Is there a wrong reason to choose UC?

[RubyLu]

I'm in the August DDC and haven't posted much elsewhere. But hello, all! I hope you can provide some advice.

My first pregnancy was a breeze and I'd planned a homebirth with a midwife but at 39 weeks my DD flipped breech and I was transferred from midwife care to an MD. Water broke before active labor. C-section. Healed quickly. Not signing-up for another surgery anytime soon, though.

This pregnancy (2 1/2 years later) I looked for midwife care for a homebirth but due to the scar on my uterus no one was able to see me. I interviewed some OBs but found them to be alarmist. Then I interviewed a wonderful family practitioner and decided upon her;  not thrilled to be delivering at at hospital, but at least had a good provider.

Except that now that provider may transfer me from her care due to politics/guidelines in her clinic. Several weeks ago my gestational diabetes testing (the 3-hour) came back with two abnormal results (one just 3 points above normal. Without those 3 points I wouldn't be in this situation), thus diagnosing me with GD. I am rather certain that this is a mistake or at least I'm low low low on the continuum (all follow-up tests, A1C and my 6x daily glucose testing has all been fabulous, better than normal), but due to that 3-hour result my doctor is required by her clinic to either have me participate in what I would consider unnecessary interventions (ultrasounds to gauge baby's weight--pitocin induction if baby found to be approaching more than 8 lbs or going over 40 weeks--and weekly non-stress tests which are not only stressful for me but take me away from my office and reduce my earnings at a time I really really need the money).

If I refuse any of the interventions her clinic requires her to require of me, she must transfer me to High Risk OB at the hospital and the remainder of my care and birth would be managed by the surgeons there. I don't want a surgeon attending my birth!!

I trust my body. I believe it can birth on its own, scarred uterus or no.  I've never really considered UC for myself before now, though. I had figured it might be something I'd do after I had at least one vaginal birth under my belt, but not really before that. I'm seriously considering it now, though. 

Is it worrisome, in your minds, that I'm considering UC at this time? Reactionary? I just don't want those interventions, knowing they can lead to unnecessary alarm and induction (which, to a VBAC hopeful is very worrisome), I can't afford to take the time off that my family practitioner wants me to, and I am angry that if I refuse even one of the interventions (which would include induction at 40 weeks, of course, if I didn't birth before then) my care would be transferred. I don't want a surgeon at my VBAC because I know the chance of me getting that VBAC go down considerably with that type of management.

[zoebird]

Well, UC is really about how you feel about the process. Do you feel worried about moving to this sort of birth at this point? Do you feel that you could prepare yourself adequately for the birth?

If you feel that you can, then I can support that. :) If you feel that you can't, then I can support that, too, and also your process of making peace with the interventions that you require because you feel it is best to stay with a care provider.

Because, either way, it's a fair bit of emotional work, you know? :)

[Alenushka]

Go get a second opinion with another OB.  Ask them to do the GD test again.

Trusting your body is not good enouught. Last night I was taking care of my firend who was trusting her body. She refuse her BP meds or to deal with her sugar. She had massive storke at age of 50. She can;t work. We are collecting money. All the herbs, accupuncture and you (she is accupancutre therapist herself) and all the trust in her body could not prevent her stroke. $2 worth of medication would have.

You are mother. It is not just about your personal expreinces, it is about taking care of kids you already have outside your body as well.

You say you can birth on you own ....but obviously you needed some help last time  . You may need help again.  There is nothing wrong with it

[Earthy Birthy]

Originally Posted by Alenushka 

Go get a second opinion with another OB.  Ask them to do the GD test again.

Trusting your body is not good enouught. Last night I was taking care of my firend who was trusting her body. She refuse her BP meds or to deal with her sugar. She had massive storke at age of 50. She can;t work. We are collecting money. All the herbs, accupuncture and you (she is accupancutre therapist herself) and all the trust in her body could not prevent her stroke. $2 worth of medication would have.

You are mother. It is not just about your personal expreinces, it is about taking care of kids you already have outside your body as well.

You say you can birth on you own ....but obviously you needed some help last time  . You may need help again.  There is nothing wrong with it

Alarmist posts like this that have nothing to do with the OP's question are ridiculous. Your friend's situation has nothing to do with the situation that the OP is in. If you are anti-UC, please just stay away from this forum.

RubyLu, I concur with zoebird. It is really about how YOU feel about having a UC birth yourself that matters. I think that your concerns about being labeled high risk and all of the interventions that come with that are very valid. However, you have to follow all of your "what-ifs", be it hospital or UC, and figure out what you really feel comfortable with.

