VBAC in a small town with limited resources and options - Mothering Forums
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#1 of 7 Old 03-25-2013, 06:33 PM - Thread Starter
 
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My first baby was supposed to be born in water at home but was delivered by emergency C-section -- the cause, apparently that her cord was wrapped around her neck six times. Nevermind the fact that I still am not "over" this horrifying experience. Nevermind the fact that I was utterly petrified of birth anyway and stressed/panicked about it for most of that pregnancy (sure that didn't help anything...).

 

The biggest issue I am struggling with is that I am bound by provincial regulations to have any subsequent births at the hospital because I've had a C-section. I'm "not allowed" to have a home birth. I live in a small town, in a small province where the majority of people and methods and beliefs seem to behind, anywhere from 5 - 50 years. We have no idea what a birth centre is. And everyone I talk to looks at me like I have two heads when I say I plan to have a "normal" birth this time. They didn't think it was possible.

 

When I was in the hospital after my C-section, I asked the surgeon during a check-up if I would be able to have a vaginal birth if I got pregnant again. This is how she worded it: "We can allow a trial of labour." What I heard: they will humour a pregnant lady who is hell-bent on a vaginal birth, let her go through the motions for a while, and then most likely section her up anyway.

 

I don't have a choice of doctors or hospitals. In my region one is lucky to find a doctor, any doctor. We do have midwives and I am lucky enough to have gotten one -- because I called when my period was just a week late -- despite a long waiting list. So I count my blessings there. But our midwives are bound by those same regulations -- that say I can't give birth at home, and that I will be subject to our hospital's protocol from the moment I walk through their doors. Their protocol includes EFM for VBACs. I have not heard good things about what they allow or offer for comfort during labour. I do know that the environment was not conducive for me labouring the first time and I did not have access to any of the methods I had planned to use to cope with labour. And I'll never forget when they made me take off my jewellery -- my special beaded brith necklace made at my Mother Blessing -- in preparation for surgery. One of the biggest things I was hoping to rely on was a birth pool. Our little hospital does not have one. I guess there is a tub. A friend of mine called it a joke, saying it didn't even cover her belly.

 

So, in addition to trying to process my first birth, and trying to wrap my head around the logistics and pain of natural birth, and trying to convince myself that I won't actually rip open from the inside... I'm grappling with the fear that my needs and desires will be ignored, refused, and disrespected in the place where I am being forced to give birth.

 

Yeah, this post is long and heavy. Any ideas?


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#2 of 7 Old 03-29-2013, 08:04 AM
 
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If I were in your shoes, this is what I would be doing (supposing that these resources are available in your area):

 

Hiring a therapist to give me strategies to deal with my fears (no doubt about it, it is scary to feel like your baby had a close call) and to act as a sounding board in terms of handling anxieties, fears, dealing with medical professionals, etc.  Honestly, I think this is essential -- no matter what you do (hire an underground midwife, travel to another location with more resources, etc.) there is NO guaranty that your new baby will not have some issue (malpositioning, etc.) that will mean you will need a c-section again.  Best to be emotionally and mentally prepared for that eventuality while working towards the best outcome for you (a VBAC).

 

Hiring a doula to act as support in labor and during pregnancy.  If possible, I would try to hire one who is well respected by the local hospital and familiar with the people there and their procedures.  If you are concerned about your mental state, I think having a doula that is adversarial would make things worse, rather than better.

 

Speaking openly with my midwife/OB about my concerns and about what happened the last time.  If they don't know, they can't help.  I also think it might be helpful for you to discuss with them how the delivery would be handled so that you have a greater understanding of WHY the hospital procedures are the way they are.   Understanding why something is being done (that it is not done out of mere whim, malice or baseless routine) may be helpful for you.  Also, maybe learning in advance which rules can be bent and which cannot may help you feel more comfortable before and during labor.

 

Hope that helps.

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I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#3 of 7 Old 04-02-2013, 09:41 AM
 
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My first reaction when I read posts like this is to think "They can't MAKE you do anything."  They can't make you wear the monitor, they can't make you get an IV, they can't make you stay in bed.  They just can't.  But knowing that and LIVING it during labor are two different things, which is why I'd advocate strongly for you to hire a doula.

 

I had a similar situation to yours in that, for my second baby, I was a VBAC in a small town with a relatively unsupportive hospital with unsupportive rules.  I ended up hiring a midwife and having her deliver my two younger kids "under the table" for cash.  She had great references and didn't support the VBAC ban on homebirths and I was a good candidate, so she felt ok about doing it anyway.  I don't know if that might be an option for you, but it worked out great for me.

 

Also, stay home as long as possible once you go into labor.  The easiest way to keep them from messing with you at the hospital is to not be at the hospital.


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#4 of 7 Old 04-06-2013, 03:21 PM - Thread Starter
 
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Thanks very much for the replies and the advice.

 

I was seeing a therapist for quite some time after I was diagnosed with PPD two years ago and at first it seemed to be helpful but there's only so far you can go with it I guess. I may look around to see what other therapists/therapies are available that might help. I also tried some Reiki but as with the therapist, it's really challenging to arrange all these appointments when you don't have reliable child care. Perhaps I've come to terms with it as much as I'm going to at this point... it's one of those things that kind of keeps coming back to haunt you however faintly, years later.

 

I am trying to get a doula, but we only have one in our area and she is just starting to think about getting back into it after having her own baby. She has yet to confirm her availability with me, but I'm hopeful. I have no idea what her relationship is with the OB staff at the hospital, nor whether she has ever attended a VBAC. But if I want a doula, she's the only one there is so I just hope she can do it.

