Planned Delivery (Induction) Due To Hospital Staff Schedules - Mothering Forums

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#1 of 32 Old 08-18-2011, 04:05 PM - Thread Starter
 
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I am new to this sub forum, I have posted in the "I'm pregnant" forum but never in my due date club. I am due November 22, 2011 and at my 19 week scan they found a mass in our baby's chest (bronchopulmonary sequestration), which is a lung malformation that often causes problems in utero and sometimes, if they don't resolve on their own before birth, may be recommended to be removed surgically after birth. 

 

We have had multiple ultrasounds so far, and just today we got some good news that the mass has shrunk a bit. (yay!) If it doesn't greatly shrink by birth, it is unknown if baby will be born under respiratory distress or not. In that case, I think they would perform the surgery to remove it right then. In many cases, however, these things shrink up and go away on their own.

 

Anyway, it's still too far off to decide what will happen, but the doctors say we should consult with the pediatric surgeon at our next appt in 2 weeks and in any case, plan on having a "planned delivery". The reason for the induction, wouldn't be because it is medically necessary to the baby, but because they wouldn't want me to go into labor in the middle of the night or on a weekend when a potential surgeon might not be working.

 

I have dreamt about an all natural VBAC ever since I found out about this pregnancy, and it is literally tearing me apart thinking that I may be induced! I am scared out of my mind of regular labor, as I have never experienced contractions due to my prior C Section....which I 100% believe was due to unnecessary pitocin induction and an epidural.....but pitocin contraction REALLY scare me. And I know they are not good for baby. This time around, I wanted to do it right. I couldn't even breastfeed last time because my body was so messed up from the section and my milk never came in like it should have. 

 

I need some insight here. What would you do if this were your situation? I know whatever is best for baby is ultimately what I will do, BUT.....a gentle, all natural drug free labor and birth is always best case scenario for mom and baby when possible. And in my case, it totally is possible...it's hospital schedules that are getting in the way. 

 

What should I do?


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#2 of 32 Old 08-18-2011, 04:27 PM
 
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So they don't just call in the surgeons if they need them? Is there a particular reason that you want one surgeon over another? I didn't realize that surgeons got 9-5 shifts.

 

This sounds like such a tough thing to deal with during your pregnancy, but also like there's a good liklihood that the baby will be looking a lot better in a couple months.

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#3 of 32 Old 08-18-2011, 04:28 PM
 
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Tell them it's not medically necessary and it goes against what you believe is right. There's GOT to be a pediatric surgeon on call anyhow, I'm sure. They just don't want to wait around for a regular labor. hug2.gif I hope you can get the delivery you want and that the mass shrinks and that they don't have to cut your precious baby open!

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#4 of 32 Old 08-18-2011, 04:48 PM
 
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I haven't been in your exact shoes, although I researched induction a fair amount during my last pregnancy when my doctor recommended it for reasons I thought were not valid.

 

Could you compromise and "schedule" the induction, but take into account how ready your body is? Is there any way the surgeon or a backup surgeon could be "on call" during the weekends during the last few weeks of your pregnancy? Theoretically you could have a super fast labor, but more likely you'd be able to give a few hours notice for the surgeon to get there. Keep brainstorming with  your doctor and let him know what is important to you. You might have to be induced, but maybe you can work out some of the details in your favor! Hope it goes well!


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#5 of 32 Old 08-18-2011, 04:59 PM
 
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I just want to say, this is going to come from a purely medical standpoint, and not from an emotional one...but...

 

Certain docs specialize in certain things.  A pediatric surgeon can be anybody who operated on peds, or it can be somebody who works in peds but SPECIALIZES in something else (like cardio-thoracic surgery).  The person with the specialty is far more qualified than just any peds surgeon.  With that in mind, they have a rotation to stick to...and they cant change schedules just for one patient.  While we all might feel like we/our babies are worth it, changing the on-call schedule for ONE patient would lead to a landslide of scheduling problems and open the door for that kind of thing to happen even in less critical cases- you just cant tell one mom her baby is worth changing the entire departments schedule for, and tell another mom her baby is not. So while there is always a peds surgeon on call, the most qualified person might not always be that surgeon.

 

Do they intend on scheduling you with the person most qualified for this surgery, or just anyone?  I can, in this case, see why they would want to "plan" this babies birth.

