"Woman Centered"/"Natural"/"Family Centered" CS - Mothering Forums
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#1 of 38 Old 06-03-2011, 04:56 AM - Thread Starter
 
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Hello!  I am looking for the closest OB & hospital to my area which will allow a "Woman Centered"/"Natural"/"Family Centered" C Section.  I am willing to travel if need be.  Does anyone know of any hospitals in your area that offer this?  Thank you!

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#2 of 38 Old 06-03-2011, 11:46 AM
 
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Where are you located?  You might ask in "Finding Your Tribe" and in the tribal areas within your travel distance...

 

Good luck!


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#3 of 38 Old 06-03-2011, 11:50 AM
 
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Oh, and Wilson Medical (outside Binghamton NY) apparently has a good c/s program... multiple support people for mom allowed in the OR, then a private recovery suite attached to the OR so mom/babe/support people can move directly there as a unit.


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#4 of 38 Old 06-03-2011, 12:49 PM
 
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Quote:
Originally Posted by wombatclay View Post

Oh, and Wilson Medical (outside Binghamton NY) apparently has a good c/s program... multiple support people for mom allowed in the OR, then a private recovery suite attached to the OR so mom/babe/support people can move directly there as a unit.



Wow, that sounds wonderful!!!


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#5 of 38 Old 06-03-2011, 08:27 PM
 
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Can you give more info??

 

 

Where exactly are you located?

What exactly are you wanting to happen or not to happen?


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#6 of 38 Old 06-03-2011, 08:35 PM - Thread Starter
 
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I have two very simple requests

 

1) I get to hold my child immediately, not just look at them while someone else holds them- Yes this is being done around the world, and has just started to be done in the US! After suffering the trauma I did during my last delivery I am unwilling not to be allowed to hold my child. It can be done safely.

 

2) I get to see my child being born

 

 

I am located in central Pennsylvania, but I am willing to travel anywhere to accomplish this. I have friends and family located across the US that I could stay with if need be.  

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#7 of 38 Old 06-03-2011, 08:37 PM - Thread Starter
 
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There is the most wonderful video on YouTube done by an ob, anesthesiologist and midwife out of England which describes this- A Natural C Section: A woman centered approach

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#8 of 38 Old 06-04-2011, 06:35 AM
 
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I'm familiar with the video you spoke of.  I had a cesarean with my 1st child and while preparing for a VBAC with my 2nd, I sought out all the information I could for a "gentle" cesarean should a cesarean end up being necessary.  I remember watching the video and wanting all of that to happen - I had intended on demanding it happen.  I ended up VBACing, but had I not, I would have had a "gentle" cesarean.

 

 

Have you discussed these wishes with your doctor yet?  Perhaps he/she is willing to work with you.

 

I am of the opinion that while it may be easier to have your wishes honored elsewhere, your wishes almost can always be honored anywhere.   I highly suggest talking to your current provider, creating a cesarean birth plan, and simply demanding your wishes and what you want to happen.


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#9 of 38 Old 06-04-2011, 02:04 PM - Thread Starter
 
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I have, in fact I have already spoken with 2 obs in the area. Both insisted that it was not possible.  I asked even about having a legal waiver drawn up ahead of time absolving them of any complications which would be possibly caused by doing a cs in this manner.  I was told no it was still too legally risky and the hospital attorneys would not allow it.  I loved that they actually admitted that it was the legal risk, not a medical risk that would keep them from doing this.  I was told that I have a greater than 50% chance of needing a cs with my next pregnancy.  

 

In fact I had interviewed one for nearly two hours, during the course of the conversation indicated that if I needed an induction that if there was no change in my cervix after 12 hours of a cervical ripening agent they would force me to have a cs.  With my son, my induction lasted nearly 48 hours.  The first 16 hours there was no change in my cervix with a cervical ripening agent. They didn't see a change until they started the pitocin.  I was able to deliver vaginally.  Obviously this scared me, but this is the perinatologist at better of the two hospitals in the area. Needless to say I am also looking into what legal means I will have at my disposal to make sure I am not forced into something that is not the best for me.       

