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

[stayathomecristi]

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 :irked:. 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. :dropjaw 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. :irked: 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 :lol ), 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.

[jessjillbolyer]

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!

[alegna]

:hug

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

good luck!

-Angela

[stayathomecristi]

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 :irked:

[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!"

:Hug

[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.

[AnditheBee]

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!

[eleven]

The ACOG changed their guidelines in 2004. They are horrible, especially for women who have had more than one cesarean. This article (http://www.aafp.org/afp/20041001/practice.html) was the first I could find that was even close to what I was looking for.

Have you contacted ICAN (http://www.ican-online.org/)? If you have a local chapter, they may be able to provide you with care provider recommendations.

[stayathomecristi]

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 :lol

[stayathomecristi]

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!"

:Hug

Ditto--this is completely ridiculous! Hey, if I stay home I call ALL the shots. I kinda like that.

[stayathomecristi]

The ACOG changed their guidelines in 2004. They are horrible, especially for women who have had more than one cesarean. This article (http://www.aafp.org/afp/20041001/practice.html) was the first I could find that was even close to what I was looking for.

Have you contacted ICAN (http://www.ican-online.org/)? 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 :lol ).

• 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 :irked: )

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.

[Tummy]

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!

[pumpkinsmama]

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!
:yeah:

[stayathomecristi]

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 :irked: . 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.

[AnditheBee]

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." :D

[AngelaB]

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

[bobandjess99]

. 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.

[stayathomecristi]

You ought to mail them a copy marked "FYI: You obviously need these." :D


:lol :lol :lol :lol :lol :lol :lol :lol :lol :lol

Yes, I should. Maybe I'll just bring one to my next appointment if I keep it!

[jessjillbolyer]

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!!

[stayathomecristi]

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...

[stayathomecristi]

They have only the power YOU CHOOSE to GIVE them.

That's it.

Best wishes.

Thanks for the hugs. I know you are right--to a point. I have refused plenty of medical advice and procedures in my short life, but I also know that stuff happens sometimes. Just ask the moms on this board who have been wheeled into the OR for no good reason and without permission, told they didn't have a choice about a c-section.

Talk to the ones who refused certain things (like vaccinations for their newborns) and their wishes were not respected. Some of those kids were given shots secretly, intentionally going against the parents wishes. Some parents have been forced by coercion or by court order to allow certain procedures for their children.

I had one close call when I showed up in labor with dc #3. We had scheduled a section for Monday and I went into labor on Friday. Even though I was in decent labor, they wouldn't "let" me continue. I finally agreed to the section b/c of the scare tactics that were presented to me, but as I was being wheeled down to the OR, then doctor shoved a paper in front of me to sign. Thankfully I had the wherewithall to ask what it was because it was a consent form for a tubal ligation. He figured while he was in there he would just "take care of that for me". Had I not asked, I wouldn't be having this baby right now.

So, you can see that my fears are real. Yes, technically I can refuse anything at all, but you just never know when a doctor god is going to push the envelope.

The other thing that is disturbing about my m/w visit is that she told me that a lot just depends on which doctor is on at the time. These are things I need ironed out ahead of time. I need to know that I'm not going to get an argument about the tub. I want in my file that there is an understanding about that. I need to know that I'm going to have a safe place without people nagging me constantly about this or that. Seems like she wants to leave it to chance.

Anyway, it will work out one way or another. I've been talking with dh about possible h/b. He's scared to death! :lol But, that's another post!

[aprilushka]

Where exactly are you in Central VA? It is true you may have trouble finding CNMs to attend an HBAC but there are plenty of CPMs in VA who can do it. I know of one in Gainsville (that might still be far from you) and I think there's a few in Richmond. PM me your exact location and I may be able to ask my mw to give you some names to try. I'm planning an HBAC in northern VA with a soon to be CPM and we have had a lot of successful HBACs with CPMs or DEMs working to be CPMs here. Unfortunately here CNMs are pretty limited (but the Virginia Friends of Midwives is trying to work on that with new legislation) in what they can do b/c of legal requirement of doctor collaboration.

