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1st MW visit--VBAC RANT!!!!!!! UPDATE - Page 3

post #41 of 64
Thread Starter 

Another update--

O.k.--here's where I'm at right now.

I'm still with the original practice I started with, but am actively searching for a homebirth m/w who will take me on. I'm simply not comfortable with the situation as it sits right now. No one will commit to anything (i.e. "allowing" me in the tub, intermittent monitoring, no IV, food and movement at will) and they keep telling me that "it just depends on who is on when you show up". Even if one of the 2 VBAC-friendly OB's in the practice writes in my chart that I should have certain things, there is no guarantee that any of my wishes will be respected. Even worse, what if a knife-happy doc is on when I show up? :

Not only that, I need women present at my birth and 70% of the practice is male which is why I'm trying to stay in the m/w program because there are 4 women--even though one m/w has already tried to risk me out of it. I have a feeling that they are just coddling me for now and when they come to the realization that I really am going to have another VBAC, someone is going to freak out and insist that I need to be under an OB's care. "There, there--don't worry your pretty little head. Now, let's just get that operating room ready..." :

I have gone deep inside and believe that the safest place for me physically and emotionally is at home. I do have some concerns about being able to pull it off, especially if this baby is OP because I seem to always get stuck at the end. I labor fine, but delivery has been a challenge. I need to find a m/w who has lots of experience with posterior presentations (if that's even going to be an issue this time). I am very confident that if this baby is positioned correctly that I will have no problems with delivery at all and could even do it without assistance, but ideally I would like to have an extra set of hands there to check the baby between pushes and keep my husband calm .

Anyway, if anyone knows of any potential m/w's or leads to potential m/w's, please post or e-mail me. My PM box is kinda full, but you should be able to e-mail me without any trouble.

Thanks!

p.s. We've decided not to move back to MA and we just bought a house with a nice, deep, jetted tub in the master bath. We're closing on it Thursday . I am leaving the door open to going back to MA for the birth, but think I'm pretty settled on sticking it out here in my own home.
post #42 of 64
Cristi - try posting on the midwife, doula, etc forum. I got some good leads to homebirth MW (CPM's) that way. Congrats on your new home - how exciting!
post #43 of 64

To play devils advocate

Just to portray the other side of the issue... (I am an OB resident - hiss hiss, right?). Policies surrounding VBAC are complicated, and set up to protect YOU and YOUR BABY. VBAC after 1 CS is relatively low risk, and where I practice (in Canada) we do regularly encourage TOL to low risk patients. However, I don't think any birth attendant would consider a VBAC after 3 CS low risk, even if you have had a successful VBAC since - the risks of uterine rupture (approx 10% I believe) are high enough that currently it is not "recommended" to have a TOL in our institution (though not forbidden), but definitely discouraged to have a TOL outside an institution not set up to do an emergency CS within 10 mins. The chances of uterine rupture are approx 1/10 "births" - therefore, your risk with this delivery is just as high risk as your last VBAC after 3CS. Having had a successful VBAC does not make you low risk. The consequences of a uterine rupture happening at home (even if somewhat rare - which I would not consider 10% rare but that is JMO) could be life altering - death of the child or mother from hemorrhage or shock, or severe fetal hypoxia leading to permanent brain injury (ie. cerebral palsy) for the baby. So, it is sort of a russian roulette you take on your baby's and your own life if you chose to do this at home...

I am not trying to discourage you from having a VBAC, but please, for your health and safety, and the safety of your unborn baby, please consider doing it in the hospital, even if that means you are under the care of an OB rather than a MW and you may or may not be able to have a water birth (depending on the hospital). In the long run, a healthy baby and a healthy mom are more important than "the perfect birth". Please trust me, I have seen some horrible outcomes in situations similar to yours because the woman was so determined not to have a hospital birth, and though it seems like the OBs are just being jerks and trying to get you to have a repeat CS, they really are looking out for your best interest IMO. Any OB or MW who tells you NOT to worry based upon your history should not be trusted IMO - you ARE high risk.

So, this will probably cause a rant/retaliation, but just think hard before making such a major decision. In 10 years, how you had your baby will be less important than that you have a healthy baby and you are alive to enjoy him or her.