 

We also only have two midwives in our area and since midwifery became regulated a few years back, midwives in our province are under the thumb of the mainstream medical system. I do not know of any underground midwives or any that would break the rules and support a HBAC. I have certainly daydreamed about relocating for the last few months of pregnancy to somewhere I can do this my way but I haven't thought up any plan that isn't financially or logistically ludicrous! My sister's last birth was a UC and while the thought has crossed my mind, I really don't feel comfortable or like I'd be able to handle that.

 

I do have a good midwife -- the same one whom I had for my last pregnancy. I don't blame her (or anyone really) for the way that birth went -- it was truly just a fluke that my daughter's cord was around her neck six times and she couldn't descend. Otherwise, she said I laboured well and quickly and there is no reason to believe I won't have a successful VBAC. My scar is the low transverse double-layered kind and my water broke and I went into labour quite spontaneously (in the mall. Shopping for home-birth supplies...). But there are compelling reasons why I didn't want to have a hospital birth the first time and the experience I had there did nothing to change my mind -- even before it got crazy scary with the sudden surgical team,  strangers shaving me, oxygen-masking me, and asking me to sign these papers saying nobody will sue if I or the baby die, WHILE I WAS HAVING CONTRACTIONS. Yeah, that's one part I'm still bitter about. That and being given narcotics I wasn't aware of once they had the IV in my arm (I was so out of it I do not remember holding my baby for the first time) which is why I'm averse to having an IV upon admittance to the hospital. And, apparently one of the other rules is that I'm supposed to come to the hospital as soon as labour is established. Just heard that one the other day at my last appointment. My plan was to wait until I was far enough along they wouldn't have a chance to do much to me and I would be able to labour my way for so many hours in the comfort of my home.

 

Liberal_chick, I'm with you -- my gut feeling is, how can they tell me I have to have EFM or an IV only because I've had a previous C-section? I will do some more research, but I can't think of any relevant reason other than convenience and compliance. And how can they tell me when I have to come to the hospital? I just feel like I don't have very much choice, and my hospital is not going to respect my wishes. There is a doula in the city (an hour away) who runs a VBAC class but it's $250 and I don't know if it matters how prepared I am, if I am subject to the hospital's rules and they don't jive with my ideas and objectives. Ditto with studying hypnobirthing and whatever else might be out there...

 

Okay, well now I'm just venting. You guys are probably like, "Well I dunno then, I can't help you!" But anyway, thanks for listening...?!


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#5 of 7 Old 04-08-2013, 06:55 AM
 
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"Liberal_chick, I'm with you -- my gut feeling is, how can they tell me I have to have EFM or an IV only because I've had a previous C-section? I will do some more research, but I can't think of any relevant reason other than convenience and compliance."

 

For my scheduled c-section with my twins, it took them about six or seven tries over about a half-hour (each person was only allowed to stick me twice before someone else had to be brought in to try) before they got the IV in -- I have poor veins for IVs and blood draws.  Given that you are at an increased risk for abruption, I can think of a number of reasons that they would want to know that they have vein access (administer blood products, to move you immediately into an emergent c-section if an abruption has occurred so as to reduce the chances of using general anesthesia) without screwing around.  I have heard of hospitals agreeing to use a heplock instead of an IV -- have you seen if something like that is possible?

 

A friend who was a sexual abuse survivor was very upfront about her PTSD, her triggers, her emotional state, etc. with her doctors and the entire medical staff.  She can't say enough about how thoughtful and kind the care was that she received.  I hope for you that if you are upfront about your emotional state with your caregivers that you will find people (whoever you choose) equally supportive and kind.


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#6 of 7 Old 04-09-2013, 03:38 PM - Thread Starter
 
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Quote:
Originally Posted by Buzzbuzz View Post"Given that you are at an increased risk for abruption,"

I'm not familiar with the term abruption... is that uterine rupture? Why would I be at an increased risk?"

 

How did your friend communicate her fears/needs to the staff? Was it part of her birth plan? The only one I will be talking to prior to being admitted during labour is my midwife.


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#7 of 7 Old 04-09-2013, 05:48 PM
 
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I am in a similar situation. I am in a county with only two hospitals and both have a VBAC ban. There are no midwives and only 2 doulas in the entire county. I will be most likely traveling two hours to a better hospital and environment for my delivery. If this is something feasible for you, I would suggest traveling to a facility that is VBAC friendly so that you don't get as much resistance.

 

As for the hospital making you be monitored and stay in bed. After all of my research I have found that they cannot make you do anything, however if you don't, you are likely to be asked to sign lots of papers that you are acting against medical advice and such. I have also heard that it will likely create an environment of hostility from staff such as "I can't believe this lady is trying to do all this stuff on her own. And doesn't she know what is best for that baby?" This might not be the case at your hospital if they are VBAC friendly, but from your original post, it sounds like they claim to be, but aren't truly supportive when it comes down to it.

 

There are a lot of resources from www.ican-online.org. This is the International Cesarean Awareness Network and I have been able to find a lot of great information through this site. If you do deliver at your local hospital, I would agree that a doula would be a great help and she will be able to help you maintain your stance and not be bullied by the staff if they try to push you into a cesarean.

 

I hope this is a little helpful. I am going through the same stuff right now, so I completely understand what you are going through. Good Luck!

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