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"Woman Centered"/"Natural"/"Family Centered" CS

post #1 of 38
Thread Starter 

Hello!  I am looking for the closest OB & hospital to my area which will allow a "Woman Centered"/"Natural"/"Family Centered" C Section.  I am willing to travel if need be.  Does anyone know of any hospitals in your area that offer this?  Thank you!

post #2 of 38

Where are you located?  You might ask in "Finding Your Tribe" and in the tribal areas within your travel distance...

 

Good luck!

post #3 of 38

Oh, and Wilson Medical (outside Binghamton NY) apparently has a good c/s program... multiple support people for mom allowed in the OR, then a private recovery suite attached to the OR so mom/babe/support people can move directly there as a unit.

post #4 of 38
Quote:
Originally Posted by wombatclay View Post

Oh, and Wilson Medical (outside Binghamton NY) apparently has a good c/s program... multiple support people for mom allowed in the OR, then a private recovery suite attached to the OR so mom/babe/support people can move directly there as a unit.



Wow, that sounds wonderful!!!

post #5 of 38

Can you give more info??

 

 

Where exactly are you located?

What exactly are you wanting to happen or not to happen?

post #6 of 38
Thread Starter 

I have two very simple requests

 

1) I get to hold my child immediately, not just look at them while someone else holds them- Yes this is being done around the world, and has just started to be done in the US! After suffering the trauma I did during my last delivery I am unwilling not to be allowed to hold my child. It can be done safely.

 

2) I get to see my child being born

 

 

I am located in central Pennsylvania, but I am willing to travel anywhere to accomplish this. I have friends and family located across the US that I could stay with if need be.  

post #7 of 38
Thread Starter 

There is the most wonderful video on YouTube done by an ob, anesthesiologist and midwife out of England which describes this- A Natural C Section: A woman centered approach

post #8 of 38

I'm familiar with the video you spoke of.  I had a cesarean with my 1st child and while preparing for a VBAC with my 2nd, I sought out all the information I could for a "gentle" cesarean should a cesarean end up being necessary.  I remember watching the video and wanting all of that to happen - I had intended on demanding it happen.  I ended up VBACing, but had I not, I would have had a "gentle" cesarean.

 

 

Have you discussed these wishes with your doctor yet?  Perhaps he/she is willing to work with you.

 

I am of the opinion that while it may be easier to have your wishes honored elsewhere, your wishes almost can always be honored anywhere.   I highly suggest talking to your current provider, creating a cesarean birth plan, and simply demanding your wishes and what you want to happen.

post #9 of 38
Thread Starter 

I have, in fact I have already spoken with 2 obs in the area. Both insisted that it was not possible.  I asked even about having a legal waiver drawn up ahead of time absolving them of any complications which would be possibly caused by doing a cs in this manner.  I was told no it was still too legally risky and the hospital attorneys would not allow it.  I loved that they actually admitted that it was the legal risk, not a medical risk that would keep them from doing this.  I was told that I have a greater than 50% chance of needing a cs with my next pregnancy.  

 

In fact I had interviewed one for nearly two hours, during the course of the conversation indicated that if I needed an induction that if there was no change in my cervix after 12 hours of a cervical ripening agent they would force me to have a cs.  With my son, my induction lasted nearly 48 hours.  The first 16 hours there was no change in my cervix with a cervical ripening agent. They didn't see a change until they started the pitocin.  I was able to deliver vaginally.  Obviously this scared me, but this is the perinatologist at better of the two hospitals in the area. Needless to say I am also looking into what legal means I will have at my disposal to make sure I am not forced into something that is not the best for me.       

post #10 of 38

In terms of holding your babe while on the table, there seem to be two things that need to be addressed... first, some hospitals wont do it because of the OR temperature (it's kept cool because that's best for the surgery/people involved but it's not necessarily best for the babe).  If you can present solutions (warmed blankets for example) it might help.  The other item is the sterile field... many anesthesiologists set the drapes (and from there, the sterile field) too "high up" on mom's chest for the babe to fit easily.  Asking to speak with the head of anesthesiology or with the specific anesthisiologist involved might lead to having the drapes set just a few inches further down the chest, creating a "space" for the babe.

