"Woman Centered"/"Natural"/"Family Centered" CS - Page 2

[wombatclay]

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.   

DLM-  From her posts, it sounds like the OP has a medical condition/medical history which limits her options.  Whether or not those limits are reasonable probably isn't a factor, or something she can control.  For example, around here homebirth midwives will not take on vbac mothers... it may not be reasonable, but it means that women in my ICAN group who want an HBAC must rent a cabin ~3 hours away and get there during labor IF they want a "home"birth.  If you can't afford the rent, the gas, the darn high oop cost, or the time it takes to get there routinely as well as in labor then a midwife attended HBAC just isn't an option.  And although I had one successful VBAC under my belt already, it took me much of my next pregnancy to find a care provider who would "allow" me to vbac again due to the birth complications that developed during my first vbac.  I've now had my second vbac and am preparing for my third... thankfully I was able to use the same provider this time because I've learned that the other two local practices would not take me as a vbac client, only as a rc/s client.  And even the practice/hospital that I'm using places restrictions on vbac moms that require some "pre-planning".

Sometimes the available choices all kind of stink and planning on how to make a "best case worst case scenario" is crucial.  It sounds to me like this is what the OP is trying to do.  And it sounds like the OP doesn't "want" a c/s, but knows that her chances of having surgery are pretty high so she's trying to find the best possible c/s practice out there so IF she ends up with that birth scenario it'll be the best birth possible in the circumstances.

Personally, I think the hypnobabies c/s program might help since there is a lot of focus on staying calm/focused/present and then recovering quickly... so that might be something to explore.  Especially if one goal is to avoid extra medication and be "parentally active" as soon as possible.

[StongWoman]

"Sometimes the available choices all kind of stink and planning on how to make a "best case worst case scenario" is crucial.  It sounds to me like this is what the OP is trying to do.  And it sounds like the OP doesn't "want" a c/s, but knows that her chances of having surgery are pretty high so she's trying to find the best possible c/s practice out there so IF she ends up with that birth scenario it'll be the best birth possible in the circumstances."

This is exactly what I am trying to do.  With my son's birth I developed preeclampsia at 36 wk 4 days.  The drs I have met with have told me that because of this, my advancing maternal age, my short stature, and my weight that my likelihood for having a cs is 75% even though I previously was able to give birth vaginally with all of the same conditions.  The fact that they won't let me labor through an induction for more than 12 hours means that there is a huge likelihood this will be true given that with my previous induction started Saturday afternoon and I didn't have baby until Monday mid-morning.  It was an extremely difficult birth with many challenges including me loosing consciousness when given the epidural and the medical staff scrambling to stabilize both of us.  It almost ended in an emergency cs.  However, as difficult as it was I am thankful that the staff at the time allowed the opportunity to give birth vaginally.  I still would not exchange the difficult time I had for a cs for all of the money in the world.  Obviously the risk of having the same reaction to an epidural exists in the future, which makes having a cs even scarier.  My lo was born not breathing and had an apgar of 2.  They were able to revive him in the delivery room and I was able to briefly hold him before he was taken to the nicu. We were separated for nearly two days after that.  Knowing what I know now I should have fought harder to see him during those two days.  I have daily nightmares about not being able to get to him. I have started to have nightmares about having a cs and not being able to hold my new lo as well.

 I also know how difficult a traditional cs can make both bonding and breastfeeding.  Both of which I was NEVER able to do with my son.  Every decision in my previous birth plan was set up to try to make breastfeeding as easy as possible.  I know that there are a lot of woman who can have a cs and overcome these issues, but there are some who aren't able to.  The ones that can should feel extremely lucky.  Knowing now what I know, I know that I would not be able to do either with a traditional cs.  I am unwilling to let this happen to a future child when it can be prevented with some minor accommodations by the medical staff.  (Yes, I the hospital did have a lactation consultant that I met with, but was still not able to given all of the delays)  OBVIOUSLY this would change if the child would need emergency medical care and I would deal with that. It is a lot easier emotionally to deal with being separated if it is for a true medical reason.  Interestingly, although the thought of surgery, the epidural, recovery, etc makes me nervous I really don't have strong reaction to it. (Weird given what happened with the last epidural I know)  I know that I could be able to peacefully have a cs if I was able to hold lo. I also know that if I am not able to hold lo, then the risk that my blood pressure would spike to an unhealthy level causing me to have other health issues is an extremely likely possibility.  Also I know that it would lead to a reoccurring of the PTSD which would also endanger my emotional health making it difficult to care for both children.  All of these risks are unacceptable to me personally.  I am willing to travel to the ends of the earth if needed to accomplish this, to do otherwise would just cost me too much.         