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#10 of 38 Old 06-04-2011, 03:25 PM
 
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In terms of holding your babe while on the table, there seem to be two things that need to be addressed... first, some hospitals wont do it because of the OR temperature (it's kept cool because that's best for the surgery/people involved but it's not necessarily best for the babe).  If you can present solutions (warmed blankets for example) it might help.  The other item is the sterile field... many anesthesiologists set the drapes (and from there, the sterile field) too "high up" on mom's chest for the babe to fit easily.  Asking to speak with the head of anesthesiology or with the specific anesthisiologist involved might lead to having the drapes set just a few inches further down the chest, creating a "space" for the babe.

 

There may be more hurdles, depending on the hospital/providers, but those are the two things I hear back from med pros who have fielded questions at ICAN meetings/conventions.

 

For seeing your child being born... that's harder.  There is a real fear that a mom might have a serious emotional/psychological response to viewing her surgery.  You can argue that if the drape is simply lowered a bit for the actual moment of delivery there isn't much chance of you seeing anything that would be disturbing, but you'll need to get the anesthesiologist on board too since they're the ones who worry the most about having a mom hyperventilate/develop blood pressure issues/have wonky reactions to medications as hormones respond to fight/flight instincts and so on.  If you can convince the anesthesiologist you might have better luck convincing the surgeon.  One option offered at a few hospitals here is a video record of the birth.  The ORs are all on video record already and, assuming nothing happens during the surgery that is considered "actionable" the OR will release a copy of the birth video.  No idea if that would be possible, or if it would be possible for a support person to film the birth from their perspective (so again not right in the nitty gritty because of the angle of filming)... that might be more palatable to the hospital legal team.

 

Either way... I'm sorry you're facing such challenges!


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#11 of 38 Old 06-05-2011, 03:36 PM
 
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I am so, so sorry you are being put in this position.  It's sad sometimes the position legalities put us in :(

 

Wombatclay has some great information for you.


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#12 of 38 Old 06-05-2011, 03:53 PM
 
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Quote:
Originally Posted by wombatclay View Post

In terms of holding your babe while on the table, there seem to be two things that need to be addressed... first, some hospitals wont do it because of the OR temperature (it's kept cool because that's best for the surgery/people involved but it's not necessarily best for the babe).  If you can present solutions (warmed blankets for example) it might help.  The other item is the sterile field... many anesthesiologists set the drapes (and from there, the sterile field) too "high up" on mom's chest for the babe to fit easily.  Asking to speak with the head of anesthesiology or with the specific anesthisiologist involved might lead to having the drapes set just a few inches further down the chest, creating a "space" for the babe.

 

There may be more hurdles, depending on the hospital/providers, but those are the two things I hear back from med pros who have fielded questions at ICAN meetings/conventions.

 

For seeing your child being born... that's harder.  There is a real fear that a mom might have a serious emotional/psychological response to viewing her surgery.  You can argue that if the drape is simply lowered a bit for the actual moment of delivery there isn't much chance of you seeing anything that would be disturbing, but you'll need to get the anesthesiologist on board too since they're the ones who worry the most about having a mom hyperventilate/develop blood pressure issues/have wonky reactions to medications as hormones respond to fight/flight instincts and so on.  If you can convince the anesthesiologist you might have better luck convincing the surgeon.  One option offered at a few hospitals here is a video record of the birth.  The ORs are all on video record already and, assuming nothing happens during the surgery that is considered "actionable" the OR will release a copy of the birth video.  No idea if that would be possible, or if it would be possible for a support person to film the birth from their perspective (so again not right in the nitty gritty because of the angle of filming)... that might be more palatable to the hospital legal team.

 

Either way... I'm sorry you're facing such challenges!


This is all good info.  Really, it is the anesthesiologist's OR.  Your OB can agree to certain things, but in the end, they are not the one with the final say. 

 

Best of luck getting the c-section you are hoping for. 