 

There may be more hurdles, depending on the hospital/providers, but those are the two things I hear back from med pros who have fielded questions at ICAN meetings/conventions.

 

For seeing your child being born... that's harder.  There is a real fear that a mom might have a serious emotional/psychological response to viewing her surgery.  You can argue that if the drape is simply lowered a bit for the actual moment of delivery there isn't much chance of you seeing anything that would be disturbing, but you'll need to get the anesthesiologist on board too since they're the ones who worry the most about having a mom hyperventilate/develop blood pressure issues/have wonky reactions to medications as hormones respond to fight/flight instincts and so on.  If you can convince the anesthesiologist you might have better luck convincing the surgeon.  One option offered at a few hospitals here is a video record of the birth.  The ORs are all on video record already and, assuming nothing happens during the surgery that is considered "actionable" the OR will release a copy of the birth video.  No idea if that would be possible, or if it would be possible for a support person to film the birth from their perspective (so again not right in the nitty gritty because of the angle of filming)... that might be more palatable to the hospital legal team.

 

Either way... I'm sorry you're facing such challenges!

post #11 of 38

I am so, so sorry you are being put in this position.  It's sad sometimes the position legalities put us in :(

 

Wombatclay has some great information for you.

post #12 of 38


 

Quote:
Originally Posted by wombatclay View Post

In terms of holding your babe while on the table, there seem to be two things that need to be addressed... first, some hospitals wont do it because of the OR temperature (it's kept cool because that's best for the surgery/people involved but it's not necessarily best for the babe).  If you can present solutions (warmed blankets for example) it might help.  The other item is the sterile field... many anesthesiologists set the drapes (and from there, the sterile field) too "high up" on mom's chest for the babe to fit easily.  Asking to speak with the head of anesthesiology or with the specific anesthisiologist involved might lead to having the drapes set just a few inches further down the chest, creating a "space" for the babe.

 

There may be more hurdles, depending on the hospital/providers, but those are the two things I hear back from med pros who have fielded questions at ICAN meetings/conventions.

 

For seeing your child being born... that's harder.  There is a real fear that a mom might have a serious emotional/psychological response to viewing her surgery.  You can argue that if the drape is simply lowered a bit for the actual moment of delivery there isn't much chance of you seeing anything that would be disturbing, but you'll need to get the anesthesiologist on board too since they're the ones who worry the most about having a mom hyperventilate/develop blood pressure issues/have wonky reactions to medications as hormones respond to fight/flight instincts and so on.  If you can convince the anesthesiologist you might have better luck convincing the surgeon.  One option offered at a few hospitals here is a video record of the birth.  The ORs are all on video record already and, assuming nothing happens during the surgery that is considered "actionable" the OR will release a copy of the birth video.  No idea if that would be possible, or if it would be possible for a support person to film the birth from their perspective (so again not right in the nitty gritty because of the angle of filming)... that might be more palatable to the hospital legal team.

 

Either way... I'm sorry you're facing such challenges!


This is all good info.  Really, it is the anesthesiologist's OR.  Your OB can agree to certain things, but in the end, they are not the one with the final say. 

 

Best of luck getting the c-section you are hoping for. 

 

post #13 of 38
Thread Starter 

Thanks for the information, I will definitely try to meet with a couple of anesthesiologists at the two hospitals.  I know both hospitals in my area that I have looked into have an absolute no videography policy.  This became very detrimental in my son's birth as the drugs they had me on fogged his actual delivery, which is a memory I will never get back.  :(   

 

I am really contemplating traveling abroad if I cannot find someone in the US who is willing to do a cs in this manner.  I had a very traumatic birth with my son, and I know that my physiological and emotional response to a traditional cs would be very detrimental to my health. Though I would really hope to avoid having to travel while heavily pregnant.  