 

 

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#6 of 32 Old 08-18-2011, 05:07 PM
 
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Okay, here's my advice:

 

First, try to be calm and not think of the worst case right now. It seems like the reason for the induction is so that a particular surgeon will be available, is that right? I'm assuming you and your doctor would prefer the surgeon you will consult with rather than just whoever is on call. That makes sense... you would want someone you feel comfortable with when it's something this important. 

 

So I suggest going to the consult with the pediatric surgeon and discussing with him/her what their potential schedule is. They may be willing to be on call and come in when necessary. That would solve the problem there. If not, see what your options are. 

 

BananaBreadGirl has some good ideas. You may be able to plan some of the induction to make the environment more like what you want. My best friend was induced a few months ago. She also had an epidural to deal with the stronger contractions. But she ended up totally happy with her birth and how it went.

 

This situation with a baby potentially needing surgery, for me personally I would feel like the induction was justified. But again, explore all your options. hug2.gif


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#7 of 32 Old 08-18-2011, 05:46 PM
 
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Oh, I pray that mass just shrinks itself away!

Is there only one "potential surgeon" who specializes in this type of surgery?  If it's something that most surgeons in the hospital can preform, I would be surprised if not one of them was on-call for nights and weekends. It just seems so icky to me that they expect you to go through a medically unnecessary induction for the sake of the surgeon's schedule. Emergency, on-call situations are part of the job, and they should have been taught that in med school. Sure it sucks to be called in the middle of the night, but it's their job and hopefully they have the heart big enough to suck it up and go when needed.  

 

Sorry, it just really bugs me.  My sister started bleeding badly at 2am on a Sunday (a week before her due date) and went straight to the hospital.  None of the nurses that night seemed to understand or agree with my mom (veteran OB RN) that my sister was bleeding quite a lot and so they hesitated to call the surgeon in before her 6:00am shift start.  They were finally convinced to call in the surgeon, because my sister's Midwife got there and noted the huge amount of blood loss.  An emergency c-section was in fact needed and performed by 4:00am.  Turned out my sister had placenta abruption and the blood was, consequently, the baby's oxygen source.  (They're both perfectly fine now, thank God.)

 

It might be worth it to set up a face-to-face meeting with the potential surgeon(s) to discuss how important a spontaneous labor is to you.  There's got to be a way to coordinate with the surgeon that there will be a 24+/- hr window in which natural, active labor will fall into.  That surgeon can be given a heads up when you begin active labor (s)he can be better prepared to get in there when birth is imminent.  You shouldn't have to bend your very rightful desires to birth naturally simply for the surgeon's convenience.  That's just not right.  You are the consumer.  You (your insurance) are paying them to help you and your baby.  You have a say in your treatment, especially if the labor itself is considered safe.

 

I hope everything goes well for you and your little one! 


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#8 of 32 Old 08-18-2011, 10:00 PM
 
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First I would like to point out that if they brought you in to induce you, they would know that your baby would be born within 24 hours, but they would not know exactly when the baby would be born.  It might only be a few hrs, or maybe 24, and the doc that you want may not even be working that whole time.  There is always an on call surgeon, and if the on call surgeon is not fully qualified and competant to perform a certain surgery, they will not do it!  They will get someone in who can!  Like you said, it is their job.  And yes, YOU are the consumer, you are paying them to provide you with a service, just as if you were paying someone to mow your lawn.

I guess another bad thing about inductions, which you prob already know, is that due dates are not always exact.  I had a friend who's OB was going to be out of town on her due date, so she convinced my friend to be induced 1 week early so that that Dr could deliver her baby and not another Dr(my friend did not like her other options for Drs).  Her baby ended up being 3 weeks early instead of 1.  He had an aweful time breathing and BFing and was in the NICU for 4 days after delivery, they said he would have been fine if he would have been in there a few more weeks.

Anyway, I would let myself go into natural labor and make the on call surgeon come in:)  A hospital protects themselves well, they are all about liability!  They are not going to be dumb enough to let someone who does not know how to do a surgery try it!   I mean a hospital routinely puts antibiotic drops in a babys eyes to protect against them getting gonnorhea and clamydia even if the mom is perfectly healthy(and if you dont sign a waiver they just do it without your permission!) and has never had those things in her life.  Why do they do that?  Liability.  They figure there is always a tiny little chance that there is something they could have missed so they do it just to be safe so that no moms are coming back and saying "you didnt do this and now look at my baby".  Its ridiculous actually, but it just convinces me even more that with something major they will not allow just anyone to do it.

