Opinions, please, Hospital's "reason" for a No-VBAC POlICY - Page 2 - Mothering Forums

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#31 of 58 Old 12-13-2008, 02:42 PM
 
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At our hospital the ER is in another building

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#32 of 58 Old 12-13-2008, 02:56 PM
 
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My OB even told me once, in a true obstetric emergency they can start the c-section using local anethesia/drugs w/out the anesthesiologist present! hoping of course he arrives w/in minutes to take over, at least the baby gets out fast if he is struggling badly
I've heard of the same thing here. A mom had a c/s without major anesthesiology to save the baby's life.

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#33 of 58 Old 12-13-2008, 02:57 PM
 
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The "what about in a true emergency?" question gets asked a lot in regards to 24/7 OR access and what it boils down to is that many smaller or rural hospitals just don't have that level of coverage. In the case of a true emergency where minutes make the difference, the chance is good they will lose the baby or the mom or both. They also don't have a level III NICU (though they did qualify for level II recently) so if babe is in distress they will keep mom but transport the babe to a hospital 1+ hour away. It's just one of the trade offs you make when you live in a remote/rural area. In the case of a car crash, boating accident, or other "big" trauma the person is life flighted to a larger medical center. During off hours it may take 20-30 minutes to assemble a surgical team if life flight isn't necessary. That may take to long for a best case outcome, but that's the best they can offer.

A speaker at my ICAN group mentioned that the drs writing the ACOG guidelines are all associated with large medical centers. They write the guidelines to reflect what they expect to have available... the problem being that there is a world of difference between the resources available at a major medical center with a roster of hundreds of providers in each specialty and what is available at a smaller hospital with only a half dozen people with the necessary credentials.

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#34 of 58 Old 12-13-2008, 04:51 PM
 
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The reason that VBAC's are considered "dangerous" and ACOG wants hospitals to have the anesthesiologist on hand is because of uterine rupture. But uterine rupture is caused almost invariably by artificial induction of a VBAC labor, something that is unique to OB's and hospitals. Rather than discourage such inductions, ACOG declared "Keep it up, boys. We'll just hire more specialists to stand by."
ACOG now discourages induction of VBAC using prostaglandins--it's in the 2004 practice bulletin.

Also, rupture is not almost invariably caused by induction. It ups it by a factor of several times, but the usual figure for a non-induced, single transverse incision is a 0.5% rupture rate. (I should add that I don't think that this, in and of itself, is sufficient not to VBAC; it's merely something the woman and provider need to keep in mind.)

The additional restrictions on VBACs are an interesting application of logic. It's true that a rupture is less likely to have a catastrophic outcome if mom can be rushed into surgery. The question is whether 24/7 coverage actually ensures that this will happen. Decision-to-incision time can vary quite a bit even at hospitals with 24/7 coverage. If they have the docs in the building but they take too long to get everything set up, it's no better than having to call the OB from his house 5 minutes from the hospital.

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#35 of 58 Old 12-13-2008, 07:11 PM
 
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Worst advice ever, ever, ever.

You're going to have a hard time finding a doctor to VBAC you AND induce you with Pit. That seriously ups your risk for rupture. If you generally don't go into labor naturally you may not be a 'good' candidate for VBAC.

Also, what if there was a true, true emergency, that actually would necessitate a c-section during your labor. At what point would you consent to a life-saving operation? If you bring in some form written up by a lawyer saying you DO NOT consent and you will bring legal action, your care may be compromised in the event of a true emergency.

I'd go to Duluth. I think being farther away is worth it, in the grand scheme of things.

no the worst advice ever is the above post. first of all how many women are now or ever have been pregnant forever? seriously, i don't know of anyone who gave birth to a teenager. and going over 40 weeks doesn't mean you don't go into labor naturally... 40 wks is an average meaning some women go under some women go over. just because some doctors like to induce at 40 wks b/c they don't understand the definition of average does not mean a woman doesn't go into labor naturally. if she has never been able to go into labor before someone induced she has no reason to believe she doesn't go into labor.

