Advice For a Planned Cesarean with an Unsupportive OB - Mothering Forums

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#1 of 12 Old 06-13-2013, 07:43 AM - Thread Starter
 
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I know this website is not exactly the one screaming for more elective cesareans, but I also know several women here can also be more informed than other sites and can drop their ideological judgment.  So, I want to give it a shot, anyways:

 

I want to plan a cesarean for the birth of my next child.  I have several reasons for this,have researched the risks very carefully as they apply to my situation, and have extensive reasons to believe that this is also the safest and healthiest option for the baby and myself.  I am particularly sensitive to vaginal birth trauma; what one woman might accept as tolerable might terrify me.  My instincts are telling me not to attempt vaginal again birth if possible; I prepared as much as possible last time and the experience made me not want to get pregnant again.  This pregnancy was unplanned or else I would have resolved it all beforehand!

 

My current ob is not very supportive and has downplayed my concerns and reasons for wanting cesarean.  I asked him to refer me to somebody for counselling birth trauma, he didn't.  I told him I have enough pelvic floor injury, nerve damage, and perineum damage that I don't want to go through labor again; he downplayed it and said the damage was done from the first pregnancy and that my labor was not what caused the damage. This is simply not true.  I am terrified of ever having to go through a forceps delivery, having severe tearing, or having another episiotomy.  He said there is no way to promise that won't happen.  I told him if I was going to do another natural birth that I would try to do so at home, and he insisted that isn't safe (and in my case, might not be).

 

Finally he sighed and said if I wanted a c-section he didn't care as long as my insurance paid for it since it would be elective. I checked and it isn't covered.  Now I'm really worried because I'm 26 weeks pregnant and do not want to go through the added stress of either looking for a different doctor or seeing if there is a midwife where I live that thinks I'm a candidate for home birth.  Note: I am not interested in a "birthing center"; I could not possibly relax in one. If I"m not going to birth in my own home, I WANT my birth to be medicalized and controlled.  I know people who have had planned cesareans and regret is just very rare and nothing like emergency related ones.

 

I don't believe therapy for birth trauma is going to change my mind about wanting a c-section, but now my concern is that even if I pay out of pocket, I am paying a jaded and somewhat misinformed doctor to do me what honor?

 

I think it is sad that doctors are under pressure to do things based on the politics and ideologies of others, just as much as I think it's a travesty that women are coerced into emergency c-sections and needless interventions for convenience and profiteering of others.  It's the flip side of the same coin.

 

I just started crying today after getting off the phone with my insurance company.  Any non-judgmental, non-assuming  suggestions are appreciated.  I'm in west central florida and looking around.

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#2 of 12 Old 06-13-2013, 09:02 AM
 
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Demeter, I understand that it's a hassle, but I honestly think you would be best served to find a different OB.  Finding an OB who supports this choice will be less stressful over the next few months and as your baby's birthday approaches, then dealing with an OB with whom you have major philosophical disagreements.

 

Additionally, I think the insurance company refusing to cover it is too big a thing.  The billing for any surgery can be insane, you could be putting yourself and your family into debt that would take years to pay off.  I absolutely support maternal request c-section, and it sucks that your insurance company is behaving this way, but I am concerned about the finances.  If it happens that you are independently wealthy, I withdraw this point, but if not, I think it needs consideration.  I am also concerned that, given what you report your OB saying (if insurance covers it... okay) he might walk back his agreement to the operation if insurance won't cover.

 

You need an OB who'll work with you.  You say your first birth was traumatic - was there tearing or quantifiable injury that a cooperative doctor might spin to the insurance company as a medical justification for c/s? Was instrumental delivery required?  Did you hemorrhage?  What complications did you experience last time that you might argue you are medically justified in trying to avoid now?

 

A lot of doctors might be sympathetic, and explain that, at 26 weeks, there are comparatively few conditions that justify a planned surgical delivery, but, as delivery approaches, you will be able to reevaluate.  An OB who was willing to engage with you in that way could be a godsend.  An OB who is already fighting you on having surgery... not so much. 