 


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#13 of 38 Old 06-05-2011, 06:50 PM - Thread Starter
 
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Thanks for the information, I will definitely try to meet with a couple of anesthesiologists at the two hospitals.  I know both hospitals in my area that I have looked into have an absolute no videography policy.  This became very detrimental in my son's birth as the drugs they had me on fogged his actual delivery, which is a memory I will never get back.  :(   

 

I am really contemplating traveling abroad if I cannot find someone in the US who is willing to do a cs in this manner.  I had a very traumatic birth with my son, and I know that my physiological and emotional response to a traditional cs would be very detrimental to my health. Though I would really hope to avoid having to travel while heavily pregnant.  

 

Do you know if they could legally prevent my husband from picking up the baby and placing it on my chest? I am trying to plan for the worst case scenario if I cannot get to another hospital.

 

Also, do you know if I would have the right to refuse any drug that they would want to administer? I do not want to be any altered mental/conscious state from drugs, especially after the birth of my son. Although I know that some are known as having a small risk of this, given my severe negative reaction to the epidural during my son's birth I do not want to take a risk with any but the most absolutely necessary drugs, ie the spinal/epidural.       

 

I have family or friends that I could easily stay with in;

 Minneapolis, MN

 NC

 Phoenix

 San Fransisco

 Boca Raton, Florida

 Atlanta, Georgia

 

 

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#14 of 38 Old 06-05-2011, 07:16 PM - Thread Starter
 
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I don't know if you have had the opportunity to read this article, but it is very eye opening.  It is also very close to where I live.  

 

http://www.msnbc.msn.com/id/5012918/

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#15 of 38 Old 06-06-2011, 07:35 AM
 
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Well, legally your husband/partner/support person is only present in the OR at the will of the hospital.  They can be removed at any time and barred from the surgical suites for endangering you, the babe, the sterile field, the surgical process, the "sense of safety" of the hospital staff, etc.  They can even be barred from the hospital grounds since they are not a patient, they are a guest.  It's not something a hospital likes to do since it creates a fair amount of negative press, but they are within their rights to have a disruptive person removed.  So yes, there is certainly a "risk" that if your partner attempted to hold the babe in a way that violated hospital policy, they could be removed and the babe sent to the nursery.  I'm really sorry.  But again, this would be something to discuss with the babe's pediatrician (the babe is technically the patient of the pediatrician, so they are the ones who can ok changes in newborn routine in the OR) and the surgical staff ahead of time.

 

As for drugs... this would be a key component in your discussion with anesthesiology.  When push comes to shove, your right to refuse medication during surgery is iffy at best.  Setting out before hand what you do and do not want in terms of types of medication (especially if you can site problematic responses to specific medications) is your best option.  Once surgery starts, the anesthesiologist kind of gets final say... you could pursue legal action afterwards but by then it would be "too late" for the birth experience as well as hard to "prove" that the medical dedcisions of the anesthesiologist were harmful unless there really was (knock on wood) serious physical harm done to you or the babe.  Proving emotional damage due to medication used would be extremely difficult.

 

As for your options... I'd suggest first posting a summary of your hopes/fears in the Finding Your Tribe area for each of the locations you've listed above.  Then google ICAN and the locations you've given to see if you can get in touch with the local ICAN group for each of those regions.  They should be able to point you towards (or away from) specific hospitals or providers in those areas.  Also, work on a surgical birth plan that addresses your top 3-4 concerns.  You might want to divide you plan into 2-3 things for the OB, 2-3 things for the babe's pediatrician, and 2-3 things for the anesthesiologist.  Each one of those providers "controls" a different aspect of the process and you'll need talk with each one about what is and isn't possible and once you're in contact with the various regional ICAN groups you could "meet" with the different teams in those locations (keep in mind though that IF you travel for birth, you'll actually need to travel a month or so before the birth to establish care... otherwise you're walking into a real unknown and have a lot less control over what happens.  Even places like the Farm now ask that moms get their third trimester care from them). 

 

And then... perhaps consider ordering the hypnobabies surgical birth/vbac prep cd?  Locate a therapist trained in EMDR or give Tapping a try (tapping is a free/diy therapy similar to EMDR)?  See if there is an ICAN, SOLACE, or birth truama support group near you?  Do what you can to prepare for various birth outcomes, get your partner and doula and as many support people as possible on board?  Maybe meet with your regular care provider to discuss post-birth options?  I had PPD with my first (c/s) birth and severe thrush/mastitis in later births so I now put together a HUGE post-birth survival kit with herbal, homeopathic, and bach flower treatments for various situations and have my doctor give me perscriptions in advance to be filled "in case".

