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1st MW visit--VBAC RANT!!!!!!! UPDATE

post #1 of 64
Thread Starter 
O.k., I'm a little upset, no a LOT upset. I recently moved and there are very slim pickin's here for MW care. I interviewed a bunch of practices over the phone. Several said that they would not take me based on my history :. Finally, I spoke with a m/w who had her head on straight, was happy for me about my VBAC and told me that we shouldn't have a problem. She did say that some of the docs would not be happy if I chose another VBAC, but that several in the practice would be open. She said that I would have to see an OB at least once during the pregnancy, but that she'd set me up with one who would be fine with the VBAC. She also remarked about how educated I was about VBAC and the fact that I had a vaginal delivery makes me somehow different from someone who hadn't.

Just for clarification: I had 3 sections and my last baby was a VBA3C (hospital birth) in 2003. It was a beautiful birth with no interventions until the very end when I was 10 cm and she was OP. I had a ton of support, from the OB who saw me most of the pregnancy, and the m/w who was there as well as a doula and my close friend. I agreed to an epidural to "power down". Basically, that meant I would have the epidural and they would roll me from side to side till the baby turned. She did and I pushed her right out.

Fast forward to today:
I decided to make my appointment with a different m/w in the practice b/c the other office was closer to my house. So, I go in there and we talk history, I decline a vaginal exam and pap (which she told me I would HAVE to have--ummm last one was less than a year ago, never had any changes before,). She does a breast exam, we talk about diet etc. She then tells me that I cannot be under m/w care for this pregnancy. Naturally I want to know why. She said that the practice won't allow it. So, I tell her what the other m/w said and she told me that she was mistaken and that no doctor in the practice would allow me to be under m/w care.

So, then I decide to ask a few questions about hospital procedures. Figured I may as well get all the stuff up front. She told me that it's MANDATORY to have a hep-lock. I told her that I didn't like the idea, but that I would consider it as long as I could still go in the water with it. She then informed me that there would be no water because I would have to have full-time monitoring. : WHAT?! Why not? I told her that I really didn't think I could agree to that.

Then she went into ACOG "recommendations". She told me that ACOG says that hep-lock and that full-time monitoring are mandatory for a VBACs. I told her that I really did a lot of research prior to my last VBAC and that I didn't recall either of those in the recommendations and anyway, I didn't get either with my last birth and that I spent MOST of my labor in the tub where I was most comfortable. I looked up the recommendations today and only was able to find them from 1995 (maybe they changed?). In any event, it said that a woman with 2 or more c-sections should be allowed a trial of labor should she desire a VBAC and that a VBAC should be carried out only in a hospital setting that has 24 hour anesthesia. I didn't read anything about a hep-lock or full-time monitoring.

This is MY birth, I've already proven I can do it once and I fully intend to give birth vaginally again (barring an EMERGENCY). Full time monitoring is IMO setting me up for another section and that is not acceptable. I know that I can refuse things in the hospital (and often do ), but last time I had my caregivers completely on board with what I wanted for my birth. I need to save my energy for labor and delivery, not arguing with people while I'm in labor.

I can hear some of you thinking in your brains--Yes, I am considering a homebirth, but I'm also considering a hospital birth again. Not under these circumstances.

Sigh, thanks for listening.
post #2 of 64
I just wanted to say I am sorry your having a hard time with docs. I just moved to another state and have a lot less midwives out here as well. I hope you find someone that will give you the birth you want!
post #3 of 64


Sounds awful. It's getting to the point that the only choice for VBAC in many many places is homebirth.

good luck!

-Angela
post #4 of 64
Thread Starter 
Thanks ladies,

The more I think about this, the more angry I become. WTF??? This is MY body, MY birth and MY baby. I understand that people want to CYA, but is all of this even medically necessary? Full time monitoring will only lead to the OR and not letting a woman sit in a tub during labor is an abomination as far as I'm concerned. Total fear-mongering and it's not acceptable to me.

Homebirth is an option, but I'm not sure that it's going to work either. I may have to go UC because the only homebirth m/w here does VBACs only in the hospital. She is on my list to call on Monday, but I have a feeling she is going to tell me the same thing.

I will do what I have to to protect my birth experience, it's too precious to me. My body was designed to give birth and I've proven I can do it. I wish everyone would just leave me alone.

If they're like this about birth, how are they going to be about all the newborn stuff I plan on declining? I think I know the answer. There is no respect in the medical community for anything other than total compliance :
post #5 of 64
Ugh. I can relate. The VBAC climate in my area is really poor and the only option I feel comfortable with is homebirth. In fact, my response to all the "you're so brave to have your baby at home" comments is "It would take more courage for me to go to the hospital!"

post #6 of 64
it sucks. Im right there with you my friend. Im almost 29 weeks pregnant and just dumbfounded by the crap that has been spewed at me.