Just my 2 cents.
post #44 of 64
Quote:
Originally Posted by cav2
Just to portray the other side of the issue... (I am an OB resident - hiss hiss, right?). Policies surrounding VBAC are complicated, and set up to protect YOU and YOUR BABY. VBAC after 1 CS is relatively low risk, and where I practice (in Canada) we do regularly encourage TOL to low risk patients. However, I don't think any birth attendant would consider a VBAC after 3 CS low risk, even if you have had a successful VBAC since - the risks of uterine rupture (approx 10% I believe) are high enough that currently it is not "recommended" to have a TOL in our institution (though not forbidden), but definitely discouraged to have a TOL outside an institution not set up to do an emergency CS within 10 mins. The chances of uterine rupture are approx 1/10 "births" - therefore, your risk with this delivery is just as high risk as your last VBAC after 3CS. Having had a successful VBAC does not make you low risk. The consequences of a uterine rupture happening at home (even if somewhat rare - which I would not consider 10% rare but that is JMO) could be life altering - death of the child or mother from hemorrhage or shock, or severe fetal hypoxia leading to permanent brain injury (ie. cerebral palsy) for the baby. So, it is sort of a russian roulette you take on your baby's and your own life if you chose to do this at home...

I am not trying to discourage you from having a VBAC, but please, for your health and safety, and the safety of your unborn baby, please consider doing it in the hospital, even if that means you are under the care of an OB rather than a MW and you may or may not be able to have a water birth (depending on the hospital). In the long run, a healthy baby and a healthy mom are more important than "the perfect birth". Please trust me, I have seen some horrible outcomes in situations similar to yours because the woman was so determined not to have a hospital birth, and though it seems like the OBs are just being jerks and trying to get you to have a repeat CS, they really are looking out for your best interest IMO. Any OB or MW who tells you NOT to worry based upon your history should not be trusted IMO - you ARE high risk.

So, this will probably cause a rant/retaliation, but just think hard before making such a major decision. In 10 years, how you had your baby will be less important than that you have a healthy baby and you are alive to enjoy him or her.

Just my 2 cents.
Sincerely curious... where did you get that 10% ur rate for vba3c's? Does that include induced labors (or augmented for that matter)? I am planning a vba2c hopefully at home, so i want every available resource i can get
post #45 of 64
i am curious about those stats, too, cav2, as every stat i've seen for non-interventive, non-induced, naturally starting vbac labors indicates rupture rates of 1-3% tops. the benefit of having an out-of-hospital birth is that there is no chance of having an epidural or spinal anesthetic administered, which can reduce the laboring mother's sensation of anything "wrong" or out of the ordinary with the laboring. also keep i mind that although i would respect your expertise in all things surgical related to the female reproductive system, the training most OBs go through in the US (and most MDs, period) is very much based in symptom management and fear of the worst possible thing going wrong. whereas an OB would believe birth is inherently dangerous for all people, someone trained under the philosophy of the wide range of "normal" birth would believe that birth is different in each case, while being respectful of those few cases where a person's life is in danger.

also, cristi, you have already had one vba3c and this would be your second! you go, mama! rock on! have you posted your request to the ican list? pm me if you want more info.

~claudia
post #46 of 64

Emtala

These snips are taken from the Winter 2006 - Number 76 issue of Midwifery Today:

Quote:
"The federal Emergency Treatment and Advanced Labor Act (EMTALA) requires hopsitals to admit women in active labor and to abide by their treatment wishes until the baby and placenta are delivered."

I can't emphasize enough the importance to individuals who may find themselves in this situation of memorizing phrases such as "It's a violation of my rights under EMTALA to force me to undergo a cesarean," or "I'm invoking my right under EMTALA to refuse a, b, c." Whether the hospital in question says it bans VBACs is unimportant; according to EMTALA, you have the right to be admitted to a hospital once you're in active labor and, once admitted, you have the right to refuse any recommended treatment.