 

Do you know if they could legally prevent my husband from picking up the baby and placing it on my chest? I am trying to plan for the worst case scenario if I cannot get to another hospital.

 

Also, do you know if I would have the right to refuse any drug that they would want to administer? I do not want to be any altered mental/conscious state from drugs, especially after the birth of my son. Although I know that some are known as having a small risk of this, given my severe negative reaction to the epidural during my son's birth I do not want to take a risk with any but the most absolutely necessary drugs, ie the spinal/epidural.       

 

I have family or friends that I could easily stay with in;

 Minneapolis, MN

 NC

 Phoenix

 San Fransisco

 Boca Raton, Florida

 Atlanta, Georgia

 

 

post #14 of 38
Thread Starter 

I don't know if you have had the opportunity to read this article, but it is very eye opening.  It is also very close to where I live.  

 

http://www.msnbc.msn.com/id/5012918/

post #15 of 38

Well, legally your husband/partner/support person is only present in the OR at the will of the hospital.  They can be removed at any time and barred from the surgical suites for endangering you, the babe, the sterile field, the surgical process, the "sense of safety" of the hospital staff, etc.  They can even be barred from the hospital grounds since they are not a patient, they are a guest.  It's not something a hospital likes to do since it creates a fair amount of negative press, but they are within their rights to have a disruptive person removed.  So yes, there is certainly a "risk" that if your partner attempted to hold the babe in a way that violated hospital policy, they could be removed and the babe sent to the nursery.  I'm really sorry.  But again, this would be something to discuss with the babe's pediatrician (the babe is technically the patient of the pediatrician, so they are the ones who can ok changes in newborn routine in the OR) and the surgical staff ahead of time.

 

As for drugs... this would be a key component in your discussion with anesthesiology.  When push comes to shove, your right to refuse medication during surgery is iffy at best.  Setting out before hand what you do and do not want in terms of types of medication (especially if you can site problematic responses to specific medications) is your best option.  Once surgery starts, the anesthesiologist kind of gets final say... you could pursue legal action afterwards but by then it would be "too late" for the birth experience as well as hard to "prove" that the medical dedcisions of the anesthesiologist were harmful unless there really was (knock on wood) serious physical harm done to you or the babe.  Proving emotional damage due to medication used would be extremely difficult.

 

As for your options... I'd suggest first posting a summary of your hopes/fears in the Finding Your Tribe area for each of the locations you've listed above.  Then google ICAN and the locations you've given to see if you can get in touch with the local ICAN group for each of those regions.  They should be able to point you towards (or away from) specific hospitals or providers in those areas.  Also, work on a surgical birth plan that addresses your top 3-4 concerns.  You might want to divide you plan into 2-3 things for the OB, 2-3 things for the babe's pediatrician, and 2-3 things for the anesthesiologist.  Each one of those providers "controls" a different aspect of the process and you'll need talk with each one about what is and isn't possible and once you're in contact with the various regional ICAN groups you could "meet" with the different teams in those locations (keep in mind though that IF you travel for birth, you'll actually need to travel a month or so before the birth to establish care... otherwise you're walking into a real unknown and have a lot less control over what happens.  Even places like the Farm now ask that moms get their third trimester care from them). 

 

And then... perhaps consider ordering the hypnobabies surgical birth/vbac prep cd?  Locate a therapist trained in EMDR or give Tapping a try (tapping is a free/diy therapy similar to EMDR)?  See if there is an ICAN, SOLACE, or birth truama support group near you?  Do what you can to prepare for various birth outcomes, get your partner and doula and as many support people as possible on board?  Maybe meet with your regular care provider to discuss post-birth options?  I had PPD with my first (c/s) birth and severe thrush/mastitis in later births so I now put together a HUGE post-birth survival kit with herbal, homeopathic, and bach flower treatments for various situations and have my doctor give me perscriptions in advance to be filled "in case".