[stayathomecristi]

April--I'm even having trouble finding m/w's for a hospital birth! One practice is going down from 4 m/w's to 1 m/w. The docs at the hospital near me dumped their 2 midwives last summer, so there are none now that practice there. The practice I am now with has 4 m/w's but now I've been told that b/c of my history that I cannot be under their care.

I'm very frustrated right now.

[stayathomecristi]

Oops, didn't finish reading your thread :o .

I'm in Midlothian at the moment.

[aprilushka]

Then Richmond mws should be able to serve you. Yes, the CNMs in hospitals have had a hard time there recently-- there was a practice shut down last year by their OB so called partners with the excuse not enough demand.

Actually HBAC with a cpm at the present time is probably more feasible than most other routes. However, they are still underground a bit until licensing goes into full effect. I will ask my mw who is serving HBAC in Richmond. Can't help you on the hospital side I'm afraid.

[veganf]

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.

Is there a way you could come back to MA and stay with friends or something just around the time of the birth?

- Krista

[stayathomecristi]

Krista--my husband and I are seriously considering MOVING back to MA--especially because of this. Our house is under contract and I'm trying to find a way to get out of it. Will be calling a real estate attorney later today.

Drastic times require drastic measures. What is happening here is simply unacceptable. I'm glad I have the option of moving back, many moms here do not. I wish I could stick around and help to change the climate down here. It's truly hostile. I called another practice yesterday and the m/w told me point-blank that this is the way it is. If I show up at the hospital they WILL give me an hep-lock and they WILL put me on full-time monitoring and they WILL NOT allow labor in the tub. I told her that I was now considering an unassisted birth and that I thought it was really sad that I was left no options besides that. She just said, "Good luck".

Even if we do not move back, I am seriously considering staying with friends or more likely at a hotel (don't forget I have 4 other kiddos and that's a lot when you're visiting for an extended time). I would go back about 2 weeks prior to my due date and stay as long as necessary.

sigh

[bobandjess99]

Thanks for the hugs. I know you are right--to a point. I have refused plenty of medical advice and procedures in my short life, but I also know that stuff happens sometimes. Just ask the moms on this board who have been wheeled into the OR for no good reason and without permission, told they didn't have a choice about a c-section.

Talk to the ones who refused certain things (like vaccinations for their newborns) and their wishes were not respected. Some of those kids were given shots secretly, intentionally going against the parents wishes. Some parents have been forced by coercion or by court order to allow certain procedures for their children.

I had one close call when I showed up in labor with dc #3. We had scheduled a section for Monday and I went into labor on Friday. Even though I was in decent labor, they wouldn't "let" me continue. I finally agreed to the section b/c of the scare tactics that were presented to me, but as I was being wheeled down to the OR, then doctor shoved a paper in front of me to sign. Thankfully I had the wherewithall to ask what it was because it was a consent form for a tubal ligation. He figured while he was in there he would just "take care of that for me". Had I not asked, I wouldn't be having this baby right now.

So, you can see that my fears are real. Yes, technically I can refuse anything at all, but you just never know when a doctor god is going to push the envelope.

The other thing that is disturbing about my m/w visit is that she told me that a lot just depends on which doctor is on at the time. These are things I need ironed out ahead of time. I need to know that I'm not going to get an argument about the tub. I want in my file that there is an understanding about that. I need to know that I'm going to have a safe place without people nagging me constantly about this or that. Seems like she wants to leave it to chance.

Anyway, it will work out one way or another. I've been talking with dh about possible h/b. He's scared to death! :lol But, that's another post!

I totally agree with you! I KNOW that things can and often DO get "forced" on women, coercion, browbeating, threats, etc...

I would be SCARED POOPLESS to go into a hospital to have a baby...not really because of the "things" i.e. procedures, etc, because i know they would very likely NOT become an issue........but because of the horrible POWERLESS feeling..the thought that somehow, things might get to a pointt where someone might take/do/perform something to me/my baby without my consent/by court order/just as a matter of routine, etc.....The POWERLESS feeling, for me, is about the worst thing i can imagine..just thinking about it nearly makes me vomit.