secondly in a true true emergency she can transfer. she can also consent to a c section in a true emergency. if only doctors listened so well that they actually respected it when someone does not want to consent to something. good grief birth is natural the odds of needing medical intervention are slim. and uterine ruptures are more common with the use of pitocin so she may very well be better off with a midwife at home far away from intervention happy doctors and their slice and dice ways.
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#36 of 58 Old 12-14-2008, 01:41 AM - Thread Starter
 
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OP here. You all sound so knowledgeable about this topic. I'm very happy to be reading all these responses. Just out of curiosity, are any of you OBs, MWs, or other med-PROFs? This is what I'm quickly coming to the realization of: I have had 5 very medical-ized births, though I've been very happy with ALL of them & I've been very happy with my current OB (except my first birth, but I was so young & "uneducated". God had us covered, is all I can say!) I think what I'm dealing with now is a lack of confidence in myself regarding my ability to "naturally" go into labor. I need to find that confidence! Please tell me if this is stupid and irrational..... what if I *DO* end up going into labor on my own, go to the hosp when I'm really-really progressed, and then refuse the CS.....? Me? Spontaneous labor? I guess stranger things have happened. Thoughts? I def. need to ask my doc how she'd handle that "hypothetical situation".....

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#37 of 58 Old 12-14-2008, 01:55 AM
 
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Originally Posted by 2boys3girls View Post
Please tell me if this is stupid and irrational..... what if I *DO* end up going into labor on my own, go to the hosp when I'm really-really progressed, and then refuse the CS.....? Me? Spontaneous labor? I guess stranger things have happened. Thoughts? I def. need to ask my doc how she'd handle that "hypothetical situation".....
Only irrational if you think you *won't* go into labor naturally. It might not be by 40wks or 42 wks (magical gestational ages that they are) and your doc may have issues with that. She might even act supportive now then turn at the end...just a ponder...

Oh, and I'm not a doc, a MW, or nurse...just a lay person who hopes to have a VBAC eventually.

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#38 of 58 Old 12-15-2008, 11:07 AM
 
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Originally Posted by 2boys3girls View Post
OP here. You all sound so knowledgeable about this topic. I'm very happy to be reading all these responses. Just out of curiosity, are any of you OBs, MWs, or other med-PROFs?
If that's the only people you want to hear from you will probably end up with another medicalized birth (with the exception of some MWs). But if that's what you want then thats fine. I think majority of what you will find here are people who have been through VBACs successful or not and all the information they gathered in their experiences.

And you are correct the fact that you don't think you are capable of going into labor on your own is a huge statement to the lack of faith in your body and what birth is.

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#39 of 58 Old 12-15-2008, 12:01 PM
 
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Originally Posted by AlexisT View Post
Also, rupture is not almost invariably caused by induction. It ups it by a factor of several times, but the usual figure for a non-induced, single transverse incision is a 0.5% rupture rate. (I should add that I don't think that this, in and of itself, is sufficient not to VBAC; it's merely something the woman and provider need to keep in mind.)
I'm fairly certain this .5% rupture rate includes induction/augmented labors. It may exclude those induced using proglastines (sp?).

There was a small study done in the last couple years in Israel, most mothers recieving no pitocin and those that did get some it was less than 20(not sure what the normal unit is). Of the almost 900 vbacing women, there was only 1 rupture and that happened several hours after birth for a rate around .12%--much lower than the usual .5%. This is SMALL study but looks promising.

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#40 of 58 Old 12-15-2008, 12:14 PM
 
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http://www.homebirth.org.uk/vbacinduction.htm

the studies they use in their chart were fairly large (over 2000 in 2 of the studies) and show a .45%-.7% rupture rate for spontaneous labor.

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#41 of 58 Old 12-15-2008, 02:29 PM
 
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Originally Posted by 2boys3girls View Post
I need to find that confidence! Please tell me if this is stupid and irrational..... what if I *DO* end up going into labor on my own, go to the hosp when I'm really-really progressed, and then refuse the CS.....? Me? Spontaneous labor? I guess stranger things have happened. Thoughts? I def. need to ask my doc how she'd handle that "hypothetical situation".....
Well just tell yourself that somewhere in your genetics is the gene for spontaneous labor. Because, well, I went into spontaneous labor, and you and I share a lot of the same genes. (Thats right, we are sisters.) And our mother never had 4 babies, no inductions.
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#42 of 58 Old 12-15-2008, 04:55 PM - Thread Starter
 
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If that's the only people you want to hear from you will probably end up with another medicalized birth (with the exception of some MWs). But if that's what you want then thats fine. I think majority of what you will find here are people who have been through VBACs successful or not and all the information they gathered in their experiences.