 

You said earlier that you are terrified of natural contractions?  I recommend Ina Mays Guide to Childbirth.  It will tell you a lot about your body and give you confidance in your body and that your body knows what it is doing and you can handle it and it will help you with ways of handling it.  Congratulations on your pregnancy and I admire you for looking into things and being so concerned about your baby and your birth experience!  You are smart too do your research!  Ina May also talks a lot about inductions and provides lots of info on that, it has really helped me with this pregnancy, and this is my second, I sooo very much wish I would have read it with my first!!

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#9 of 32 Old 08-18-2011, 10:22 PM
 
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If this procedure requires a surgeon with specific skills, it is posibale that he is quiet busy with other cases during the day and is not on call at night. Or perhaps, because he is busy, the minimizing using him at night. Doctors can't operate 24/7

 

Sometime there is no substitute for someone's specific expertise.

 

Also, it is not only the doctor who is needed in OR. Perhaps there are other requirements that make surgery safer during the day.

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#10 of 32 Old 08-19-2011, 08:29 AM - Thread Starter
 
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I am not sure if a specific doctor is needed for this surgery or not. I haven't talked to surgeons yet. Something I still need to do. As another poster suggested, (and I hadn't even thought of this) what if we have my due date wrong and they take the baby too early thinking he is ready, and he's not, and he has lung problems? Respiratory problems are the exact issue we are trying to avoid. That really scares me.


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#11 of 32 Old 08-19-2011, 08:36 AM
 
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Excellent points. 
 

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Originally Posted by Alenushka View Post

If this procedure requires a surgeon with specific skills, it is posibale that he is quiet busy with other cases during the day and is not on call at night. Or perhaps, because he is busy, the minimizing using him at night. Doctors can't operate 24/7

 

Sometime there is no substitute for someone's specific expertise.

 

Also, it is not only the doctor who is needed in OR. Perhaps there are other requirements that make surgery safer during the day.



 


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#12 of 32 Old 08-19-2011, 08:40 AM
 
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How sure are you about when you conceived? You said you've had several ultrasounds... how is your baby measuring at these? Is is consistent? On target? If you have to be induced, you could try to insist on waiting until you are 40 weeks. 
 

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I am not sure if a specific doctor is needed for this surgery or not. I haven't talked to surgeons yet. Something I still need to do. As another poster suggested, (and I hadn't even thought of this) what if we have my due date wrong and they take the baby too early thinking he is ready, and he's not, and he has lung problems? Respiratory problems are the exact issue we are trying to avoid. That really scares me.



 


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#13 of 32 Old 08-19-2011, 08:51 AM - Thread Starter
 
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Pretty sure I am right about conception. Docs say baby is measuring like he should for my due date. If I do end up needing to be induced for one reason or another, what are my induction options? Are there different kinds of induction meds that are better and safer than others? 


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#14 of 32 Old 08-19-2011, 09:00 AM
 
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Unfortunately, I don't know much about that. But if it turns out that is what you need, I bet there are a lot of moms on here who do. Probably posting in the general pregnancy area would help. I know there are plenty of moms on MDC who have had to be induced/ managed/ have c-sections for legitimate reasons and can give advice on your options and how to make it the experience you want.

 

Hoping for you that things turn out the way you want them and you don't need to be induced. I'm sure you'll know a lot more after the consult with the ped. surgeon. 
 

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Pretty sure I am right about conception. Docs say baby is measuring like he should for my due date. If I do end up needing to be induced for one reason or another, what are my induction options? Are there different kinds of induction meds that are better and safer than others? 



 


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Pretty sure I am right about conception. Docs say baby is measuring like he should for my due date. If I do end up needing to be induced for one reason or another, what are my induction options? Are there different kinds of induction meds that are better and safer than others? 

Please read Ina Mays Guide to Childbirth, she goes through all the induction options and the risks that they carry, etc.  You will feel so much better with all of that knowledge

 

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#16 of 32 Old 08-20-2011, 09:34 AM
 
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 Are there different kinds of induction meds that are better and safer than others? 