 

Hang in there and good luck!


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#16 of 38 Old 06-06-2011, 08:20 AM
 
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You did deliver vaginally the first time?  Are you certain you don't want to try a vaginal birth this time?  They usually go quicker the 2nd time.   I guess I'm trying to understand how traveling for a family centered cesarean is going to be less traumatic than attempting another vaginal delivery. 

 

I had a great and truly respectful cesarean with my last baby.  I did not ask to hold him in the OR because I knew that the spinal anesthesia would freak me out (which it did) and I needed to be able to move my arms.  I didn't want to worry about trying to hold my baby at that point.  He was brought to me within 30 minutes of getting to recovery.   I was offered an anti-anxiety med which they could not give me until the baby was born but it was definitely not forced on me.  I kept asking when I could have it but after the baby was born, I started feeling better so the anesthesiologist asked if I still wanted it.  I didn't watch the surgery (again, no desire to see my stomach opened up) but the nurse anesthetist did take some pretty graphic birth pics which I do appreciate now.  I have a friend who was at another local hospital whose midwife took some graphic birth pics as well.  In the interest of being completely honest, that was my 2nd cesarean.  My 1st one was pretty miserable so I was rather scared of the 2nd one (which, again, turned out very nice).  My 2nd baby was a vaginal birth after 41 hours of labor.  Obviously, I stalled a lot during that labor but I would take that birth over either cesarean.  As long and tough as it was, it was still a lot better than the cesareans. 

 

The biggest criticism I saw of the experience you are looking for is that it needs to be scheduled.  They won't do it on an "emergency" basis so if you go into labor ahead of time, they might not be willing to do it.  My personal feeling was that I wanted to give my LO as much time as possible and go into labor on my own so that I knew he was ready.  You always run the risk of baby not being ready during a scheduled c-section which means they may need to take the baby for suctioning or breathing help which will also throw off plans. 

 

I'm NOT trying to discourage this particular type of family centered cesarean.  I think it's awesome and should be done more.  Instead I am encouraging you to ask about all situations (e.g. going into labor ahead of time) before committing to traveling some place far where you will be stuck recovering for several weeks before you can get home (though that could be a good thing, depending on where you are and who you are with!). 

 

Good luck!
 

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 They didn't see a change until they started the pitocin.  I was able to deliver vaginally.  Obviously this scared me, but this is the perinatologist at better of the two hospitals in the area. Needless to say I am also looking into what legal means I will have at my disposal to make sure I am not forced into something that is not the best for me.       



 


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#17 of 38 Old 06-06-2011, 09:14 AM - Thread Starter
 
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Thanks for all of the wonderful info Wombatclay.  I have already contact ican in my area, so far no one has been able to provide me with any information.  I will try the other areas I listed as well.

 

I suffered from Post Traumatic Stress Disorder with the birth of my son due to being separated from him.  I am hoping to avoid repeating this emotional injury.  Do you know when parental rights start in concern for the treatment of your baby?  When do you get to start to make decisions regrading their care.  Obviously if the hospital staff has the right keep you from your baby they don't start at birth.  

 

I should be able to travel for third trimester care because of my work schedule.  However, obviously as you pointed out this would be far from idea, especially given I have a little one already.  

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#18 of 38 Old 06-06-2011, 09:24 AM - Thread Starter
 
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dlm194, I absolutely want to try for another vaginal birth.  However, I was told that I have an extremely high risk for needing a cs with my next child.  The problem is the doctors in my area may force me into a cs despite my wishes.  As I posted the one dr informed me that they would force me to have a cs if I had spent 12 in the induction process without a change in my cervix from a cervical ripening agent, which happened with my previous child.  They only saw a change in my cervix after 16+ hours and starting the pitocin.  

 

You mentioned that your baby was brought to you 30 minutes after you went to the recovery room, how long was this after the birth? 