Also, it's helpful to know that EMTALA begins to apply once you are anywhere within 250 feet of a hosptial; you don't have to be in the emergency room. You can be standing in the hospital parking lot, and if they so much as touch you against your express consent, they are in violation of EMTALA. For anyone interested in reading more, we've compiled a legal primer on the rights of pregnant women at http://www.birthpolicy.org
I sincerely hope you are able to have a HBAC, but if you aren't then I thought that article might have some useful information. You can also go to http://www.emtala.com for more info about it.
post #47 of 64
Thread Starter 
Quote:
Originally Posted by cav2
Just to portray the other side of the issue... (I am an OB resident - hiss hiss, right?). Policies surrounding VBAC are complicated, and set up to protect YOU and YOUR BABY. VBAC after 1 CS is relatively low risk, and where I practice (in Canada) we do regularly encourage TOL to low risk patients. However, I don't think any birth attendant would consider a VBAC after 3 CS low risk, even if you have had a successful VBAC since - the risks of uterine rupture (approx 10% I believe) are high enough that currently it is not "recommended" to have a TOL in our institution (though not forbidden), but definitely discouraged to have a TOL outside an institution not set up to do an emergency CS within 10 mins. The chances of uterine rupture are approx 1/10 "births" - therefore, your risk with this delivery is just as high risk as your last VBAC after 3CS. Having had a successful VBAC does not make you low risk. The consequences of a uterine rupture happening at home (even if somewhat rare - which I would not consider 10% rare but that is JMO) could be life altering - death of the child or mother from hemorrhage or shock, or severe fetal hypoxia leading to permanent brain injury (ie. cerebral palsy) for the baby. So, it is sort of a russian roulette you take on your baby's and your own life if you chose to do this at home...

I am not trying to discourage you from having a VBAC, but please, for your health and safety, and the safety of your unborn baby, please consider doing it in the hospital, even if that means you are under the care of an OB rather than a MW and you may or may not be able to have a water birth (depending on the hospital). In the long run, a healthy baby and a healthy mom are more important than "the perfect birth". Please trust me, I have seen some horrible outcomes in situations similar to yours because the woman was so determined not to have a hospital birth, and though it seems like the OBs are just being jerks and trying to get you to have a repeat CS, they really are looking out for your best interest IMO. Any OB or MW who tells you NOT to worry based upon your history should not be trusted IMO - you ARE high risk.

So, this will probably cause a rant/retaliation, but just think hard before making such a major decision. In 10 years, how you had your baby will be less important than that you have a healthy baby and you are alive to enjoy him or her.

Just my 2 cents.
O.k. Cav--Let me address my concerns and we can continue this dialogue. First, I want to tell you that I respect your opinion, however, it's not as cut and dried as you make it seem.

1) You are an OB resident and that is nothing to hiss about. You undoubtedly have worked hard to get to where you are at. I hope that you will be more open-minded than most OB's are these days and actually research the benefits and risks of VBAC fully.

2) You mentioned that policies surrounding VBAC are complicated and that they are in place to protect ME and MY BABY. I respectfully disagree with you. My personal experience (and that of many other moms) is that the OB's are MORE concerned with covering their a$$es than to keep me and my baby safe. It's simply safer for THEM to cut me open, than to take a chance that something will happen during my birth. While there are some out there who are genuinely concerned with the whole person, I would argue that the vast majority are not. They figure that the woman will "get over" the section and move on with her life with a healthy baby. All is well that ends well, right? WRONG. Just ask some of the mom's here (including me) who have serious birth TRAUMA due to an unnecessary abdominal surgery. I hope that you will develop into an OB who can look at the whole woman--her physical, emotional, and spiritual needs during pregnancy and delivery and I truly hope that you will not cut a woman unnecessarily EVER.

3) I believe you are mistaken on the 10% rupture risk. I spent hours and hours pulling and reading medical journal articles. There is very little written about VBA3C, but enough IS written about VBAC in general and VBA2C to extapolate the data for MY risk of UR. Now, it's been about 2 1/2 years since I did all my research, and my memory isn't the greatest. If I remember correctly the rupture rate after one section is slightly under 1%, after 2 sections it goes up to .9%-1.2% and after 3 sections the range is between 1%-1.7%. Again, I'll have to dig out all my articles and sit down with PubMed to confirm all of this, but I can tell you that if my risk remotely resembled 10% that I wouldn't have gone for my initial VBAC!!!