 

Hang in there and good luck!

post #16 of 38

You did deliver vaginally the first time?  Are you certain you don't want to try a vaginal birth this time?  They usually go quicker the 2nd time.   I guess I'm trying to understand how traveling for a family centered cesarean is going to be less traumatic than attempting another vaginal delivery. 

 

I had a great and truly respectful cesarean with my last baby.  I did not ask to hold him in the OR because I knew that the spinal anesthesia would freak me out (which it did) and I needed to be able to move my arms.  I didn't want to worry about trying to hold my baby at that point.  He was brought to me within 30 minutes of getting to recovery.   I was offered an anti-anxiety med which they could not give me until the baby was born but it was definitely not forced on me.  I kept asking when I could have it but after the baby was born, I started feeling better so the anesthesiologist asked if I still wanted it.  I didn't watch the surgery (again, no desire to see my stomach opened up) but the nurse anesthetist did take some pretty graphic birth pics which I do appreciate now.  I have a friend who was at another local hospital whose midwife took some graphic birth pics as well.  In the interest of being completely honest, that was my 2nd cesarean.  My 1st one was pretty miserable so I was rather scared of the 2nd one (which, again, turned out very nice).  My 2nd baby was a vaginal birth after 41 hours of labor.  Obviously, I stalled a lot during that labor but I would take that birth over either cesarean.  As long and tough as it was, it was still a lot better than the cesareans. 

 

The biggest criticism I saw of the experience you are looking for is that it needs to be scheduled.  They won't do it on an "emergency" basis so if you go into labor ahead of time, they might not be willing to do it.  My personal feeling was that I wanted to give my LO as much time as possible and go into labor on my own so that I knew he was ready.  You always run the risk of baby not being ready during a scheduled c-section which means they may need to take the baby for suctioning or breathing help which will also throw off plans. 

 

I'm NOT trying to discourage this particular type of family centered cesarean.  I think it's awesome and should be done more.  Instead I am encouraging you to ask about all situations (e.g. going into labor ahead of time) before committing to traveling some place far where you will be stuck recovering for several weeks before you can get home (though that could be a good thing, depending on where you are and who you are with!). 

 

Good luck!
 

Quote:
Originally Posted by StongWoman View Post


 They didn't see a change until they started the pitocin.  I was able to deliver vaginally.  Obviously this scared me, but this is the perinatologist at better of the two hospitals in the area. Needless to say I am also looking into what legal means I will have at my disposal to make sure I am not forced into something that is not the best for me.       



 

post #17 of 38
Thread Starter 

Thanks for all of the wonderful info Wombatclay.  I have already contact ican in my area, so far no one has been able to provide me with any information.  I will try the other areas I listed as well.

 

I suffered from Post Traumatic Stress Disorder with the birth of my son due to being separated from him.  I am hoping to avoid repeating this emotional injury.  Do you know when parental rights start in concern for the treatment of your baby?  When do you get to start to make decisions regrading their care.  Obviously if the hospital staff has the right keep you from your baby they don't start at birth.  

 

I should be able to travel for third trimester care because of my work schedule.  However, obviously as you pointed out this would be far from idea, especially given I have a little one already.  

post #18 of 38
Thread Starter 

dlm194, I absolutely want to try for another vaginal birth.  However, I was told that I have an extremely high risk for needing a cs with my next child.  The problem is the doctors in my area may force me into a cs despite my wishes.  As I posted the one dr informed me that they would force me to have a cs if I had spent 12 in the induction process without a change in my cervix from a cervical ripening agent, which happened with my previous child.  They only saw a change in my cervix after 16+ hours and starting the pitocin.  

 

You mentioned that your baby was brought to you 30 minutes after you went to the recovery room, how long was this after the birth? 

post #19 of 38

I'm not certain what the legal "moment of authority" is... I'm sure that on paper a parent's rights start at birth (or sooner, since a court order would be required to "force" medical care like a transfusion on a late term unborn infant against parental will, which suggests that parental rights exist at that point).  But given that one parent would be in surgery (so probably not considered legally in full pocession of their faculties) and the other parent doesn't have a legal right to be physically present during that surgery, the reality is probably a bit different. 