And you are correct the fact that you don't think you are capable of going into labor on your own is a huge statement to the lack of faith in your body and what birth is.
OceansEve: No, I'm NOT saying "that's the only people I want to hear from"..... NOT IN THE LEAST.... basically what I was trying to say is, "you all sound so knowledgeable, sounds like you've spent years studying this....." I love REAL information gained from REAL LIFE EXPERIENCE so a huge thank you to those who have shared their wealth of information with me.

I readily admit that I do seem to have a "lack of faith in my body", at least in my body's attempt to "naturally" begin labor. It just hasn't happened that way for me. I'm not proud of that fact. Yes, I know I haven't "always" allowed myself to go significantly passed my due date. My second got up to 9.13 lbs and I'd personally rather my baby not get that big in utero.

All in all, I put my faith in God. The desire of my heart is to go into labor naturally, wait it out at home, then drive to the hospital & have a VBAC. If the hospital isn't okay with a VBAC, I just might have to say that I'm not okay with surgery. I've been doing lots of reading on the ICAN website & I'm gathering info to present to the hospital, when the time comes. Also, I plan on being armed with info to bring up with my doc later this month, and I'll confirm her position.

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#43 of 58 Old 12-15-2008, 06:13 PM
 
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Don't let them scare you with big baby. I have a friend that hombirthed a 10+ lber w/o tearing If only my insurance covered her MW

Just keep researching and talking to people outside those who profit from western medicine. It took me a while to get to the frame of mind I'm at now. I remember my "can I have a vbac" post right after I found out we were preg w/ DD2. It takes a while to come around but the more you have under your hat the better you will feel about it.

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#44 of 58 Old 12-15-2008, 07:58 PM
 
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basically what I was trying to say is, "you all sound so knowledgeable, sounds like you've spent years studying this....." I love REAL information gained from REAL LIFE EXPERIENCE so a huge thank you to those who have shared their wealth of information with me. .
That is one of the great things about the internet - tons and tons of resources available, not only articles but access to the abstracts of thousands of studies, and communities of people who are learning the same things to bounce your knowledge/questions off of.

if you know your stuff it becomes much easier to advocate for yourself and take responsibility for your decisions

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#45 of 58 Old 12-15-2008, 11:14 PM
 
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My good friend in my birth circle just had a VBAC at home Thursday. 10lbs 8oz. Her first was CS due to double footling breech. My CS baby was 7lbs 5oz and my vbac at home was 9lbs 4oz. Don't let size be your fear. Your body knows what it's doing. And my vbac was at 41+6 incidentally. My CS was after an induction at 41+2.

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#46 of 58 Old 12-15-2008, 11:52 PM
 
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This is no longer up, but I found the page I was looking for for you on the wayback machine. Not sure how many of the links work. Let me know if they don't & I'll see if there's any other way to get them. It's all about 10 month mama's, which it sounds like you might be.

http://web.archive.org/web/200608130...onth_mama.html

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#47 of 58 Old 12-16-2008, 12:48 PM - Thread Starter
 
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hello, thanks for the above post, I did check out the ten month mama website. VEry interesting!!!! Okay, please forgive me for sounding like i don't know a THING, WHEN does the placenta actually stop working?!!! I don't want to sound insensitive toward anyone who has had a stillborn baby, but I would personally be afraid that I would end up birthing a dead baby, if I remained pregnant til 46 weeks. I do need to do some more reading & researching. My prayer has already been said for a truly natural VBAC..... I just need to believe!!! And I will!

