Tell me about your backup for HBAC!

[Phoebe]

I would like to know how others are handleing this. My ds was born via csection after a very long labor at home (was planned to be a homebirth), transfer for some hlep, then in the end was transverse occiput. By 52 hours I was ok with a section...if being ok with it is the word. Anyway, I would like to give HBAC a shot but I'm unsure about medical backup. With my first birth, I didn't have a backup dr. at all. I never saw anyone but my mw. She's located about an hour and 1/2 from me so her backup is not near me and she didn't have any established in my area. So, I went with the idea that the hypocratic oath insured that if I were to transfer, the dr. on call would have to help me out. That is exactly what happened and I actually was treated very well and I feel I got good care from them. I'm not sure I want to fly by the seat of my pants this time...with it being a VBAC. All the literature I read seems to say that HBAC is ok but make sure you have adequate backup...what ever that means.
I really think that the OB that delivered my son is very sweet and had said that I am eligible for VBAC but "we really don't want you to try this at home again". She was very sweet about it and not condesending at all. I don't want to go to her for back up because frankly I'll be kind of, well, embarassed (not sure if that is right word for how I feel).

So...
Do you have backup at all?

Is it backup established through your mw?

If you find backup independed of your mw, how the heck to you get a dr. to agree?

What's your story...

Amy

[AllisonK]

.

So...
Do you have backup at all?

Is it backup established through your mw?

If you find backup independed of your mw, how the heck to you get a dr. to agree?

What's your story...

Amy

I have no backup

My MW has an OB she likes to txfr to but the hosp is too far away for us to go there from my house. We will go to the closest hosp (30mins) and take whos on call. I figure the only way I am txfring is for a emergency and then I am having a c/s anyway.

I know some women just don't tell the OB they are planning a HB. I think it would really depend on the Dr. but I think that most of them would not be very supportive of being backup. ???

Allison

[AnditheBee]

In my case, I have "unwitting backups" with two OB's in one of two practices in town. Our hospital is really small, so they aren't allowed to do VBACs because of malpractice insurance (both for the docs and the hospital), nor can they be seen as having "supported" homebirth. Soooo...the only option, if I want backups, is to not tell them. They think I transferred care to a practice in a larger city to get a VBAC, and that's fine with me (and them). They could get in serious trouble if I had given them any hint of the truth, so I figure I'm protecting them and the OB care in this town, by allowing them to be deceived. I don't know if this is altruism or rationalization! :lol Since they also would have the option of dropping me as a patient if they felt I was jeopardizing their practice, and I don't want to risk going in without a doctor of record...there is an evil OB here in town, you see, and I want to avoid him at all costs...

At any rate, that was the hardest part of it all--figuring out what to say and how to say it. In the end, I actually lied, which I didn't want to do, but they kept asking questions that I couldn't get around without them figuring something was up.

If you are in a town where the docs aren't under such restrictions, I'd just ask around--casually at first, not like you know this is what you're doing, but that you're just "feeling them out." Their reactions should tell you whether or not they'd be willing to knowingly back you up. Or you could trust fate to hand you to a good doctor again, in case you do transfer. The other option is just to hide the truth while getting OB care. It sucks, but as long as insurance companies are controlling medical care, it's a sad necessity in some cases.

Chances are, you won't have to transfer, though--so your planning could be for naught--just keep that in mind! :)

[txgal]

We have a couple of different scenarios for back up. There is doctor about 45 min. away (he performed my sect.) that will support a VBAC and backs up my HB midwife. If we had a situation that was not a life threatening emergency ( like labor stalled, and just needed a little help with pit) we would go to him. If there was an emergency then we will go to the nearest hospital for a sect., with whoever is oncall since no one in my immediate area will do a VBAC.

[Phoebe]

Do any of you think there is a real big reason to get a backup dr? Either one who knows you are doing a HBAC or one who doesn't have a clue? I just wonder what the real advantage is? The books I read make it sound like there should be an ambulance on call and a Dr. waiting around for you just in case...that's the way I'm reading it. I just don't think I want to mess with back up. I'm terrible at lying and I do not like to argue. I just don't want that to be a stupid decision, to not get backup that is.

Any of you think it's STUPID? Seriously, hit me with it.

[AnditheBee]

I don't think it's stupid whatsoever! As I said, the main reason I've been keeping docs "on reserve" is to avoid getting the "evil" one in town if I do have to transfer. If you have no such problem to deal with...and your pregnancy is healthy...then why not go without? I mean, it's everyone's individual choice--there is no "right and wrong" here, but it sounds like you're wanting to lean that way. I see nothing wrong with it. :thumb

[Electra375]

I pre-registered at the hospital. That was it. Of course, my circumstances were a bit different I was 'fired' by my OB at 28wks pregnant scheduled for my 3rd c/s in 10 wks.
I figured the only way I was going to end up at the hospital and in need of a doc was in an ER and at that point the fastest doctor to get there is the doc I'd get anyway.
If I were to have another baby, I'd do the same. I would not see an OB unless my mw said I had something wrong with me or the baby and needed to address it.

[eleven]

My DD was born by cesarean after 52 hours of labor due to occiput transverse presentation, too. Cue the Twilight Zone music! :lol

I have a back up doc through my midwife. They used to work together and seem to have a supportive, respectful relationship. I met with him once to establish a relationship and he was very positive and supportive of my plans. It was a HUGE surprise, considering the negative attitude towards any VBACs, forget HBACs, round these parts.

A friend of mine has not told the practice she is seeing about her HBAC plans. The downside of that (besides not being upfront and honest) is that she's had to go to regular appointments with them throughout her pregnancy.