YES!!  Definitely do your research if this is what it comes to.  There are some meds that are still given and are not yet banned despite the fact that they have caused severe problems including death.  The one that comes to mind immediately is Cytotec, featured in the movie "Pregnant in America" (the drug is not intended for labor induction, but has been used this way for years).  Here is some information on Cytotec: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684033/.   But there are risks to almost all (if not all) induction techniques, so looking into some studies and hearing some experiences would be your best bet to start a dialogue with your doctor and find the best method for you.

 


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#17 of 32 Old 08-21-2011, 10:10 PM
 
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YES!!  Definitely do your research if this is what it comes to.  There are some meds that are still given and are not yet banned despite the fact that they have caused severe problems including death.  The one that comes to mind immediately is Cytotec, featured in the movie "Pregnant in America" (the drug is not intended for labor induction, but has been used this way for years).  Here is some information on Cytotec: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684033/.   But there are risks to almost all (if not all) induction techniques, so looking into some studies and hearing some experiences would be your best bet to start a dialogue with your doctor and find the best method for you.

 

Cytotec is waht came to my mind immediatly as well and is discussed in the book I recommended.  I guess one thing that concerns me about ALL inductions is that you automatically have a higher risk of getting a c section.  My mom was induced with her second pregnancy and she said that the contractions are different than with natural labor, mainly they are much more intense and painful towards the end especially.  She had refused pain meds with her first but she said the pain was so severe with the induction that she ended up getting a little Demerol even tho she was so passionate about wanting to go all natural, if you can even consider an induction as such.  I have also heard other people say and read that induced contractions can be more severe which is one reason that the risk of uterine rupture is greater- your body is not controlling the intensity of the contractions, a synthetic drug is, and you dont really know how your body will respond to this.

Also be aware that in a hospital birth even if you go into labor naturally they will likely hook you up to an IV which sometimes you can refuse other times it is policy, but try!:)  Anyway, be aware that they will tell you at first that they are putting a saline solution into you, but they often switch it to pitocin without asking/telling you during the birth or shortly after to help with delivery of the placenta and to help avoid hemmorhage.  So, let them know ahead of time(if you go into natural labor) that if you do have an IV that you ONLY want saline in it, NO pitocin!!   Especially if you breastfeed immediatly and eat a diet with vitamin K(leafy greens!) I feel it is so pointless.

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I think everyone here has given great advice already, but I do want to echo what Ilove4ever said about induction and not knowing how long it will take.  The thing is, they could induce you and then just end up having to c-section so that the surgeon is still there.  Personally, I would be happy to have a healthy baby BUT I would always wonder "what if" I had gone into labor naturally and delivered on my own during the surgeon's shift anyway?  You know?  I think this is a very personal decision and everyone here has given you much food for thought already.  I hope that the mass shrinks and baby does not need surgery!

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#19 of 32 Old 08-22-2011, 10:48 AM
 
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You said you wanted a VBAC - my understanding is that do not induce when Mom has had a previous c-section. At least that seems to be the blanket policy in the US. Induction apparently increases the chances of uterine rupture, and is not generally done in women with a uterine scar, so I would definitely ask. Scheduling birth in this case may end up meaning a guaranteed repeat c-section.


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You said you wanted a VBAC - my understanding is that do not induce when Mom has had a previous c-section. At least that seems to be the blanket policy in the US. Induction apparently increases the chances of uterine rupture, and is not generally done in women with a uterine scar, so I would definitely ask. Scheduling birth in this case may end up meaning a guaranteed repeat c-section.



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#21 of 32 Old 08-22-2011, 10:26 PM
 
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You said you wanted a VBAC - my understanding is that do not induce when Mom has had a previous c-section. At least that seems to be the blanket policy in the US. Induction apparently increases the chances of uterine rupture, and is not generally done in women with a uterine scar, so I would definitely ask. Scheduling birth in this case may end up meaning a guaranteed repeat c-section.

I did not even think about the fact that this would be a VBAC, so this is correct!  Induction in even a first time mom increases the risk of uterine rupture because like I said before, your body is not in control of the contractions, a drug is.  Your body knows what to do, and it knows how to do it on its own, naturally, but the drug can cause the contractions to be too strong and cause rupture.  I would guess that if you chose induction it would pretty much mean c-section

 

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#22 of 32 Old 08-24-2011, 12:15 AM
 
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I am in the middle of watching Pregnant in America on Hulu for free, I am so excited to see it on there.  Here is the link for anyone who;s interested!  http://www.hulu.com/watch/235715/pregnant-in-america 

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#23 of 32 Old 08-24-2011, 02:07 PM
 
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It's on Netflix streaming as well!