Dana, Wife to DH, SAHM to Mac, 14, Mikael, 10, Holland Eve, 8, Danica Lyn, 5, Noah Rebekah, 3, & baby brother Elisha Isaac, born 7/21/09
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#48 of 58 Old 12-16-2008, 04:57 PM
 
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hello, thanks for the above post, I did check out the ten month mama website. VEry interesting!!!! Okay, please forgive me for sounding like i don't know a THING, WHEN does the placenta actually stop working?!!! I don't want to sound insensitive toward anyone who has had a stillborn baby, but I would personally be afraid that I would end up birthing a dead baby, if I remained pregnant til 46 weeks. I do need to do some more reading & researching. My prayer has already been said for a truly natural VBAC..... I just need to believe!!! And I will!
I don't think there is a magical number of when the placenta no longer works. Every woman gestates her babies at different lengths.
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#49 of 58 Old 12-16-2008, 05:18 PM
 
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Worst advice ever, ever, ever.
Hm. Guess I should have had my second VBAC in the hospital then. OP, my HBAC baby was over 10 lbs and she was late -- 43 weeks! From your descriptions, your body did not fail to work. However, it does sound like your care providers failed to wait. There is nothing in your history that say a VBAC is high risk for you. Your previous vaginal births should make you a more appealing VBAC patient. In my experience, if the hospital won't do VBACs, then neither will the OBs. You might be able to convince your doc that if they will wait, you will refuse the surgery so they don't get in trouble. That's pretty rare, though.

I would recommend seeking a VBAC friendly OB and hospital. Better yet, seriously consider homebirth.
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#50 of 58 Old 12-16-2008, 05:51 PM
 
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WHEN does the placenta actually stop working?!!!
It's different for every woman & every pregnancy. Lots of women have perfectly healthy placentas well into 46 weeks. Many years ago, I heard a story of a woman who was pregnant well past 50 weeks. She was in a concentration camp in Germany & kept her baby safe the only way she knew how. The baby was perfectly healthy when it was born.

Remember that for most of history, the closest 'due date' a woman had was "in the spring". Who knows how many babies were safely born at much longer gestations than we now consider normal.

If you're really worried about the placenta, you could agree to having non-stress tests (NST) (don't let them talk you into a stress test, those are just inductions in disguise) &/or biophysical profiles (BPP) every week or few days after 42 weeks. The only problem with that idea is that they may very well come up with "problems" to try to scare you into an immediate induction/cesarean. It's hard to resist when you don't have the research to back you up.

I really, really reccommend that you get your hands on 'The Thinking Woman's Guide to a Better Birth' If you can't afford it, you can probably borrow it from your local library. It's not nearly as long as it looks & is a *wonderful* resource to actual research.

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#51 of 58 Old 12-17-2008, 07:15 PM - Thread Starter
 
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Hi, I heard *again* from the clinic with the docs that do VBACs at the hospital in Duluth. The 3 docs that are currently accepting new patients have been in practice for 6, 6, & 8 years respectively. According to the woman who called me, they do about 6-8 VBACs per year. She also told me they don't "track the info any further than that". Does that sound funny to anyone but me? I was also wondering how many *approximately* plans for a VBAC have they actually followed through with. The woman on the phone told me "if they think you're a good candidate for a VBAC they will do everything possible to help me have one."

I guess i'm just going to talk to my doc later this month. I know she is totally in support of VBACs, I just need to find out her feelings on ME having a VBAC in THAT hospital, with a no-vbac policy. and of course, I do not think I'd tell her, "*When* I go into Labor on my own, i'm coming here and refusing the cs." Although I actually don't think she'd have a problem with it. I'll find out......

Dana, Wife to DH, SAHM to Mac, 14, Mikael, 10, Holland Eve, 8, Danica Lyn, 5, Noah Rebekah, 3, & baby brother Elisha Isaac, born 7/21/09
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#52 of 58 Old 12-18-2008, 04:57 PM
 
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OP, just to let you know, there is a section here for "birth professionals" where you can post questions that the doulas, midwives and nurses can answer for you. (I suppose there could be an OB posting but I've never seen one here LOL!)

On the question of placenta functioning, this is an excellent source of evidence based research:
http://www.childbirthconnection.org/...e.asp?ck=10575

You have to register but I can tell you are thirsty for facts so I promise you'll be glad you did.