Its a hostile environment out there. I truly believe I could make a better case (in the md's eyes) for a nasal delivery of my baby.
post #7 of 64
Quote:
Originally Posted by stayathomecristi
Full time monitoring will only lead to the OR and not letting a woman sit in a tub during labor is an abomination as far as I'm concerned. Total fear-mongering and it's not acceptable to me.
You know, it seems to me that sitting in the tub probably takes pressure off the uterus and thus likely decreases the chances of a rupture! Plus stuff stretches better when it's warm and underwater, right? Sheesh! You'd think places that allow VBAC would make sure to have those remote monitors that you can wear underwater. You'd THINK. It's all so counterintuitive.

Hugs and luck to you, mama! I'm sure you will find a way to keep your birth the way you know it should be. I originally hired a mw who lives two counties away, so research your options for out-of-town HBAC help as well!
post #8 of 64
The ACOG changed their guidelines in 2004. They are horrible, especially for women who have had more than one cesarean. This article was the first I could find that was even close to what I was looking for.

Have you contacted ICAN? If you have a local chapter, they may be able to provide you with care provider recommendations.
post #9 of 64
Thread Starter 
Quote:
Originally Posted by saritabeth
it sucks. Im right there with you my friend. Im almost 29 weeks pregnant and just dumbfounded by the crap that has been spewed at me.

Its a hostile environment out there. I truly believe I could make a better case (in the md's eyes) for a nasal delivery of my baby.
LMAOROF!!!!!!! Can't stop laughing--even showed this one to dh
post #10 of 64
Thread Starter 
Quote:
Originally Posted by mamameg
Ugh. I can relate. The VBAC climate in my area is really poor and the only option I feel comfortable with is homebirth. In fact, my response to all the "you're so brave to have your baby at home" comments is "It would take more courage for me to go to the hospital!"

Ditto--this is completely ridiculous! Hey, if I stay home I call ALL the shots. I kinda like that.
post #11 of 64
Thread Starter 
Quote:
Originally Posted by pease
The ACOG changed their guidelines in 2004. They are horrible, especially for women who have had more than one cesarean. This article was the first I could find that was even close to what I was looking for.

Have you contacted ICAN? If you have a local chapter, they may be able to provide you with care provider recommendations.
Summary of Recommendations

The following recommendations are based on good and consistent scientific evidence (Strength of Recommendation Taxonomy [SORT] = A; see page 1201 for an explanation of SORT):

• Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.

Ummm-has anyone here actually been OFFERED a trial of labor????

• Epidural anesthesia may be used for VBAC.

No mention of the fact that epidural can increase the risk of a repeat section, but o.k.

The following recommendations are based on limited or inconsistent scientific evidence (SORT = B):

• Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.

I have nothing to add, no experience here.

• The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged.

Agreed--induction and augmentation have been shown to increase the chance of uterine rupture.

The following recommendations are based primarily on consensus and expert opinion (SORT = C):

• Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.

In the ideal world I suppose, but IRL we're not willing to risk some renegade doc who is knife happy when he finds out we've had prior section (or 3 ).

• After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.• Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery.

Discuss? You mean coerce into a repeat section, don't you? You've got to be kidding. Oh, and make sure you note the "discussion" in the medical record. In fact, you should get them to sign a waiver totally absolving the practice of any and all responsibility should something go wrong during the delivery (had one practice insist on this : )

Sorry, couldn't resist. Just summing up some of my personal experiences. I do have the number for ICAN and guess what?! One of the other midwives in the practice (the one I spoke to initially) goes to each meeting. I have a feeling she is "it" for VBAC advocates in our area.
post #12 of 64
Quote:
Originally Posted by stayathomecristi

Just for clarification: I had 3 sections and my last baby was a VBA3C (hospital birth) in 2003. It was a beautiful birth with no interventions until the very end when I was 10 cm and she was OP. I had a ton of support, from the OB who saw me most of the pregnancy, and the m/w who was there as well as a doula and my close friend. I agreed to an epidural to "power down". Basically, that meant I would have the epidural and they would roll me from side to side till the baby turned. She did and I pushed her right out.



This is MY birth, I've already proven I can do it once and I fully intend to give birth vaginally again (barring an EMERGENCY). Full time monitoring is IMO setting me up for another section and that is not acceptable.

First of all, YOU ROCK!!!

Second of all.. your right, this is YOUR birth!!! You have already proven you can birth vaginally!