4) I'm not suggesting that having had a VBA3C makes me "low risk", but there is a school of thought that once a uterus is tried by VBAC, that the risk decreases dramatically.

5) Let's define risk as well. Risk of what? I've already suggested to you that my risk of UR is relatively small. My risk of mortality and morbidity goes WAY up in a hospital setting (especially with providers who are more interested in CYA than my well-being). My risks of serious complications from surgery are there and they are greatly decreased by a vaginal delivery.

My chances of a VBAC are exactly 0% and exactly 100%. Either I will do it or I will not do it. What will increase my chances of being successful? Certainly not what some of my providers are recommending--Full-time monitoring, no food or drinks, no mobility. My chances are very much increased by not having parnoid people around me during labor, but people who will watch for signs of distress with me or my baby and act appropriately IF IT IS NEEDED. My chances are increased with every intervention that I decline. The logical conclusion then, is that if I cannot find someone who is willing to work with me (like I had last time), then I MUST take things into my own hands for the health of ME and MY BABY.

6) My birth experience is extremely important to me and I'm not going to allow someone who has unfounded fears to ruin it for me. Yes, it's horrible when a UR happens and better for it to be in an environment where someone could help me in the event that there is a problem, HOWEVER I am not going to risk another unnecessary surgery (LIKELY to happen in my current situation). I could die from that as well. We all take risks in life and I believe that mine is a calculated risk. Until healthcare providers can start REALLY listening to their patients wants and needs, then people will continue to stay at home.

BTW--there are plenty of kids who end up with hypoxia and CP BECAUSE of OB error, who, if they were left alone or at home would have a perfectly NORMAL babe.

More later, my duties call.
post #48 of 64
cristi: that was more eloquently stated than i could have written if i were the original poster of this thread and it was interrupted by a post like cav2's. you already had my utmost respect and honor and love, and now you have even more. mama...

~claudia
post #49 of 64
Thread Starter 
Thanks!
post #50 of 64
Quote:
Originally Posted by TurboClaudia
cristi: that was more eloquently stated than i could have written if i were the original poster of this thread and it was interrupted by a post like cav2's. you already had my utmost respect and honor and love, and now you have even more. mama...

~claudia


Cristi~ I too (as many of us VBACing mamas) had to jump thru many hoops to achieve my HBAC. I have just skimmed through the majority of this thread (my nursling is very interested in "helping" ) I think with these battles that we face when PG make the birth that much sweeter. I will never forget the moment that I pulled my slippery, wet, newly birthed baby to my chest in my home, in my bedroom, in the very bed he was conceived in 10 months prior... Nor giving birth to his little brother 2 ½yr later in that same room. I hope you too will get to experience this when your little one arrives in this world.

Bright Blessings to you and yours.
post #51 of 64
Quote:
Originally Posted by cav2
I am not trying to discourage you from having a VBAC, but please, for your health and safety, and the safety of your unborn baby, please consider doing it in the hospital, even if that means you are under the care of an OB rather than a MW and you may or may not be able to have a water birth (depending on the hospital). In the long run, a healthy baby and a healthy mom are more important than "the perfect birth".
A healthy mom isn't a factor here. If it were, I wouldn't have been cut last time. I'm still suffering from depression 8 months after my baby's delivery. The entire lower half of my stomach still has no feeling...except for the sore spot between my belly button and this godawful ugly scar. I'm the least healthy I've ever been, as a result of trying to look after my family, while recovering from major surgery (AGAIN!) last summer.

There is absolutely nothing more vile to me than listening to the obstetrical community talk about their concern for my health after forcing me into surgery once, and coercing me into it twice. You can bet that if I have another baby, it will be at home...because it's been forcibly (very forcibly) impressed upon me that there is no possibility of coming out of the hospital in a healthy state. Poking needles into a healthy woman's spine, cutting her belly open and forcing her baby out by violently pushing on her torso would be considered assault in any situation except this travesty of a childbirth. C-sections have become a handy weapon in the obstetrical arsenal (I'm sure you prefer to see it as a tool in the toolkit), instead of being saved for when there's actually a problem. Being pregnant isn't an illness, and doesn't require heroic measures to "cure".