BUT, CHOOSING to even go to a hospital/hire a doctor or midwife/go to a birth center/hire a homebirth midwife IS a choice!! IF you stayed at home by yourself, in your own house, no doctors/nurses/midwives would have any control over you. Now, I'm not saying you should do that...not by a long shot..I'm just saying that it is **technically** a choice....perhaps not the best choice, perhaps not even a good choice, perhaps a totally horrible choice, but it IS an option......Basically, you are in a position where you are being forced to give up your power in order to receive care you feel is necesary, and I think that is TRULY abominable. You SHOULD be able to get the care YOU CHOOSE, where you chooose, by the type of provider you choose. It is outrageous that ANY professional believes they can tell someone how/when where they are going to PROVIDE a service for them...I mean really, if you told a plumber your toilet was clogged and you wanted it snaked, and he told you he doesn't believe in snaking, he only replaces toilets and so thats what he's gonna do...would you hire him? would you PAY him to do something you don't want, and to be rude to you while he was at it? HECK NO!! Ir just kills me the way medical "professionals" treat women on this country....and for the most part, people just go along with it!!!!!

Sorry, this has turned into my little rant here......

I do hope you find someone...even if it means moving...it is wrong you do not have the options you want available to you....heck, major kudos to you for even having a VBA3C!!!!!!!!!!!

And we won't even go into the tubal consent thing.....my rant on "informed consent" could take up pages.....here, they do not allow ANY VBACS at all....and REQUIRE a tubal form at your 3rd CS..I'm a social worker with pregnant women/new parents, and have literally had women SOBBING to me about how they had dreamed of a large family, but had to get a tubal, becauSe of the (MOSTLY BOGUS) C/S they were forced into...it is HEARTBRAKING....and yes, they really do "bully" women into thinking that they HAVE to sign it...so the women do!!:angry :( ..but i will say that i am SO HAPPY you were able to have your wits about you to refuse such a thing!

Perhaps you could arrange a few week vacation at my house around your due date...my midwife does home VBACS!! :thumb

Jess

[cathicog]

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 :irked:. 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.


Welcome to VBAC in Virginia if you want to birth in the hospital. It isn't ACOG I think that sets those protocols, it is the Virginia Medical Society...has nothing to do with ACOG protocols. The docs pretty much do what they want. PM me,cuz I found a homebirth mw you might be interested in. I just had a neighbor who did a UC because she had 3 VBACs and they were talking surgery by the time she was 4 months. We gave them lots of info and videos, and they had a fine 8 lber at home after a 2 hr labor! :)

[stayathomecristi]

Bobandjess--you captured exactly what I've been feeling. POWERLESS!

I absolutely hear what you are saying about homebirth being an option. Homebirth is definitely on the table and I am looking into it--even if I do move back to MA. Heck, I didn't show up to the hospital till 5 cm last time and was laboring just fine at home. What's the point in showing up at 10cm? So someone else can take credit (and my money) for catching a baby that I can catch? Truth be told--I just wanted the jacuzzi tub :lol

You got my point completely though--women shouldn't be FORCED into having a homebirth. If they feel more comfortable in a hospital setting, so be it. They should have that option. Last time it was a bit of a comfort to me that I had the OR available should I need it. This time I feel much more confident in my ability to birth. Of course, I had a lot of confidence last time. Who would ever insist on a VBA3C that didn't?

The way women are treated regarding this issue is inconceivable. The medical profession down here (and I'm reading elsewhere) should be ashamed of themselves. Instead of working with women like me, they are choosing to be divisive. There is a grassroots movement toward homebirth and I believe that it's only going to get stronger because these docs are so full of themselves. That, and their insurance companies are paranoid about lawsuits. Instead of doing what is right for each patient (and that may be a repeat section) and looking at it individually, they are putting us all into a cookie cutter. I, for one don't appreciate it and if I stay geographically here I hope to be able to be part of the solution to the problem.

This is a real injustice!

Cathi--Can you e-mail her to me? My MDC in-box is full. Thanks!

[aprilushka]

The sad thing is Virginia is probably slightly better than average for VBAC b/c at least HBAC is an option in much of the state and there are a few doctors who will do it. Try going to NJ, or many states in the South or Oklahoma. It only gets much worse. MA is just way better about birth choices than just about any other state-- it must be a shock to go to about any other state after that.