[dlm194]

Wombatclay ~ Trust me, living in a state where it is illegal for midwives to attend HBACs and having had a CBAC after a VBAC, nothing you said is lost on me and I'm not glossing over anything.   ;)

Stongwoman ~ I understand much better what you are trying to do.  I think you are taking the right approach.  Plan for the best and the worst.  I'm just not sure how easy it is going to be to have the best of the worst if that scenario pans out.  Does that make sense?  I guess I'm not sure how committed you are to having a vaginal birth. Obviously, an intervention free vaginal birth would be ideal for you so that you can hold the baby right away and bond.  I understand that you have other medical conditions going on but I'd be hard pressed to give you a 75% chance of a c-section.  Even women who have had a c-section in a similar situation go on to have VBACs.  You won't necessarily have pre-e again.  Without pre-e, you probably don't need to expect an induction.  Even with an induction, putting a time limit on your labor doesn't make sense (assuming you and the baby are fine throughout labor).  You are obviously working through a lot of issues.  Do you *want* a c-section?  Do you want a c-section if you labor takes more than 12 hours?  I almost think you need to prioritize your desires for your birth.  Are you first looking for a patient OB that will give you all the time you need but will honor a family centered cesarean?  Or are you more committed to finding an OB who will honor a family centered cesarean regardless of his/her stance on vaginal birth in your situation.  My personal thought is that you need a hospital-based midwife with a good back up doctor.  It sounds like you need a midwife that will be patient with your labor (and can perhaps advise you on keeping your pregnancy as healthy as possible to avoid complications if possible) but can then advocate for you if it comes down to needing a cesarean.  The reason I suggest a midwife to attempt a vaginal birth is because she can usually come into the OR with you.  Obviously she won't have a part in the surgery so she can focus on you and making the experience better for you whereas a doctor will mostly focus on the surgery. 

Central PA is huge but there are some ICAN groups out there that may have some suggestions.  My midwives for my VBAC (I'm in NJ) recently attended a family centered cesarean but I believe the mom went to 42 weeks and opted for a repeat c-section instead of an induced VBAC.  I understand the cesarean was well planned out but they mom.  I'm not sure how it would have been handled on an emergency basis (I didn't go there for my CBAC; I was at a different hospital where my dh took over giving orders on how things needed to happen). 

That's my 2 cents anyway!  ;) 

[StongWoman]

I would absolutely love another vaginal birth and would welcome everything and anything I could do to accomplish this.  I am working on trying to control and correct those things with my health that I can so I can be as healthy as possible and try to avoid complications that could possibly lead to needing more interventions.  I am, just as was said, trying to plan for both eventualities given my current situation.  The dr I met with was the perinatologist that works at the local hospital.  If I was to develop preeclampsia and admitted to this hospital I would be transfered to his care.  This is also what happened at the other hospital I delivered at, my ob was taken off my case and I was reassigned to the hospital's perinatologist.  I totally agree that putting a time limit on the induction of labor doesn't make sense, but that is their policy and I was told I would be forced to have a cs at the end of 12 hours.  His reasoning was that after 12 hours everyone is ' too sick'  to deliver if an induction was necessary in the first place.  Obviously given my previous birth experience I know this not to be true, but I really wouldn't have the ability to fight at that point.  I would rather have the ability to labor as long as needed given obviously the health of my lo.   I would love to have a hospital based midwife with a back up OB who would be willing to to work with me and my situation allowing me to hold lo.  Obviously if it was an emergency cs this wouldn't be possible and all the points would be all out the window.  But most cs aren't emergency but emergent.  Meaning that you have already gone into labor, you need cs but it's not like you have to be rushed down the hall either which is where I am trying to focus.  I have not found any hospital based midwives in my area, I have found a few midwives who will do home/center births but not hospital births.  Both local hospitals will only allow one other person in the OR so at that point the choice would have to be the midwife or my hubby.  Obviously my hubby would win out.   

"Are you first looking for a patient OB that will give you all the time you need but will honor a family centered cesarean?  Or are you more committed to finding an OB who will honor a family centered cesarean regardless of his/her stance on vaginal birth in your situation. " 

 

I would definately prefer a patient OB that will give me all the time needed and honor a family centered cesarean.  If that is not possible I think that a family centered cs would be best, because the likelihood that I would be able to delay it until absolutely necessary would be greater except of course at the local hospital.  

Given that I also don't know if I will or will not develop preeclampsia again, I need to plan for getting it again while praying that I don't.  

[dlm194]

It's been several years since i did any research about hospitals/midwives/doctors in the central PA area. When I did, I was specifically looking for VBAC friendly but a VBAC friendly care provider should be even more vaginal birth friendly to a woman who already had a vaginal birth.

