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Doesn't anybody want to VBAC where I live? - Page 2

post #21 of 31

I'm sorry if you're getting from what I'm writing that I'm judging you, I don't know you personally and I've never experienced your care, so I'm responding based on what you're writing. You asked why women would choose not to VBAC, so I responded with ways you might try to improve communication to get them to consider that. I've mentioned repeatedly that a supportive OB is hard to find and that the things you've said you do are exactly the reason I'd recommend a doctor like you to people I know. I've basically tried to explain, from a patients point of view, how some of your patients might feel based on your responses here which prompted you to respond that you can do "nothing right". I never said that you sited 50 % of patients leaving YOUR practice, I said that half of the reason women do leave ANY doctor is because of personality clashes and disdain with beside manner. I know I've done this myself. If that is not the case and you get along with your patients, wonderful, I hope you do because as I said I'd be happy to have an OB option that I could feel good about. I've used midwives with 2 of my 4 pregnancies because I have not had good experiences with OB's, but that doesn't make me feel that all of them are bad people and I have no reason to believe that you're the kind of doctor you say you are. My experiences have more to do with OB's who speak in terms of the only options being the options they see fit and the most natural birth I would be able to have would be tethered to a bed with constant fetal monitoring, no food or drink, etc so I have sought other options. That doesn't mean I believe all OB's are of the same mindset. I don't attempt to punish one person for what another has done. I'm simply responding to try to help, which was what I gathered from your original post that you wanted. Advice. 

 

I think I'll stop trying to answer your question since it seems you don't feel there is an answer other than drug use and lack of concern from your patients. Maybe that is the case and it's nothing you're doing personally, so I suppose it's something you'll have to live with no matter how frustrating. And I'm sure it is very frustrating, it must feel a lot like when I read posts from women advising others to get epis immediately and schedule their C-sections in advance. Maddening.

 

I do know that if you contact the Bradley Method organization, they might be able to pass on your offer to instructors and students in your area, and you could potentially have classes right there in your office coordinated through that instructor. There are birth centers here who do the same thing, as well as offering infant massage, lactation consulting, doulas, etc and they are highly successful. Best of luck. 

post #22 of 31

I am originally from east TN, family is still there!  If you want to offer your space for ICAN, etc, perhaps it's just a matter of reaching out to the people in your community who can make that happen.  Give the Knoxville chapter a call.  Maybe they have people coming from your neck of the woods already and would be interested in starting a local chapter.  Maybe there are childbirth educators around you or in Knoxville who would love nothing more than to add a class in your office to their schedule.  Maybe the area homebirth midwives would be interested in knowing which birth/vbac-friendly OBs they can refer clients to if needed.  Etc, etc.  I get the cultural thing, and the drug thing with that area.  But having grown up in a small town there, I also get how invaluable a great OB can be in a community like that.  Having an OB who offers good information and choice and has respect for autonomy may be a slightly novel thing.  I don't know how long you've been practicing there, but give it time.  Some folks may be slow to trust the new doc from out of town...

post #23 of 31
Thread Starter 

I made contact when I moved here 5 years ago--and my name is on their VBAC MD list---but transportation to there is too much for most people----and despite me giving their number and "mothering" and "birth solutions" and LaLeche League---the only classes given here are at the hospital--or at the health department on breast feeding--I have never had a mother take the time to go.  Like I previously said---50% will go for it---the other 50% will listen but then make it clear that a VBAC is not going to happen.  I will typically give them information and ask that they at least read about it and research it on-line--and not make a hasty decision---I will see them the next month and it is a "no-go"   So---I reiterate the risks of C. Section

 

Some women are seeking out care and are very interested in their pregnancy and up-coming birth---and those women will ask questions and you get to know each other quite well---it makes for a lovely birth---when everybody is chatting and knows each other and relaxed--and the family is involved.

 


Then there is a large faction of women (and men) who do not practice preventative health care---they go to the doctor when they are sick or they are pregnant---and really are very pragmatic---I often think of Maslow's Hierarchy of Needs---it is hard to discuss "bonding", and "birth plans"--when the mother is on a different page---she could be thinking of how she is going to pay the bills, whether her husband is going to beat her up today, how she can get help with that abscessed tooth with no medical coverage, how to feed her other children that night.........she is at "basic needs" level-- of needing food, shelter and affection--and for those lucky enough to have that and have the luxury of planning what they would like to happen for their birth experience--I think that is beyond their scope.   We keep a well-stocked fridge--and always ask if a mother has eaten today---and have had them go directly to social services for food vouchers--and we have the number and address for the local "soup kitchen" in our Rolodex.  A great deal of our time in prenatal sessions is trying to resolve a pressing need---food being a big one.