Do not let your hopes down in any way... you will find that care provider you need! I wish you the best!
post #13 of 64
Quote:
Originally Posted by Tummy
First of all, YOU ROCK!!!

Second of all.. your right, this is YOUR birth!!! You have already proven you can birth vaginally!

Do not let your hopes down in any way... you will find that care provider you need! I wish you the best!
:
post #14 of 64
Thread Starter 
Thanks Tummy and Pumpkin--I needed to hear that. The way these m/w's and docs have been talking you'd think that I'm entering into some life-threatening situation that they have to save me from : . They are so completely paranoid and I'm not going to let it rub off on me. I have done my research (I bet they have done next to zero) and I feel confident in my decision to pursue another VBAC.

I have not signed papers on my house in MA and I am seriously considering backing out of the deal in order to get my support system back. It's just taken so long to get an offer on our house that wasn't $40,000 below asking price. I dunno. In all seriousness, I'm very concerned that I will not find someone compatable with me. I also know that I need support at the end of the delivery--I still have stuff to deal with. I'm not 100% sure I can pull this off as a homebirth or U/C, but I am doing some soul-searching about that.

Oh, and another thing--no where in the ACOG recommendations did I see anything remotely stating that a hep-lock and full-time monitoring were necessary. They think they are gods and I hate it b/c they have power over me in some ways.
post #15 of 64
Quote:
Originally Posted by stayathomecristi
Oh, and another thing--no where in the ACOG recommendations did I see anything remotely stating that a hep-lock and full-time monitoring were necessary. They think they are gods and I hate it b/c they have power over me in some ways.
You ought to mail them a copy marked "FYI: You obviously need these."
post #16 of 64
I had a vbac in a hospital and spent about 4 hours in the tub before i started pushing and the doll of a nurse put a monitor in the water to my tummy and most of the time i didnt even know she was doing it. She just sat there and held it in the water. She was very quite and calm and sweet. She picked up on all the cues from me and dh and let us be.
This was at a large hospital and I didnt have to have anything strapped to me. She followed my request to only be monitored twice an hour for as little time as possible.
I did the heplock, but I had it done in my forearm and was able to have it in the tub. My water had broken before I got to the hospital as well and I was able to stay in the tub until I started pushing and then the nurse encouraged me to be in any postion I wante. I seem to remember they put the heplock in while I was in the tub.

She kept everyone out unless it was a nurse setting up the room for baby procedures but I wasnt even aware that they were there.

The hospital has changed their policies since then and i will be going to a birth center with midwives and a md that works there as well.
It all can be done you just have to fight this rediculous fight. I would home birth if I could find a home birth midwife that did vbacs.
Angela
post #17 of 64
Quote:
Originally Posted by stayathomecristi
. They think they are gods and I hate it b/c they have power over me in some ways.

First of all, **hugs**

I know this is easy for someone not in a difficult situation to say, but as i grow and **hopefully**, become wiser, LOL, I am really starting to believe more and more what i am about to tell you

They have only the power YOU CHOOSE to GIVE them.

That's it.

Best wishes.
post #18 of 64
Thread Starter 
Quote:
Originally Posted by AndiB
You ought to mail them a copy marked "FYI: You obviously need these."



Yes, I should. Maybe I'll just bring one to my next appointment if I keep it!
post #19 of 64
Have you looked in other places that aren't to far of a drive like 2 hours out? I ask cause I am in La and we are real close to the Texas boarder. OR do you have realtives in another area where you could do a homebirth? I figured at the least if I can do a VBAC anywhere here I will stay in Texas my last month with family have my homebirth there. Just a thought.

I hope you can find something that is what your looking for!!
post #20 of 64
Thread Starter 
AngelaB--My last experience was similar to yours. I had free rein to do whatever I wanted and my caregivers were on board with it. Once they got a baseline strip (I think 15 mins and I was on the birthing peanut during that time), I spent most of my time in the tub. I even pushed in the tub (technically water birth is against hospital policy,but both my m/w and my OB just looked the other way). No one pushed for me to have any interventions at all, they just let me labor in peace. They all understood exactly what I wanted and needed and there was no energy expended on declining procedures and interventions (until after the babe was born and I refused the eye goop and Vitamin K, but that's another issue). We created a safe place for me to give birth, no one was there who wasn't invited and it was wonderful. Naturally, I want a repeat--it was a great birth. I even had a sign on the door that said, "VBA3C in progress, enter only with a positive attitude. No men allowed."

I moved to Central VA a couple of months ago and nothing has been easy. I've interviewed several practices over the phone and they dismissed me without even seeing me. The one that I'm with now is obviously giving me a hard time about everything I want. I talked with dh about moving back to MA and he's seriously considering it based on a bunch of things.

We'll see...
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