Most hospitals will allow midwives who are on staff in the OR with her patient. Even the baby factory I used with my 1st birth let the midwife in.  Doulas and CPMs are not often allowed in the OR.

Anyway, the suggestions I got several years ago were the Birth Care midwives who attend out of Ephrata hospital (the have a birth center too), Center for WOmen's Health and Wellness in Camp Hill, and May Grant Associates with Lancaster General. I don't have current info about these practices but you might ask in the finding your tribe section.

I might be overstepping my suggestions a bit here but it sounds like you've talked to a couple crappy OBs who are knife-happy and trying to get you to believe that you are broken when there isn't enough evidence to suggest that you can't have a vaginal birth (especially since you already did; that's what really blows my mind).  The 12 hour limit on an induction is silly.  It sounds like you need to be delivered by the end of a shift or you get sectioned.

I realize most c-sections are not done emergent cases but I would still ask about the family centered cesarean during the course of labor.  Once the call is made for a cesarean, they often try to fit you in as soon as they can.  My 1st baby was born on a pretty busy day so they were rushing about.

[StongWoman]

Warning: Spoiler! (Click to show)

I might be overstepping my suggestions a bit here but it sounds like you've talked to a couple crappy OBs who are knife-happy and trying to get you to believe that you are broken when there isn't enough evidence to suggest that you can't have a vaginal birth (especially since you already did; that's what really blows my mind).  The 12 hour limit on an induction is silly.  It sounds like you need to be delivered by the end of a shift or you get sectioned.

I would agree with your assessment in general, but I do also know that I at a higher risk so I want to plan for that given my past history.  In general, I think that obs who are willing to do a family centered cs get the whole birthing dynamic.  I don't want to get into the situation where I am in my third trimester and it becomes apparent I will need a cs and not have a provider who is willing to do a family centered one.  It is important enough to me that I am willing to do what needs to be done to ensure that it happens if I need a cs.

And obviously trying to avoid these knife-happy providers would be a great benefit to going elsewhere since I would most likely be switched to their care immediately upon check-in at the hospital.  

[StongWoman]

I found a hospital in Brooklyn, New York that has allowed a mother in the past to hold and nurse in the OR after she had gone through an unsuccessful induction of labor for preeclampsia. She had a midwife advocating for her.  Sounds like a good solution if I can't find anyone closer. And they only have a 20% cs rate. 

Maimonides

http://67.192.244.61/main/clinicalservices/206.aspx#AFTER

[yaboobarb]

I have a friend who had a previous c-section, and pre- negotiated her c-section to include all of her wishes ( if her try at vaginal birth should fail.)

I wrote her story here.

"Invictus,"  (It means “Unconquerable,”)

[StongWoman]

That is such a wonderful story!!!!! Thanks for sharing! 

Can you give me the name of the hospital/OB where she delivered? I am trying to compose a list to share with other women hospitals that have allowed this in the past.  I may have found one semi-close to me that although they have not done one in the past are willing to work with me.    I would like to provide them also with a list of hospitals/obs that have done it for possible resources.  I can provide you with my email off of the message board if needed.  Thanks again!!!!

[bcrn]

So try a CNM with hospital privileges,who you remain under their care even for a c/s,who will have you meet the ob that works with us,tour the unit,have a talk with the anesthesiologists about lowering drapes,mirror so you can see and a midwife who goes through all of this with you helps to place lo on chest and spend time with you in recovery as much as they can sounds like the best of both worlds,even helps to initiate breastfeeding.I hope this helps{consultation maybe worthwhile at Special Beginnings in Arnold md. good luck

[StongWoman]

Thanks, I will check with them.   I have found a lot of places that will allow a mirror and to hold lo in recovery, but I am actually looking for holding lo in the or such as is described in the post above 'Invictus'. 

[StongWoman]

So far I have found the following hospitals which will allow woman centered C sections:

Fort McMurray, Alberta Canada
Hendricks County Hospital, Danville, IN
Memorial West, Pembroke Pines, FL
Maimonides Med Center, Brooklyn NY with help of Midwives from Brooklyn Birthing Center
Brandon Hospital, Brandon, FL
Riverside Methodist, Columbus OH
Carolinas Medical Center - Pineville, Charlotte NC (experiences vary)
Sparrow Hospital, Lansing, MI
Saddleback Memorial in Laguna Hills Ca

[StongWoman]

And the list grows :)

Birthing Inn in Landsdowne, Va with the Loudoun Community Midwives
UNC hospital in chapel hill NC
Fort McMurray, Alberta Canada
Hendricks County Hospital, Danville, IN
Memorial West, Pembroke Pines, FL
Maimonides Med Center, Brooklyn NY with help of Midwives from Brooklyn Birthing Center
Brandon Hospital, Brandon, FL
Riverside Methodist, Columbus OH
Carolinas Medical Center - Pineville, Charlotte NC
Sparrow Hospital, Lansing, MI
Saddleback Memorial in Laguna Hills Ca

[StongWoman]

 And the list grows again!!!!

