birth. I'm ecstatic.

The Farm Midwifery Center is the best of any I know. YAY!

With them on my side, I'm absolutely positive my VBA3C with T incision is going to go smoothly!!!

[CookAMH]

That is fantastic to hear. I am very happy for you, and this sounds like a very good arrangement. Will you get your prenatal care from The Farm?
 

Originally Posted by memphrika 

Here is an UPDATE!!!  So, the regulations at "The Farm" on VBAC is as follows: they "allow" any VBA2C when double stitching was done on the uterus.

They discourage anyone with more than that from delivering vaginally. The midwives I spoke with yesterday said they have seen ruptures in their clinic before.

They will not let me birth in their center on the farm, but they do know of doctors in hospitals nearby who will let me labor and birth in their hospital...

AAAAND... for the awesome part. The midwives from the Farm will still come with me to the hospital while i'm in labor, to be my midwives, but we have to be in the hospital because of the risk of rupture.

I just told them my plans for laboring at home and showing up to the hospital late and they said as long as I paid them the amount for a VBAC, they would attend my birth. I'm ecstatic.

The Farm Midwifery Center is the best of any I know. YAY!

With them on my side, I'm absolutely positive my VBA3C with T incision is going to go smoothly!!!

[blessedwithboys]

Welcome to MDC!

It's so beyond awesome that you have been able to find support.  :)

As for being forced into a csec, read the birth story "Tyler and Sam".

Best wishes!

[Mamatoabunch]

Good news! I have read on another forum and a mama that has a T incision, primary c/s vertical for triplets, RCS for next pregnancy, bikini and third a HBAC.

[AlexisT]

Technically, the Farm midwives cannot "be your midwives" in the hospital (CPMs don't have hospital privileges anywhere as far as I know). I'm sure the Farm midwives are well known at their local hospital, but you'd better find out what the OB who will officially be in charge thinks of all this.

[memphrika]

Yes, I will be receiving prenatal care from The Farm.

The midwives at the farm have a doctor which they work with in situations like this. It is "their doctor" who they go to and bring all their risky patients too. The doctor and the midwives work together. This is why they would not tell me the name of the doctor to speak with him myself, I must go through them.

So yes, the midwives themselves have an arrangement with the doctor and he supports their practice. They would not have accepted me if the situation was any other way. I will let everyone know what happens when i go to my first appt.

I feel much more confident now and am ready to TTC. I'm excited!!!

The Farm is also going to do my "well woman" visit before I am pregnant. I'm so happy you ladies are giving me support and helping me think of questions I need to ask. Thank you.

[mrsberman]

That's a great update! I was going to suggest asking if they knew anyone that would see you, but this is even better. I didn't know they attended hospital births either.