[stayathomecristi]

Bobandjess,

I forgot to add: I'm appalled that those women you mentioned are forced into c-sections and tubal ligations. It's unbelievable that they don't do VBACs and simply don't give women options. All of us should be fully informed of the benefits and risks of any procedure--including VBAC and repeat sections. This is just not happening.

The scare-mongering continues...

And, yes, I think we should have a thread on informed consent because I know that even mamas here at MDC have experienced breeches of their rights concerning this aspect.

[stayathomecristi]

O.k. so over the weekend I put a call into the original m/w I had spoken with. I just got off the phone with her and she was very encouraging. She spoke with one of the OB's about me and I will be meeting with her in the near future. The OB told her that she wouldn't need to see me every visit, but that I could just see her once or twice during the pregnancy, and could remain under m/w care.

She did tell me that a lot depends on which attending OB is on when I am in labor as to whether or not I can go into the tub and that they generally only allow women to labor in the tub for 1 1/2-2 hours max at a time. They apparently do have telemetry monitoring (which I'm still not interested in), which would enable me to move around (no tub though). I'm still not liking the situation, but feel that I at least have an advocate right now.

She encouraged me that the baby will decide who will be there when I go in.

Thought y'all would like to hear my update.

[angelcat]

The ACOG changed their guidelines in 2004. They are horrible, especially for women who have had more than one cesarean. This article (http://www.aafp.org/afp/20041001/practice.html) was the first I could find that was even close to what I was looking for.

Have you contacted ICAN (http://www.ican-online.org/)? If you have a local chapter, they may be able to provide you with care provider recommendations.


Interesting link. I had to have c-section with my first baby, born last June. I think if I have another, I'll just schedule a c-section. I hate the recovery, but since it's safer, why risk a vbac?

[stayathomecristi]

"Interesting link. I had to have c-section with my first baby, born last June. I think if I have another, I'll just schedule a c-section. I hate the recovery, but since it's safer, why risk a vbac?"



Angelcat--I can't tell if you are being facetious or sincere. I will give you the benefit of the doubt in this case.

In the event that you believe that a repeat c-section is better/safer for you and your baby, by all means have one. VBAC only works if a mom feels strongly that it is the right path for her and her baby. I respectfully suggest that you fully inform yourself of the benefits and the risks of both repeat cesarean and VBAC before you make that decision for yourself. I think you will find that if you read enough medical journal articles, you will see that VBAC is really safer for both mom and baby.


I think that if you'd like to hash out whether VBAC or repeat c/s is safer, then we should start another thread. Many of us (pro and con) would be willing to have a discussion about it. This thread is about me--someone who has thoroughly researched the subject and was successful last time. It's about the lack of support in the medical community for what I believe is the RIGHT of women to have the birth they desire (barring complications, of course).

Some of us were truly traumatized by our cesareans. It does not sound to me that this was the case for you. If so, you are one of the lucky ones.

OH--and WELCOME to MDC!

[angelcat]

"Interesting link. I had to have c-section with my first baby, born last June. I think if I have another, I'll just schedule a c-section. I hate the recovery, but since it's safer, why risk a vbac?"



Angelcat--I can't tell if you are being facetious or sincere. I will give you the benefit of the doubt in this case.

In the event that you believe that a repeat c-section is better/safer for you and your baby, by all means have one. VBAC only works if a mom feels strongly that it is the right path for her and her baby. I respectfully suggest that you fully inform yourself of the benefits and the risks of both repeat cesarean and VBAC before you make that decision for yourself. I think you will find that if you read enough medical journal articles, you will see that VBAC is really safer for both mom and baby.


I think that if you'd like to hash out whether VBAC or repeat c/s is safer, then we should start another thread. Many of us (pro and con) would be willing to have a discussion about it. This thread is about me--someone who has thoroughly researched the subject and was successful last time. It's about the lack of support in the medical community for what I believe is the RIGHT of women to have the birth they desire (barring complications, of course).