 

It would be ideal if we had a system in place much like Holland--where  the country has midwives doing home births and working in partnership with MDs--and referring the high risk---VBACs are done in a hospital by midwives---best of both worlds--and then you get ONE YEAR of paid maternity leave--here you get 6 weeks if you are lucky---many women have to go back to work after a few days simply because they don't get paid time off.

 

 FMLA may guarantee their position---but not their pay---so we have many women leaving their babies with relatives as they go back to work--entirely too early---they work right up until they go into labor.   This is the working poor---decent folks who are struggling to make ends meet---many times making too much to get Medicaid--yet facing hospital bills.   One woman made FIFTY dollars above the cut off for Medicaid--so because of that will face large bills---basically punished for working TOO MUCH!?!?!

 

Drugs ---35 % of babies spend about 2-4 weeks in hospital going through withdrawal.  Doctors and social workers--attempting to keep mother/baby unit together tried to have the baby go home on a reducing regimen that the parents (mother ) would give --but the mothers took even their baby's weaning doses, and then were calling the hospital and you could hear the baby SHRIEKING in pain in the background--so all stay in now until weaned.

 

http://www.knoxnews.com/news/2011/nov/01/where-withdrawal-starts-early-drug-addicted-to/

 

http://www.volunteertv.com/news/headlines/Tiniest_patients_face_huge_battle_drug_addiction_127554808.html

 

Pregnancy can be quite an ordeal for the mother, her baby --and the social workers, nurses and doctors involved---drug abuse is extremely difficult to overcome.   Just this week I had to transfer 3 moms out with preterm labor----2 of 3 were drug addicts and the third--a heavy smoker.  We keep NICU going!!!  Would be so nice to not need to do this. 

 

 

 

post #24 of 31

What if you stopped just doing whatever the women wanted.  When I had my first VBAC, I was never told I had the option to have a repeat c-section.  The practice I went to only did VBACs (unless medically indicated of course). All women had TOLs.  that's just the way it was.

 

Could you work your practice like that?

post #25 of 31
Thread Starter 
Quote:
Originally Posted by roadfamily6now View Post

What if you stopped just doing whatever the women wanted.  When I had my first VBAC, I was never told I had the option to have a repeat c-section.  The practice I went to only did VBACs (unless medically indicated of course). All women had TOLs.  that's just the way it was.

 

Could you work your practice like that?

Not in today's medical climate--I can't force someone to VBAC.   On the other hand I have not had a request here to do a primary C.Section ---but if I did I would have to tell them to find another doctor----bit of a difference/
 

 

post #26 of 31

I'm not suggesting you force anyone to do anything but not offer to do repeat elective c-sections. If that's what they want, they are referred to another OB.

 

Do you work alone or in a multi-OB practice?

post #27 of 31

OBDoc - You do seem to be very frustrated in your situation.  Being in the South I think maybe I can understand why some of your patients are reluctant to VBAC.  First I would I think you are probably correct about some of the women just wanting the pain meds.  It's sad, but I can totally see that.  I worked with at risk kids and from a psych point of view it make perfect sense.  The second thing you are facing is women not wanting to VBAC because their families.  In the south family is key to everything.  If you are facing negative reactions from your family it is very difficult to break away.  Plus, if anything should be wrong with baby whether it's related to VBAC or not then these women will hear for the rest of their lives how they didn't listen to their families.  The thought of future guilt is enough to motive women to just have a RCS.

 

As for education...As an educator I can you that trying to educate women and families who have no interest in learning is going to frustrate you even further.  It's like you said when people are struggling daily putting something extra on their plate is just a no go.  You also have to consider that some of these women consider themselves uneducated and don't even believe they are capable of learning or smart enough to make their own choices.