 

In NY (where I live) there is no longer a legal excemption from the newborn eye ointment/vitamin K injection.  A hospital can either respect a parent's authority and refrain from administering the ointment/shot (but they are legally required to report the family to CPS) or, more often, the hospital wil administer the ointment/shot without parental knowledge and against parental consent.  Although the legal rights of the parent are being violated, because of the way the health code is set up, the hospital isn't really taking any legal risks... even if the parent brought legal action against the hospital for violation of parental rights, the health code comes down on the side of the hospital and it's unlikely a lawyer would take the case or that a court would find in favor of the parents.  :(  This isn't an exact match for the rights of the parent during a cesarean obviously, but I bet it's pretty similar.  There's the legal right and then the way that right plays out in reality.

 

I'm guessing that if your husband was actually holding the baby his parental rights would win over the hospital as long as he wasn't doing anything that could be considered an "immediate threat" (trying to take the babe out of the maternity unit which might suggest parental kidnapping, endangering you or the child by interfering with medical action that was considered "critical" like pulling out an IV or breathing tube, and so on).  I'm not sure when your rights would win out over the decisions of the medical staff in the OR however... so much could be covered by a statement that drug X or procedure Y were required to save your life.  For example, if the anesthesiologist administered something due to excessive bleeding you probably wouldn't be given the chance to say yes or no and if the drug didn't work and they performed an emergency hysterectomy they probably wouldn't need any sort of consent form there either.  And bringing legal action after the fact might be difficult.  You'd probably need to discuss this before the surgery and make sure the surgical consent forms specify what interventions are off the table (for example, blood product transfusion if your religion prohibits this) so that alternatives can be planned for and approved.

 

I guess it just kind of comes down to "be prepared"... meet with the hospital staff as much as possible and see what can be done.  I really hope you don't need all this, and that you have a great VBAC, but I totally understand the need for planning.  My first vbac left me with a 4th degree tear and pelvic organ prolapse after the prolonged shoulder dystocia of my daughter.  Finding a team that would attend a vbac after that was tough, and I spent a lot of time planning and plotting and "worst case scenario-ing".  It helped.  So hopefully this will also help you find the balance you need to get through this birth with grace and dignity and at least a few happy memories!

post #20 of 38

Would you need to be induced?  I don't mean to get personal but is the issue just long labors or do you have another factors going on that you know will require an induction or delivery by a certain time?   I'm trying to figure out if you really just need a patient care provider or you really need someone that can do the cesarean you are looking for.  My midwives would let me labor as long as necessary to get the baby out (as long as baby and I were okay).  My 1st c-section was for failure to progress so I was expecting a long labor for my VBAC. 

 

Not having been through a cesarean, you really don't know how you are doing to react to it.  I think it's essential that you plan for a nice cesarean but I'm trying to figure out if a cesarean is really the best answer for you, especially if you suffered PTSD from separation.  I'm not getting on a soapbox about c-sections here because I do think there are situations where moms do better with cesareans after traumatic vaginal births.  But no one can guarantee that a c-section will result in a baby healthy enough for you to hold right away.  I guess that's my concern.  Many women have terrible reactions to the anesthesia and spend hours throwing up.  These are just things to think about. 

 

I watched my LO the whole time I was in the OR.  The room was set up so that he did not leave my sight while I was on the operating table (unlike my 1st c-section).  He left when I left the OR.  By the time I was getting settled in recovery (after my vitals were taken, etc), the nurse was running him back to me (after a quick visit to the nursery).  I honestly barely noticed he was gone and we were breastfeeding within about 30 minutes of birth.  This was a good scenario for me because I was out of the OR so I was feeling much better that everything was over and I could really enjoy my baby.    I was in recovery and separated from my 1st baby for 3 hours post birth which was awful.  :(  

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