Some of us were truly traumatized by our cesareans. It does not sound to me that this was the case for you. If so, you are one of the lucky ones.

OH--and WELCOME to MDC!


Sorry for being O/T. If I get the same dr. again, and she thinks a a vbac would be safe to try, I'd go for it. But it said in the article that it wasn't as safe as a c-section. I'd never read that before. wasn't traumatized as I was aware I might need one. But the recovery at least for me, was AWFUL! I'm still recovering almost 8 months later. But I don't care about that, it's just whatever is best for baby. That article was the first thing I've EVER read saying it was safer for baby to schedule a c-section.

[stayathomecristi]

I get it now :wink

I can tell you from my experience with 3 sections that the recovery from my VBAC was immensely better. My suggestion to you would still be to look up as much information as you can before you simply listen to what a doctor has to say about it.

[poxybat]

What's the point in showing up at 10cm? So someone else can take credit (and my money) for catching a baby that I can catch? Truth be told--I just wanted the jacuzzi tub :lol

the jacuzzi tub is so not worth it :lol
and augh i showed up at the hospital at 8 cm... was complete within 2 min and pushed the baby out in no time flat. im still a bit p.o'ed that i even agreed to go to the hospital. (dont let fearful people *into your house* during active labor) and i absolutely bristle whenever anyone asked who 'delivered' my baby. id give them that are-you-stupid?-look and say 'well i did of course'... argh!
i would have been much better off at home... especially since they borught in social workers afterwards... i agree on the powerless thing. augh


I would be SCARED POOPLESS to go into a hospital to have a baby...not really because of the "things" i.e. procedures, etc, because i know they would very likely NOT become an issue........but because of the horrible POWERLESS feeling..the thought that somehow, things might get to a pointt where someone might take/do/perform something to me/my baby without my consent/by court order/just as a matter of routine, etc.....The POWERLESS feeling, for me, is about the worst thing i can imagine..just thinking about it nearly makes me vomit.

remembering it makes me want to vomit... augh...
if you do end up in the hospital put your war face on and remain strong. i think those last few minutes in the hospital were more demanding, more stressful, more exhausting than the whole 40 hours preceding it... because i had to get my wits about me mid contraction and yell 'get your fingers out of me!' ect...
the birth climate here is hostile, to the point that i was just disgusted with even the midwives in the area(i have talked with some really beautiful women but alas they were tied down with rules-some against thier wills- about who they could and couldnt see, its sad) and after one particularly nasty incident i decided to ubac. and i probably would have gotten away with it too if it werent for those pesky kids :lol (my mom and 'friend' freaked out on me, then got me all paranoid-easy to do since i was in transition :( )

but this is just my long rantish thing to say i was in your boat and had a glorious vbac(at a banning hospital even :mischief ) and i know your birth will be wonderful. hostile environments are a PITA but were strong and inventive and a million other things too. :thumb

[amm0406]

Actually, first I have to thank you for giving me a good idea, which is to go home to my home state (Minnesota) prior to giving birth to my second so that I can deliver there. I am finding troubles here in PA just as you are in VA.

Secondly, I've been reading a lot about VBACs and how rare they are nowadays in hospitals. So many hospitals are denying them, OBs and midwives aren't performing them, Birth Centers refuse to do them... and that leaves many, many women who desire VBACs to turn to HBACs. I read an article that said that it is going to take a catastrophic event happening to a woman during a HBAC before attention and light gets pulled onto this subject enough that VBACs are allowed again where medical intervention is available if needed. Basically, a woman is going to have to die during an HBAC many times over before it is shown how important this issue is to women. It's sad but true. :(

I really wish that the change we all are becoming would ripen the medical community without anything dire having to occur to draw light on the subject.

[bobandjess99]

[QUOTE=amm0406]. Basically, a woman is going to have to die during an HBAC many times over before it is shown how important this issue is to women. It's sad but true. :(



EXCEPT that's not gonna happen, because HBAC's are very safe and many might argue, safER than hospital VBAC's, because of the non-intervention...women aren't going to be induced at home, which is such a huge risk factor for vbacs....there is so much more, but babe just woke, I have to go, but i just had to chime in that hbac's are NOT dangerous, nor are scads of women likely to die while having them.....sheesh....