 

Windham Hospital in CT with Dr. Mansfield or Dr. Gildersleeve

UPMC in Pittsburgh, PA advertises on their website that you may get to hold baby in the OR, have not had any personal recommendations

Birthing Inn in Landsdowne, Va with the Loudoun Community Midwives

UNC hospital in chapel hill NC

Fort McMurray, Alberta Canada

Hendricks County Hospital, Danville, IN

Memorial West, Pembroke Pines, FL

Maimonides Med Center, Brooklyn NY with help of Midwives from Brooklyn Birthing Center

Brandon Hospital, Brandon, FL

Riverside Methodist, Columbus OH

Carolinas Medical Center - Pineville, Charlotte NC

Sparrow Hospital, Lansing, MI

Saddleback Memorial in Laguna Hills Ca

 

 

[StongWoman]

New edited list, I was contacted by one of the providers saying that they do not allow mom to hold baby but for a brief moment before they seperate them for hours until mom is out of recovery and being moved to the regular floor.

University of Iowa, Self reporting no confirmation from any patients
Cox health system Springfield,MO
Windham Hospital in CT with Dr. Mansfield or Dr. Gildersleeve
UPMC in Pittsburgh, PA advertises on their website that you may get to hold baby in the OR, have not had any personal recommendations
Birthing Inn in Landsdowne, Va with the Loudoun Community Midwives
UNC hospital in chapel hill NC
Hendricks County Hospital, Danville, IN
Memorial West, Pembroke Pines, FL
Maimonides Med Center, Brooklyn NY with help of Midwives from Brooklyn Birthing Center
Brandon Hospital, Brandon, FL
Riverside Methodist, Columbus OH
Carolinas Medical Center - Pineville, Charlotte NC
Sparrow Hospital, Lansing, MI
Saddleback Memorial in Laguna Hills Ca

Possibly  Franklin County Medical Center in Greenfield MA- they have reported a willingness to try

[StongWoman]

Dr. Shanon Forseter and Missouri Baptist Medical Center in St. Louis

Reston Hospital, Reston VA

Lexington Medical Center, Columbia SC

St. Lukes Hospital, Jacksonville, Fl

Garrett Memorial Hospital Oakland, MD Wellspring Family Medical Doctors will, the other practices won't.

Waukesha Memorial Hospital, Waukesha, WI

Sky Ridge, Lone tree Colorado 

Strong Rochester, NY

St. Jude's in Fullerton, Ca

University of Iowa, Self reporting no confirmation from any patients

Cox health system Springfield, MO

Windham Hospital in CT with Dr. Mansfield or Dr. Gildersleeve

UPMC in Pittsburgh, PA advertises on their website that you may get to hold baby in the OR, have not had any personal recommendations

Birthing Inn in Landsdowne, Va with the Loudoun Community Midwives

UNC hospital in chapel hill NC

Hendricks County Hospital, Danville, IN

Memorial West, Pembroke Pines, FL

Maimonides Med Center, Brooklyn NY with help of Midwives from Brooklyn Birthing Center

Brandon Hospital, Brandon, FL

Riverside Methodist, Columbus OH

Carolinas Medical Center - Pineville, Charlotte NC

Sparrow Hospital, Lansing, MI

Saddleback Memorial in Laguna Hills CA

Possibly  Franklin County Medical Center in Greenfield MA- they have reported a willingness to try

Good Sam, Brockton, MA

Please note, too, that even if a particular doc says yes to those things, the person who truly runs to OR is the anesthesiologist. That being said, it is important to talk to one's doctor because they can have influence in the OR and can give input as to which hospitals that they have rights at are more supportive of such choices. I would also add that if a woman would like to have such options during a cesarean, it is wise to call the hospital well in advance and ask to speak with the head of anesthesia. Also, be prepared to calmly yet assertively talk to whoever ends up being your anesthesiologist during all the pre-op prep. This is where having a doula can be extremely helpful, too

[Bekka]

My friend had a very good planned CS I believe at the hospital in Williamsburg, VA after the hospital near her described their policies.  I am not sure whether she was actually about to hold the baby; I seem to remember she got to nurse the baby immediately, but could be wrong...

[Bekka]

Originally Posted by Bekka 

My friend had a very good planned CS I believe at the hospital in Williamsburg, VA after the hospital near her described their policies.  I am not sure whether she was actually about to hold the baby; I seem to remember she got to nurse the baby immediately, but could be wrong...

Ok, I verified with her, she said at VCU med ctr in Richmond, with Dr. Isaacs.  My mistake.