I don't give a damn about a "perfect birth" - I just don't want my babies removed by surgery.
post #52 of 64
Storm Bride -- : :

I could have writen that myself after my own c/s. I *SO* know where you are coming from. I wish you healing (emotional, mental and physical), support w/ any future PG's, and a happy, healthy and safe birth AT HOME. You deserve it!
post #53 of 64
Thread Starter 

Just adding a couple more thoughts

Another thing that I wanted to point out to Cav2 (that is, if he/she ever comes back) is that while hospitals in Canada may be fine with TOL for VBAC patients, MANY hospitals here in the US are NOT. Many hospitals here do not even allow VBAC after ONE section, nevermind 3. The climate is definitely different and it's just getting worse.

In many areas of the US the section rate is approaching or exceeding 30%. I happen to live in one of these states. Are all of these surgeries necessary? I would argue that the vast majority of them are not. Birth is a natural, physiological process and should be treated as such. Yes, there are times that intervention is required, but they are much rarer than a lot of docs will admit. I am thankful that there are surgeons who can help in the event of a true emergency, but we are cutting way too many moms IMO.

BTW--do you know what the rupture rate for moms who've NEVER had a section is? My guess is that they didn't tell you that in medical school.

(In case you are wondering---it's about the same as moms who have had one section).

The point being that ANYONE can rupture--even a prima gravida. Most ruptures are partial and not life-threatening to the mom or baby. Those that are life-threatening usually present warning signs enough ahead of time to do something about it.

Which brings me to another facet that another poster brought up. I had a doctor at the hospital with my last pregnancy (VBA3C) tell me that he would feel more comfortable INDUCING me so that they could keep a better eye on me. Ummmm. : I pointed out to him that the UR rate goes up exponentially when a VBAC labor is induced or augmented. He wasn't aware of that! Needless to say, I told him that the hospital was just going to have to wait till I spontaneously went into labor and then some because I wasn't coming in at the first sign of labor.

Another thing that helps to prevent the tragedy of UR is when women do not use epidural anesthesia. Epidurals can mask the signs of UR and when I woman is able to feel all of the sensations of labor, she will most likely notice a change. Most women with uterine rupture will feel some sharp pains in the lower abdomen, very different from labor pains. At home, there is no option for epidural and most women who labor at home are very in tune with their bodies.

Doctors and midwives need to fully educate themselves about VBAC. I believe that once they look at the studies, they will feel a lot safer about "allowing" VBACs.
post #54 of 64
Thread Starter 

Storm Bride

I agree totally!!!! A perfect birth would be nice, but keeping us and our babies safe from violence is even more important. Just because a surgery has become common, doesn't mean that it's become safe (emotionally, physically or otherwise).

I'm also sorry that you've gone through the trauma and I hope that you are gently healing physically and emotionally from it.
post #55 of 64
Please note that this forum is for support and information, not to debate. Though it is appropriate to consider and discuss any risks associated with VBAC, please do so in a respectful manner and do not try to sway people away from their birthing choices with opinion.

post #56 of 64
Thread Starter 
Quote:
Originally Posted by Desdamona


Cristi~ I too (as many of us VBACing mamas) had to jump thru many hoops to achieve my HBAC. I have just skimmed through the majority of this thread (my nursling is very interested in "helping" ) I think with these battles that we face when PG make the birth that much sweeter. I will never forget the moment that I pulled my slippery, wet, newly birthed baby to my chest in my home, in my bedroom, in the very bed he was conceived in 10 months prior... Nor giving birth to his little brother 2 ½yr later in that same room. I hope you too will get to experience this when your little one arrives in this world.

Bright Blessings to you and yours.
Thank you soooo much for your encouragement! I almost cried when I read your post about your beautiful births. Yes, this is what I want (although I'm hoping to do it in the tub ). Truth is that whether I'm in the hospital or at home I'm the only one who can birth this baby. I had a wonderful hospital birth last time, no regrets, but there were things that I would have done differently at home (caught the baby myself, etc.). I did get to cut the cord myself which was wonderful.