[stayathomecristi]

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? :yikes:

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..." :irked:

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 :lol.

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:thumb. We're closing on it Thursday :love. 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.

[warrior mama]

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!

[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.

[channelofpeace]

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

[TurboClaudia]

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

[amydidit]

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

"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.

[stayathomecristi]

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.

[TurboClaudia]

cristi: :bow 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. :hug mama...

~claudia

[stayathomecristi]

Thanks! :o

[Desdamona]

cristi: :bow 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. :hug mama...

~claudia

:truedat:

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" :down ) 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.

[Storm Bride]

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.

[Desdamona]

Storm Bride -- :ribces: :hug :ribces:

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!

[stayathomecristi]

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. :irked: 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.

[stayathomecristi]

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.

[annakiss]

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.

:hippie

[stayathomecristi]

:truedat:

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" :down ) 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 :lol ). 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!

[Storm Bride]

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.

[egoldber]

Just wanted to point out some inaccuracies.

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.

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.

[stayathomecristi]

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!

[egoldber]

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.

[stayathomecristi]

THANKS!

I'm sorry to hear about your UR, too and appreciate your sharing that it could go unnoticed. Did you find out b/c of the baby's heart-rate? Did you end up having to have a hysterectomy or were they able to save your uterus?

[egoldber]

I'm sorry to hear about your UR, too and appreciate your sharing that it could go unnoticed. Did you find out b/c of the baby's heart-rate? Did you end up having to have a hysterectomy or were they able to save your uterus?

I labored at home with my DH and doulas for most of my labor. I went to the hospital and was 5-6 cm, baby's heart rate was good. Hospital policy was intermittent monitoring (20 minutes per hour). Initial 20 minute monitoring looked good and I labored for an hour in the shower and felt the urge to push. I was checked and found to be complete, monitored briefly, and left to push. (The hospital staff was very respectful of my wishes and essentially left me with my DH and doulas to do our thing.) After 20-30 minutes of pushing, I was hooked up for intermittent monitoring again. Baby's heart rate was in the 60s. After her heart rate did not bounce back, I was rushed for an emergency C section.

They were able to save my uterus, and I am currently 6 weeks pregnant. They were able to rescuscitate my baby, but she was born severely hypoxic and we took her off the ventilator when she was 9 days old. And FYI, this was a major teaching hospital with 24 hour anesthesiology and neonatalogy and a level 2 NICU.

One of the reasons I did not have an epidural was so that the pain of a UR would not be masked. I had honestly never heard of painless UR, but it is real and as I said, is not an uncommon experience among women who rupture. I had no pain that I did not consider to be a normal part of labor and had no vaginal bleeding. (I also has a placental abruption along with the UR, which again is not an uncommon experience.)

Anyway, I did not mean to make this thread about me and my experience. But I did want to point out some inaccuracies.

[mamameg]

egoldber... :hug and thanks for sharing your story. I know it's "just one person's" experience, but I actually find individual stories more informative and helpful than a bunch of statistics. Not to say stats don't have their place, but I am always left wondering what exactly went down for those women who DID rupture? We are often led to believe that they all experienced the worst case scanario (death) for themselves or thier babies. And that's simply not true.

[doctorjen]

My biggest frustration with VBAC moms and the climate of practice in the US (and for what it's worth, in my particular institution it is nowhere near as hostile as it is in many places) is how the current climate of fear surrounding birth in the US influences are decision making.
I wish that every mom could be educated and make her individual decision on her own based on knowing what "facts" we have available. It's so unfortunate that the malpractice climate leads docs to feel they are in an adversarial relationship with their patients who may sue them if everything doesn't go right, so they use language with their patients designed to get them to agree to what is legally safer and defensible in a court of law.
It's also so unfortunate to me that having one intervention usually means buying in to the whole shebang. So even if a client decides they'd like to have some interventions, they often still feel like they have to refuse everything to keep from having everything done.
Of course, even with full knowledge of risks and benefits, individuals will make different choices - as they should. Only an individual can know for herself what they can feel comfortable with.