 

I'm currently in the position of having to decide on VBAC or RCS.  I had c-section for a surprise breech and up until I was 10 weeks all I wanted was a VBAC.  I drove to different doctors trying to find the most VBAC friendly one around.  I rejected one doctor because he just wanted to schedule a C-section at 39 weeks because well my chances were 50/50.   The doctor I have now says I'm one those rare candidates that's perfect for VBAC.  She encouraged me to study up on it and said the hospital where I'll be delivering is able to handle it.  The problem is that the more I think about it the less sure I am.  I labored with my breech baby and it wasn't bad.  My LD nurse said I had a high pain tolerance and ob thought I'd had and epi when I hadn't.  So, I'm not afraid of labor pain.  However, I have suffered from infertility.  It's taken me two and half years to get this baby.  I always wanted 3 kids, but I'm older than I wanted to be having kids.  Who knows how long it would take me to get pregnant again.  I know the risk of rupture is low  However,if I'm that 1% and something happens to this baby it's not like I can just get pregnant and try again.  (And no I don't think babies are replaceable).   I know there are risks with both VBAC and RCS...yet sometimes I am way more comfortable with thought of just getting another CS.  A CS my be more Risk to me, but I know the risk to the baby is way less with it.

 

I've spent countless hours working around special needs kids.  I know what going without oxygen can do.  That's what scares me about any vaginal birth.

 

So there are my thoughts.    Maybe it will give you some insight into how different women think about VBAC.

post #28 of 31

Wissa, it's funny that you mentioned that you experienced secondary infertility after your c-section, as it's one of the many untalked about complications following Cesareans. 

 

 

post #29 of 31

 

Quote:
Originally Posted by roadfamily6now View Post

Wissa, it's funny that you mentioned that you experienced secondary infertility after your c-section, as it's one of the many untalked about complications following Cesareans. 

 

 

 

I didn't get from Wissa's post that she's worried that her c-section caused her infertility, but that she has already suffered from it and is afraid of something happening to her baby during a VBAC. After suffering from infertility (before my first c-section due to breech), two losses, and complications during this pregnancy, that's exactly why I have chosen an RCS over VBAC. I've done the research and made an informed choice that I'm happy with. I think that can be just as empowering as VBAC.


Edited by alittlesandy - 4/19/12 at 10:51am
post #30 of 31

 

 

Quote:
Originally Posted by roadfamily6now View Post

Wissa, it's funny that you mentioned that you experienced secondary infertility after your c-section, as it's one of the many untalked about complications following Cesareans. 

 

 

 

I was not inferring that my c-section had anything to do my secondary infertility.  I was always afraid that I had PCOS and was relieved to have gotten pregnant easily with my 1st child.   The secondary infertility was due to many factors, none of which can be directly traced to my c-section.  

 

I know many women feel they had c-section they didn't need, but in my case it was very much needed.  If they had told me going into the OR that having a c-section would have meant I wouldn't have been able to have anymore children, I still would have had the c-section.   My DS is the sweetest, funniest, smartest little fella I know.  I would make the same choice 100 times over even if it did cause my secondary infertility.

 

 

Quote:
Originally Posted by alittlesandy View Post

I didn't get from Wissa's post that she's worried that her c-section caused her infertility, but that she has already suffered from it and is afraid of something happening to her baby during a VBAC. After suffering from infertility (before my first c-section due to breech), two losses, and complications during this pregnancy, that's exactly why I have chosen an RCS over VBAC. I've done the research and made an informed choice that I'm happy with. I think that can be just as empowering as VBAC.


alittlesandy - I'm completely with you.  I think women should have the choice to VBAC or RCS and not be judged either way.  There are many reasons a woman might choose one way or the other and only she knows the choice that she can live with in the end.  

 

Two months ago I couldn't imagine just scheduling a c-section.   However, the more I have researched it the more I might just ask to be scheduled for the c-section.  As I mentioned, I'm most likely not going have anymore children, so complications for future pregnancies is not one of my main concerns.  I went thorough infertility treatments so I could have a baby and grow my family.  My goal is a healthy baby and I will do whatever I think will get me that.  (whether it's the most pleasant or ideal way is not really that great of a concern to me)

 

 

 

post #31 of 31
Thread Starter 

A good dialogue going---and it IS interesting to see women who HAVE read articles and who have done their research choose RSC.  I had a mom the other day who was an "excellent VBAC candidate"--heck she 4 cm and in good labor when she showed up----I made another plea but she wanted her C. Section--and is home now ----  she had no regrets--and it is SHE who will remember her birth---I feel I did all I could but as you can see--there are MANY factors that make one women choose VBAC and another choose repeat CS.

 

I really think my role after I have done my best is to SUPPORT her---not to make her feel she made a mistake in choice.  As stated above--for some women--the method of delivery is not a pivotal occasion.

 

I do hope this keeps dialogue going--as lowering CS is something I aim for---but I really feel that the one thing that can lower the rate is to do everything we can to get that first baby out SAFELY----VAGINALLY so that VBAC is a much smaller piece of the pie...

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