Keep the positive thoughts coming!
post #57 of 64
stayathomecristi & Desdamona: Thank you. I'm actually doing a lot better than I was. DH is pretty sure he doesn't want any more kids, so it's looking as though that last section was my last chance to find out what birth is like. That messes me up, but I'm coping better. I think I've finally realized it's never going to go away totally, so....I enjoy the good days a lot, and try to ride out the bad ones without plunging into a full-out depression again. It's taken a lot of work, and tons of support, both here and at ICAN to get here, though.
post #58 of 64
Just wanted to point out some inaccuracies.

Quote:
Originally Posted by stayathomecristi
BTW--do you know what the rupture rate for moms who've NEVER had a section is? My guess is that they didn't tell you that in medical school.

(In case you are wondering---it's about the same as moms who have had one section).
The rupture rate for an unaugmented, non-induced VBAC is about .4% or 1 in 200. Most stats I have read indicate that the rupture rate for an unscarred uterus is about 1 in 17,000. About 1 in 10 ruptures result in the death of the baby.

Quote:
Originally Posted by stayathomecristi
Another thing that helps to prevent the tragedy of UR is when women do not use epidural anesthesia. Epidurals can mask the signs of UR and when I woman is able to feel all of the sensations of labor, she will most likely notice a change. Most women with uterine rupture will feel some sharp pains in the lower abdomen, very different from labor pains. At home, there is no option for epidural and most women who labor at home are very in tune with their bodies.
Many women who experience uterine rupture do feel pain, even through an epidural, but painless, asymptomatic (other than fetal heart rate decels) rupture is a common experience among women who have had a rupture.

I'm not making any assertions about the safety of VBA3C, just wanted to clarify a couple things.
post #59 of 64
Thread Starter 
Quote:
Originally Posted by egoldber
Just wanted to point out some inaccuracies.



The rupture rate for an unaugmented, non-induced VBAC is about .4% or 1 in 200. Most stats I have read indicate that the rupture rate for an unscarred uterus is about 1 in 17,000. About 1 in 10 ruptures result in the death of the baby.



Many women who experience uterine rupture do feel pain, even through an epidural, but painless, asymptomatic (other than fetal heart rate decels) rupture is a common experience among women who have had a rupture.

I'm not making any assertions about the safety of VBA3C, just wanted to clarify a couple things.
Beth,

Thank you for the corrections. I absolutely would not want to mislead people because a lot of moms here read these boards and rely on the information to make choices in their own situations.

Would it be possible for you to document your findings with links or references to the studies that led you to these conclusions?

I realize that I'm asking you to do something that I did not, but I sincerely want to know. I did my research about 2 1/2 years ago, so things may have changed since then as well.

Thanks!
post #60 of 64
Quote:
Originally Posted by stayathomecristi
Beth,

Thank you for the corrections. I absolutely would not want to mislead people because a lot of moms here read these boards and rely on the information to make choices in their own situations.

Would it be possible for you to document your findings with links or references to the studies that led you to these conclusions?

I realize that I'm asking you to do something that I did not, but I sincerely want to know. I did my research about 2 1/2 years ago, so things may have changed since then as well.

Thanks!
My reference for the .4% rate is the large New England Journal of Medicine article from December 2004.

The 1 in 17,000 rate I "remembered" from various places. I did a quick search a found this pdf from the AAFP that summarizes some rates and actually lists the rate of rupture in an unscarred uterus as between 1 in 8000 and 1 in 15,000, so I may have understated that, but I know I have read the 1 in 17,000 rate somewhere recently. Anyhoo, my only point was it is significantly lower than the 1 in 200 rate. The largest risk factor for a uterine rupture is previous uterine surgery, including a C-section.

www.aafp.org/afp/20020901/823.pdf

Note that this was before the 2004 NEJM study.

The observations about pain and rupture are anecdotal ones. I myself had a uterine rupture last year (unaugmented, non-induced, no epidural) and felt no pain and had no other symptoms than a low fetal heart rate. I am on a Yahoo Group for women who have suffered uterine rupture. While many women there experienced pain with their ruptures, many did not. So I am afraid I have no stats for that, only personal observations.
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