 

I hope you are able to have a peaceful, healing birth, however it happens.

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#3 of 12 Old 06-13-2013, 09:40 AM
 
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Did you have a csection with your first birth or a vaginal birth? I would find another ob. I would not reference any of your reasons for having a csection. I would say things like "I am afraid this baby is going to be to big. or have low amniotic fluid." Ob's tend to bate women for csections I do not see why it should not work the other way around.

 

Though I think it is your choice and your reasoning and so on makes sense to have a csection a Dr will not view it that way at all. I would also try counselling anyway birth trauma can be really intense. But Drs need medical reasons for insurance to cover it.
 

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#4 of 12 Old 06-13-2013, 11:08 AM - Thread Starter
 
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Meep, thanks for the insight.  I have started looking for a new OB; very stressful but might save me a lot of trouble down the road.  

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#5 of 12 Old 06-13-2013, 11:11 AM - Thread Starter
 
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LL, I had a vaginal birth.  I don't feel that there was anything that specifically makes me a better candidate for c-section than most women; my stance has simply become that I will probably end up with one anyway because of my high stress levels about vaginal delivery, and emergency c-sections are much, much more dangerous.  I also contacted a midwife about assisted home birth to see what she has to say, to keep my mind open a little.  

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#6 of 12 Old 06-24-2013, 12:51 PM
 
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demeter 888 - It sounds like you have a real fear of Vaginal birth.  I think you should have the right to a c-section, if that is truly what you want and are aware of the risks.  Will your insurance cover for you to see a psychologist?  A psychologist might be able to diagnose your fear and give your doctor are reason for the c-section.  Or at least help you over come your anxiety about the birth.  

 

Of course, you only at 26 weeks or so.  A lot can change between now and then.  If you are afraid of a vaginal birth, I'm not sure what is driving you to a homebirth midwife????  If you had a terrible experience at the hospital maybe a doula could help you?  Have someone there help calm your fears and hold your hand.  

 

I've only had c-sections, but maybe you could find some women to share their experiences giving birth a 2nd time.  Almost everyone I know that have had vaginal births mention that the 2nd time was a lot easier both mentally and physically.  


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#7 of 12 Old 06-25-2013, 05:42 AM - Thread Starter
 
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Hi, I spoke to my OB again and he has changed his tune a lot.  He actually agreed that scheduled cesarean at 39 weeks is actually the safest thing for the baby but they make you sign a waiver.  He freely admitted that nobody talks about the risks of vaginal birth and for all these websites touting all the benefits I am angry at how much time I  spent informing myself only to have such a major a glaring gap in my knowledge.  I am not even sure I belong here.

 

I plan to talk to him about getting it covered under insurance next week.

 

Aside from being scared, which I could overcome but don't feel I should have to, is the knowledge that future births will do more damage to my already damaged pelvic floor.  I am sorry if this is TMI but smelling like a urinal and wearing panty  liners for the rest of my life being deemed "normal" just really pisses me off (no pun intended), not to mention other issues related to nerve damage and my wrecked sex life.  If I hear one more person tell me our bodies are designed to give birth I hope they are behind a monitor and not within  reach.  

 

I am going to ask about referral to a urogynecologist who can add their weight.

 

Sorry for ranting:-(

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#8 of 12 Old 06-25-2013, 12:51 PM
 
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I hear where you're coming from. I wanted a natural birth, but in the middle of an induction for which an epidural was not an option, i was so ecstatic when we made the decision to go the c-section route. Suddenly, the fear of going further with the induction was so much more unbearable than having surgery!

i absolutely support your decision to elect to have a c-section and i absolutley agree that incontinence is a valid reason for having one.

I'm all about healthy baby, health mom and part of that includes future health - and mental well-being. Here's to making health decisions that are perhaps unpalateable to some but best for us! And don't feel like you need to apologise for your decision, especially here. It's your body, it's your choice and for all the people with opinions, you are the one who has to live with the choice, good or bad (which you seem very aware of).