[DirtyHippyMama]

since the OP asked for our personal opinions, here's mine:

i don't know the whole story, but going off what you wrote here it seems kinda iffy to me.  are you thinking of continuing prenatal care with the professionals, regardless of your end choice, or at least doing thorough prenatal care on yourself?  i mean blood sugar testing (which i see you are doing), blood pressure, weight (watching for sudden weight gain), etc.??  if you are doing all of this and the numbers are within normal range (i assume your sugar levels are well controlled with diet?), then the "GD" is the least of my worries.  (i am not a professional, btw!!  this is JMO.)

is your scar vertical?  i think VBACs in general are relatively safe with a horizontal scar, but vertical scars can be tricky, and are inherently more risky (of uterine rupture) than horizontal ones.  i would suggest thoroughly researching the matter before making your decision (e.g. credible statistics of rupture risks, what signs would indicate a problem, how likely you would be able to get emergency help quickly enough if necessary, etc.).  personally, i might want to try and bargain with the docs about attempting a UBAC (of sorts) in the hospital, so that there is an OR available immediately should you run into a problem.  remember, you can always refuse any treatment.  you can insist that the room be dim, quiet, limited number of staff people, etc.  you can insist that you not be touched without permission.  it is possible to avoid unnecessary procedures/interventions at a hospital, if you are prepared in advance.  and that preparation includes knowing when the interventions might actually be necessary.

i understand the desire to UC, i do (i have had one and loved it, and am definitely pro-UC in general), but i recently went through this with a friend of mine, and the thought of her UC'ing was kind of scary to me.  the problem is that in the case of rupture, although rare, you can bleed out faster than any ambulance can get you to any hospital.  the decision is ultimately yours, of course, but it is so important to do thorough research and be as prepared as humanly possible when you are dealing with potentially complicating (if statistically rare) factors.

ETA: it all comes down to the fact that YOU need to feel 100% comfortable with your decision.  i UC'ed because the OB considered me "high risk" and would not sign off on my HB with MWs.  i did tons and tons of research about everything that made me "high risk" (for a homebirth; i am considered normal risk for a hospital birth).  i came to the ultimate conclusion that i was educated and prepared enough to take the risk and UC.  however, my risk factors were not the same as yours.  i say all this not in an attempt to sway your decision in any way, only to demonstrate that i am not coming at this without some personal experience.  YMMV.

Edited by DirtyHippyMama - 6/20/11 at 7:38pm

[Alenushka]

There is nothing alarmist. People trust their bodies every day, refuse reasonable treatment and end up really ill.  I gave an example of the same sort of "magical thinking".  Positive thought do not override physiology and anatomy of a scar and GD.  The question here is  "what true risk and benefit analysis". There serious statistical studies that are available to the general public.

If the risk is high, does it it worth the risk considering the person in question could potently leave orphans behind?

The person above mentioned very realistic risk of rapture. There is simply no ambulance fast enough to deal with it.

and it is true about the hospital,  you can refuse every treatment.

[ursusarctos]

RubyLu, I'm in the same DDC as you! I remember your post about GD. I don't really have anything great to add but just wanted to ditto everyone else here who has said that it really depends on if you feel like UC is really the right choice, in the positive sense of really wanting to and feeling good about it, not the negative sense of doing it only because you feel like there is no other choice. I personally chose not to UC after going through that process. When you get the strong urge to UC, I think it's something you really need to deeply look into and explore for yourself (What would be the logistics of UCing? Why do I really want to UC? What are the risks of going to the hospital vs. UCing? What would I do in an emergency? Am I comfortable dealing with one? Am I comfortable accepting full responsibility for the entire birth and its results, even if they are negative?). In the end, even if you decide to go to the hospital, you will have more peace with it because you will have considered all the options and you will know what you *really* feel is right (not necessarily the nicest option, but the *right* option for you).  

I also wanted to give you my sympathy on the situation you are finding yourself in. I think that given the whole situation the interventions they want to force on you are just absurd, as is transferring you to a high-risk OB (who will want to do the exact same interventions!) if you refuse them. This is a prime example of why the hospital system (or perhaps the malpractice insurance system) needs to be reformed.

Alenushka, I can see that you are concerned about the OP. I think you can relax in this case - she doesn't really have GD as far as I can gather (issues with meds most likely skewed the results, her practitioners refused a re-test, and as she detailed in her post, her other blood sugar monitoring has shown better than normal blood sugar control). It's true that there are slight increased risks with a VBAC, but for example pitocin increases the rate of uterine rupture and is contraindicated in the case of VBAC - so the "treatment" (induction at 40 weeks) the CP is proposing actually increases the risk in itself. And they are proposing it in response to a bogus GD diagnosis in the first place. This is really a case of the practitioners making things way higher risk than they have to be (I'm not saying that's always what happens!) - because they are looking at a couple of numbers, and not the patient's actual condition, and blindly following policy, rather than trying to work with the patient.

And, really, while I understand you are trying to make the point that sometimes medical interventions are necessary (I don't think anyone here would disagree with that, by the way), having a stroke because you refused to control your blood pressure or sugar has absolutely nothing to do with deciding to have a UBAC or not. I could understand the example if the OP had said something like "I have rampant GD but I refuse to stop guzzling sugar, and I also want a UBAC," but she didn't.

You will note also, I hope, that nobody here is saying "whoohoo go mama, have a UC and no worries!" - we are encouraging her to make her own decision with her own good sense and intuition about what is right.