For me, the reason I wanted to have a back up doc is that I'd like to be able to have a more positive experience if I do need to go to the hospital or have surgery again. I felt powerless and disrespected during DD's birth. If I end up in a hospital situation, I'd like to be cared for by someone who is respectful of me and my wishes for my child. Since the back up has a professional relationship with my midwife, I know that she would be there with me and advocate for me if need be.

A lot of women do not have back up drs. It's a personal comfort thing. Go with your gut. :)

[mamameg]

I am not using any backup. I know how the hospitals around here work and you get whatever doctor is there when you show up, so it seemed pointless to me to try to establish a r-ship with a doctor who might very well not even be there when/if I show up. TRUE, the staff might be more friendly if I had established care with them and I wasn't just some HB freak coming in off the street, but my MW assured me she will interface with them as much as possible (sparing me from having to do it) and I just don't care about friendly so much. If I transfer to the hospital, it would only be for a serious medical issue and at that point, I could give a rats a$$ about how friendly anyone is to me. I am totally ready to rip into anyone who is rude to me for just showing up at their precious hospital, based on my thoughts that THEY ARE THERE TO TREAT MEDICAL EMERGENCIES, IT'S THEIR JOB!!!! But that's just me. :o :lol

[Phoebe]

I am not using any backup. I know how the hospitals around here work and you get whatever doctor is there when you show up, so it seemed pointless to me to try to establish a r-ship with a doctor who might very well not even be there when/if I show up.

That is essentially how I feel and how I felt last time. My mw did do most of the talking when we were checking in, which was the only time that they weren't really nice to me.

Gee Pease! Do do do do (thats my version of twilight zone music). I'm glad to hear someone else got a csection for the same reason as me. I always wondered if I was just a sissy or something. Dr. kept trying to manually turn the baby during contractions and I had had enough of it all. I have to remind myself that people don't have to labor nearly that long, almost 2 days med free. Doncha hope this babe is a quicky one...like 24 hours!!!

[juliema]

We didn't have any backup either. We would have just taken the doc on call if we had needed to transfer. I did see my original ob for my first appt. and I asked him about backing me up but he said he specifically signed something in his malpractice insurance that said he couldn't back up midwives so that was the end of that. Honestly, I think if you have a good midwife, the risk of transferring is very very low anyway and really, do you truly know if one ob is better at performing a c/s than another?

Oh, and eta: my first was also occiput transverse in addition to asynclitic. ;)

[txgal]

I don't think it is crazy not to have aback up, if you can't find one that is going to be supportive of what you are doing anyway. You would be just as well off taking whoever is on call in case of an emergency. In my case the OB that backs up my midwife would actually come in just for her patients and is very suportive of home birth and VBAC in general.

[mamameg]

Another thing to consider is insurance coverage. A lot of plans will cover either OB or MW care, but not both. You might have to pay one of them out of pocket, which could get pricey.

[eleven]

I have to remind myself that people don't have to labor nearly that long, almost 2 days med free. Doncha hope this babe is a quicky one...like 24 hours!!!
24 hours sounds just heavenly!! :laugh:

Oh, and eta: my first was also occiput transverse in addition to asynclitic.
:nod Asynclitic here, too. She had a nice egg above her ear after she came out.

[aprilushka]

I'm not having a back up (no one would agree openly to it) or shadow care (where you just don't mention your real plans) b/c I really don't have the time or patience to deal with the medical system at all other than the u/s we managed to get without having to use a doctor. My mw said she's had virtually no problems transferring to the closest hospital so I figure we will just deal with it. My only fear is that in a true stat emergency the ambulance will take me to the other second closest hospital which is a nightmare, but I guess I would only call an ambulance if we thought we didn't have much time, otherwise drive fast. I also figure I will be getting a c/s if we go to a hospital so I wouldn't necessarily get my back up anyway. The main risk I took on not having shadow care was not having anyone to go to in case of preterm labor or PROM as a better choice (ie, in not an emergency situation), but I decided to take my chances.

I'll just be yelling "double suture" in the or if I do end up with another surgery and, "dont' even think about tying me down" and "give me my baby right away". Assuming I don't have to be knocked out, in which case, all bets are off and I'll just be out of luck.

[Desdamona]

I didn't have formal back up with either of my HBAC's. My MW's back up (and hospital) was so far away that if we needed to transfer in an emergency I would have been going to the local hospital... And much in the fashion of the PP I would have been screaming "double suture, my baby stays with me, etc..."

I did have shadow care during my first VBAC pg until about 26 wks at which time I found that I was investing too much emotional emergy into deflecting the negativity I was getting with my hospital based MW's Vs. investing that energy into focusing in on my impending birth with my HB MW.

[perditafoster]

I had a backup OB, and boy, was I glad I did! I transferred after three days of labor and had a VBAC...all because the doc convinced me that I could do it :) When I got to the hospital at ten centimeters with a posterior baby, I begged him to section me. He was very patient and told me that after the epidural, he would try to turn her and I could push her out. Oh, and it was New Year's Eve and he wasn't the doc on call...when the nurse called him at home he remembered me and agreed to come to the hospital to deliver me. Unbelievable. Really amazing. My doc with my first dd was only one step away from Satan, so I was super-reluctant to even have a backup, but my mw insisted on it. Good thing that she did and really good thing that he was my backup. The doc on call was Satan (as opposed to only one step away :lol) and he would have sectioned me gleefully, I'm sure :lol So for me, a backup was a godsend and I'll have a hospital birth with him (and my doula) next time. I will labor at home again, but I'll go to the hospital at around six centimeters or so. Like the pp post said, a 24 hour labor would be heavenly!