Regardless of this birth/pregnancy, it seems like it may be highly beneficial to seek some sort of counselling for your first birth experience. Even if you aren't able to seek services until after this pregnancy, it is still worth doing so you don't have to continue to live with unmitigated trauma.

Good luck, lady!!
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#9 of 12 Old 06-25-2013, 01:19 PM
 
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a) get a different OB ASAP

 

b) It is not elective in your case if it causes you psychological distress. See a psychaitrist and get letter for your insurance company.

 

c) see a UroGyn at the nearest university hospital

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#10 of 12 Old 06-25-2013, 03:57 PM - Thread Starter
 
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Fairy and alenushka,  thanks again for the advice.

 

I know it's hard to believe but I still like my OB.  He has spent a lot of time talking to me about these topics and is in a predicament I understand.  He is wrong but  I understand.  I personally know 4 women who recommend him and have heard of a dozen others who adore him, and haven't  found one bad comment on him.  His office is attentive and well run.

 

Due to moving in part, I saw four different practices and countless doctors and midwives during my last pregnancy and was not completely happy with ANY of them in the end.

 

This OB is the sole doc at his practice and seems to never miss a delivery and the hospital staff has very high regard for him.  I know,these guys are arrogant and make mistakes and there are many victims of just this type of doctor, but I am going to have to choose the lesser of the available evils.  That is particularly important for a cesarean too. So, I'm giving him a chance on monday to see if he will support me obtaining third party recommendations for a cesarean if he wants more data.  I know they can cost more but over all if we were all scheduled, they would in fact lower costs and save more lives.  I'm not advocating that but it's based on research. Doesn't mean it's ideal either.

 

It's also just very stressful to change practices and I am going to be sure it's necessary this coming week.  I have another practice to try out if needed.

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#11 of 12 Old 06-27-2013, 12:43 PM
 
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Quote:
Originally Posted by demeter888 View Post

Hi, I spoke to my OB again and he has changed his tune a lot.  He actually agreed that scheduled cesarean at 39 weeks is actually the safest thing for the baby but they make you sign a waiver.  He freely admitted that nobody talks about the risks of vaginal birth and for all these websites touting all the benefits I am angry at how much time I  spent informing myself only to have such a major a glaring gap in my knowledge.  I am not even sure I belong here.

 

I plan to talk to him about getting it covered under insurance next week.

 

Aside from being scared, which I could overcome but don't feel I should have to, is the knowledge that future births will do more damage to my already damaged pelvic floor.  I am sorry if this is TMI but smelling like a urinal and wearing panty  liners for the rest of my life being deemed "normal" just really pisses me off (no pun intended), not to mention other issues related to nerve damage and my wrecked sex life.  If I hear one more person tell me our bodies are designed to give birth I hope they are behind a monitor and not within  reach.  

 

I am going to ask about referral to a urogynecologist who can add their weight.

 

Sorry for ranting:-(

 

Best of Luck Monday!  I hope you are able to get the planned c-section. Your reasons for wanting one sound very reasonable to me!!    And you're right you really shouldn't have to overcome your fear or face more pelvic floor damage when there is a very good alternative.  

 

Forget the people telling you natural is better.  The birth of a child should Maybe it is better for them, but it's not for you!!!  As for being designed to give birth...our bodies tend to fail us in lots of areas and childbirth can be one of those areas!    Childbirth should be a joyous time not a time of fear.  My planned c-section was joyous and I don't have any damage from trying push out a nearly 10 pound baby!!  

 

 

And you might not belong here, but I think you've found some support even with your jaded view of vaginal birth! ;)


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#12 of 12 Old 06-27-2013, 01:27 PM
 
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Also, there are lots of ways to have a *perfect* birth. My favourite stories are those that end with happy, healthy babies and happy, healthy moms.

I hope your current dr does come around & that you feel well supported & cared for.

Hugs!!
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