[MittensKittens]

Hi and welcome! 

So, your main concern is additional interventions for something you don't think you have (GD)? Seems like you have quite a few options - 

1. Stay with your current doc and accept all the interventions you think are unnecessary. 

2. Refuse the proposed interventions and be signed over to high risk OB care. 

3. Refuse interventions and skip medical prenatal care from there on, UC-ing. 

4. Getting a second opinion and redoing the GD test, hopefully resulting in a confirmed negative result, allowing you to stay with your doc without the interventions. 

In your situation, I'd at least like another glucose test to totally exclude GD for myself before UC-ing, and prenatal care would be important to me as well (not as frequent as your doc suggests though). I do think there are wrong reasons to choose UC (mother on drugs, wants to avoid CPS), but this is not one of them. However, you have quite a few options. Don't choose UC unless you really do feel comfortable with it and are prepared, mentally and practically. How far along are you?

[RubyLu]

I really appreciate all the responses! I'm 34 weeks as of yesterday, so I've got a lot of big decisions to make in a short amount of time (which is part of my stress).

Originally Posted by ursusarctos 

 I could understand the example if the OP had said something like "I have rampant GD but I refuse to stop guzzling sugar, and I also want a UBAC," but she didn't.

Hah! Okay, I admit this made me snort/laugh. But you're right on. I was diagnosed with GD, but in the end the diagnosis is based on just 3 little points and every subsequent follow-up (the A1C and the daily blood sugar testing) has all been better than ideal (even without change to my regular diet/exercise). My weight gain and measurements have also been right on. The interventions required of me by my PCP's office have everything to do with protocol/routine/fear of the general practitioner losing rights at the hospital and less to do with my personal health situation. And the interventions themselves have risks (like how easily they may lead to a recommended induction, which I simply cannot believe is still on the table with my prior c-section history, but it is. ::Sigh::) My c-section used a horizontal cut (the only kind which would have allowed my current PCP to see me in the first place). I'm not unaware of the risks of rupture nor of shoulder distocia. Nevertheless I do believe that my body is healthy and able to successfully birth my baby. It's my mind I'm more worried about---being coerced (I understand that a laboring woman is especially susceptible to direction). I will have my spouse and doula with me, however.

I think as of this morning I'm prepared to refuse the ultrasounds and non-stress tests my PCP's clinic requires of me. Which means a transfer from her care. Whether I'll see the surgeons/OBs for the rest of my prenatal care or check my measurements, BP, etc., at home I'm not sure. Either way, I could UC or head to the hospital when in labor. Regardless of what I decide for the birth, I will continue to monitor my blood sugar in the meantime (I filled a Rx for strips and lancets that will last me several weeks beyond the EDD) so I have a heads-up if something changes for the worse (at which point I would reach out to the MDs, certainly).  

It's been helpful to "talk" this through with you all, thank you. When I focus on my heart, I am not certain that I'm truly called to UC at this time (not in the way I feel called to homebirth with a midwife). Perhaps I would be able to develop my feelings more one way or the other if I meet with one of the OBs at the hospital and get a feel for how it'll be, working with them. 

[DirtyHippyMama]

i wanted to add a few things...

fwiw, i was also diagnosed with GD when pg with my twins...for failing the 1hr test by 5 measly little points -- they didn't even bother with the 3hr test.    it was frustrating, because it compounded my "high risk" factors (twins alone makes one "high risk").  it was easily controlled with diet (when i cheated my sugars went up, but never above ~150 anyway), and my babies were NOT big (4'10 and 5'10 at 36 weeks).  they did have low blood sugar after birth, but i believe that was aggravated by hospital routine (being separated from me), and also they were sleepy (being preemies) and didn't want to nurse very often.  all my other numbers remained in safe parameters throughout my pgcy, so i really don't think my "GD" was much of an issue.  sounds like your case is very similar.

also, i'm glad to hear your scar is horizontal.  that makes it MUCH less risky than vertical -- but you already knew that. 

and, i was like when i read that they would induce.  that is WIDELY KNOWN to increase the risk of rupture.  i would definitely refuse that if it comes down to it.

[zoebird]

i'm glad you were able to "talk" it out, and really come to a clear sense about the GD, and that you may be transferred from care because of it. I would be clear with the doctor as to WHY you were refusing -- that you don't think that you have GD  based on one test, when you have plenty of information to the contrary from other, equally good or even better tests. Your care provider may be willing to redo the test and therefore not transfer you.

if you are transferred, you are right -- you have options. one is that you may like the doctor a lot, and that doctor may be quite open about vbac's. my one client's OB was very much open to VBACs, even though she ultimately chose to have a second c-section. he's one of the few in the area, and he was happy for her to go that route with many women. :) another is that the doctor will be not open to it, and you could go for concurrent care and make the decision on the go. just so many options. :) UC being one of many, but I also support you if you don't feel safe, comfortable, and fully on board with it. you need to be.