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#24 of 32 Old 08-25-2011, 12:07 AM
 
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The Business of Being Born is free on Youtube as well:)  I bought the movie and am waiting for it to be delivered from Amazon because it was cheap.  Netflix costs money right?  I have never really looked into it lol.

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#25 of 32 Old 08-25-2011, 06:18 AM
 
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Netflix does cost, but it's not much for what you get... if you regularly watch movies, that is!


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#26 of 32 Old 08-25-2011, 07:06 AM
 
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Both are awesome movies, and I recently learned that Rikki Lake is making a follow-up film.  I heard Pink may appear in it (planned natural birth-turned unplanned csec for stubborn breech).

 

I am an unnecessary csec mama x2.  I wanted a VBAC so badly the 2nd time, but a few hrs into labor an OB I had never met b4 walked into my room with a police officer and a CPS worker and I was in surgery within the hr.  I HATE unnecessary c-birth...

 

That said, in the shoes of the OP, I would wait until 40 wks and plan a calm, unrushed ERC, with the ped surgeon in the OR, JIC.

 

Best wishes to you mama.  You are a wonderful advocate for your babe, and I hope all goes well for you both!

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#27 of 32 Old 08-25-2011, 01:26 PM - Thread Starter
 
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I am an unnecessary csec mama x2.  I wanted a VBAC so badly the 2nd time, but a few hrs into labor an OB I had never met b4 walked into my room with a police officer and a CPS worker and I was in surgery within the hr.  I HATE unnecessary c-birth...

 

 

Oh my! Why was there a police officer and a CPS worker forcing you to have a C Section?
 

 


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#28 of 32 Old 08-25-2011, 02:12 PM
 
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I'm all for Vbac's and natural childbirth. I do think women should be allowed to have the birth they want when the circumstances allow for that. I just have to say that this may not be one of those cases. I do agree that there are often unnecessary inductions and c-sections and there are many times doctors are to blame. I certainly know and am aware of the fact that it's a whole lot easier for them to schedule for convenience and it end up being a bad birth experience. I also understand that is something you really want to avoid, especially considering you were really hoping for a VBAC. 

 

That being said, the most important outcome is a healthy baby and mother. It could very well end up that none of this is necessary, and I really, really hope that is the outcome for you. I really do. But if that's not the case... then you'd better believe I'd be fully ready and willing to take the induction and possibility of a c-section if it means my baby would have the best doctor available to care for him/her at the birth. As a previous poster said, with an induction there may not be a guarantee that you'd deliver while that surgeon was on rotation, but I would think the surgeon would be a lot more able and willing to be on-call or around for the procedure if s/he has a window of time that it will happen in. I.E. You're being induced on this day, so within that 24 hour period, there will likely be a baby. 24 hours is a lot easier to schedule around than a window of a couple of weeks. 

 

I know you don't feel like you should have to schedule your baby's birth to fit someone else's schedule, but if you need that particular surgeon then yes I do think you should be willing to bend a little to fit his/her needs as well. I wouldn't expect a whole staff to make special arrangements just on my behalf because I want a particular kind of birth experience. I think you should remain hopeful, but prepare yourself for what might not be your ideal birth experience. Again, the most important detail of this birth is to have a healthy baby at the end of it.

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Mallory. Happily married to Joe since 6/25/05. Loving my adventure with my girls, Owyn Samantha, born 3/1/09. dust.gif and Greta June, born 11/2/11  babygirl.gif

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#29 of 32 Old 08-27-2011, 02:50 PM
 
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Oh my! Why was there a police officer and a CPS worker forcing you to have a C Section?
 

 



 

BC the OB who was on call that night didn't believe in VBAC.  My options were have a vaginal birth and lose custody of my newborn or have an ERC and take him home.

 


Bring back the old MDC
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#30 of 32 Old 09-06-2011, 06:17 PM - Thread Starter
 
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OP here. Got great news today. My midwife called and said that the perinatologist approved me to have a spontaneous labor and delivery. The mass has shrunk to half its size and they said if the baby continues to do well, there will be no problem with this. They still are going to want neonatal staff present but hopefully they will allow me, my husband, and doula to privacy until the baby is coming out. 


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