The section on post-dates basically says, according to a review of all the research, that there is a slight increase in stillbirths AFTER 42 weeks (not before) which may be a sign the placenta deteriorates, or something else, I don't know. So this report suggests that induction AFTER 42 weeks may be of benefit. But it also affirms that there is NO evidence that it saves lives or helps anything to do an induction at 40 or 41 weeks just for "post-dates" with no signs of anything wrong.
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#53 of 58 Old 12-18-2008, 06:09 PM
 
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You want the real reason? Don't gripe about the docs and the hospitals, look at the lawyers and their clients! After a few multi-million dollar jury rewards for predictable complications like ruptured uteruses and dead babies, the hospitals have decided to get very careful.

http://www.medical-malpractice-attor...caesarean.html

http://www.nnepqin.org/ViewPage?id=3

http://www.storknet.com/cubbies/vbac/excf32.htm

http://accidentlinks.com/Medical-Malpractice/VBAC.html

http://cerebralpalsy.texasinjuryatto...rom_a_vbac.htm
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#54 of 58 Old 12-18-2008, 06:18 PM
 
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You want the real reason? Don't gripe about the docs and the hospitals, look at the lawyers and their clients!
I think it's much more about the client part. Some attorney's may seem greedy but they probably wouldn't have frivoulous cases if the overall attitude of America weren't "Deflect the responsibility to someone else" and "Sue somebody".

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#55 of 58 Old 12-18-2008, 06:36 PM
 
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I think it's much more about the client part. Some attorney's may seem greedy but they probably wouldn't have frivoulous cases if the overall attitude of America weren't "Deflect the responsibility to someone else" and "Sue somebody".
: america is ridiculous about law suits...some bozo spills a drink and then slips in it and breaks their leg the sue the store, the floor maker, the drink maker, and anyone else they can think of.
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#56 of 58 Old 12-19-2008, 06:52 PM
 
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Originally Posted by Lazy Gardens View Post
You want the real reason? Don't gripe about the docs and the hospitals, look at the lawyers and their clients! After a few multi-million dollar jury rewards for predictable complications like ruptured uteruses and dead babies, the hospitals have decided to get very careful.
But lets be honest here, CYA has become more important than the hippocratic oath. Majority of them are only interested on the cheapest CYA method which is simply denial of service rather than getting the proper insurance.

attached to DH superhero.gif 10/03, DD1 blahblah.gif 8/06, DD2 bouncy.gif 12/07, DD3 energy.gif 5/09, DD4 slinggirl.gif 11/12

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#57 of 58 Old 01-01-2009, 02:43 AM - Thread Starter
 
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Hi,

I met with my OB on monday 12/29. As I've said, I know she is a true believer in VBACs. I was straight with her. I told her that I'm believing that I will begin labor on my own this time & that I will be continuing my OB care with her & will have my baby at this hospital. I am planning to wait it out at home as long as possible before coming to the hospital. And I told her that i know that i cannot be forced into surgery. She said, of course there could be no CS w/o my consent. She also added that in that event there would be lots of "unhappy people" at the hospital. I asked her, "what about you? would you be unhappy?" she said, & I quote, "no, I would not be unhappy. however, I cannot advise you to refuse a cs. and I must advise you that this hospital has a no vbac policy and you need to plan on an elective cs if you come here." I told her I understand. She's a very cool doc, in my opinion, and she knows that i'd never do anything to risk my health or my child's. So, I am not going to talk to her anymore about a VBAC at this hospital. I am going to ask her what the hospital's policy is about women going past the DD who 'supposedly' need repeat CS. I just want a healthy baby, no matter how I deliver. Thanks, everyone. Any more advice, keep it coming please!

Dana, Wife to DH, SAHM to Mac, 14, Mikael, 10, Holland Eve, 8, Danica Lyn, 5, Noah Rebekah, 3, & baby brother Elisha Isaac, born 7/21/09
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#58 of 58 Old 01-01-2009, 11:14 PM
 
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Have you considered a home birth? I know it's not for everyone - just throwing that out there since you've had no pain meds and such.
I would find a HB midwife or a new hospital in which to deliver. It sounds like the hospital you've delivered at in the past is are more concerned with themselves than your well being. It sounds like you would be fine health wise, and opening you up again is not the best thing for your body!!
YOU need to make this decision. Do not give in to their insistance for a repeat c/s if that is not what you want!!

Proud Army wife and Momma of two.
Jay-my precious boy 2/20/08 & Caroline-my beautiful HBAC baby 8/22/09 :
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