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#19 of 38 Old 06-06-2011, 11:23 AM
 
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I'm not certain what the legal "moment of authority" is... I'm sure that on paper a parent's rights start at birth (or sooner, since a court order would be required to "force" medical care like a transfusion on a late term unborn infant against parental will, which suggests that parental rights exist at that point).  But given that one parent would be in surgery (so probably not considered legally in full pocession of their faculties) and the other parent doesn't have a legal right to be physically present during that surgery, the reality is probably a bit different. 

 

In NY (where I live) there is no longer a legal excemption from the newborn eye ointment/vitamin K injection.  A hospital can either respect a parent's authority and refrain from administering the ointment/shot (but they are legally required to report the family to CPS) or, more often, the hospital wil administer the ointment/shot without parental knowledge and against parental consent.  Although the legal rights of the parent are being violated, because of the way the health code is set up, the hospital isn't really taking any legal risks... even if the parent brought legal action against the hospital for violation of parental rights, the health code comes down on the side of the hospital and it's unlikely a lawyer would take the case or that a court would find in favor of the parents.  :(  This isn't an exact match for the rights of the parent during a cesarean obviously, but I bet it's pretty similar.  There's the legal right and then the way that right plays out in reality.

 

I'm guessing that if your husband was actually holding the baby his parental rights would win over the hospital as long as he wasn't doing anything that could be considered an "immediate threat" (trying to take the babe out of the maternity unit which might suggest parental kidnapping, endangering you or the child by interfering with medical action that was considered "critical" like pulling out an IV or breathing tube, and so on).  I'm not sure when your rights would win out over the decisions of the medical staff in the OR however... so much could be covered by a statement that drug X or procedure Y were required to save your life.  For example, if the anesthesiologist administered something due to excessive bleeding you probably wouldn't be given the chance to say yes or no and if the drug didn't work and they performed an emergency hysterectomy they probably wouldn't need any sort of consent form there either.  And bringing legal action after the fact might be difficult.  You'd probably need to discuss this before the surgery and make sure the surgical consent forms specify what interventions are off the table (for example, blood product transfusion if your religion prohibits this) so that alternatives can be planned for and approved.

 

I guess it just kind of comes down to "be prepared"... meet with the hospital staff as much as possible and see what can be done.  I really hope you don't need all this, and that you have a great VBAC, but I totally understand the need for planning.  My first vbac left me with a 4th degree tear and pelvic organ prolapse after the prolonged shoulder dystocia of my daughter.  Finding a team that would attend a vbac after that was tough, and I spent a lot of time planning and plotting and "worst case scenario-ing".  It helped.  So hopefully this will also help you find the balance you need to get through this birth with grace and dignity and at least a few happy memories!


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#20 of 38 Old 06-06-2011, 11:49 AM
 
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Would you need to be induced?  I don't mean to get personal but is the issue just long labors or do you have another factors going on that you know will require an induction or delivery by a certain time?   I'm trying to figure out if you really just need a patient care provider or you really need someone that can do the cesarean you are looking for.  My midwives would let me labor as long as necessary to get the baby out (as long as baby and I were okay).  My 1st c-section was for failure to progress so I was expecting a long labor for my VBAC. 

 

Not having been through a cesarean, you really don't know how you are doing to react to it.  I think it's essential that you plan for a nice cesarean but I'm trying to figure out if a cesarean is really the best answer for you, especially if you suffered PTSD from separation.  I'm not getting on a soapbox about c-sections here because I do think there are situations where moms do better with cesareans after traumatic vaginal births.  But no one can guarantee that a c-section will result in a baby healthy enough for you to hold right away.  I guess that's my concern.  Many women have terrible reactions to the anesthesia and spend hours throwing up.  These are just things to think about. 

 

I watched my LO the whole time I was in the OR.  The room was set up so that he did not leave my sight while I was on the operating table (unlike my 1st c-section).  He left when I left the OR.  By the time I was getting settled in recovery (after my vitals were taken, etc), the nurse was running him back to me (after a quick visit to the nursery).  I honestly barely noticed he was gone and we were breastfeeding within about 30 minutes of birth.  This was a good scenario for me because I was out of the OR so I was feeling much better that everything was over and I could really enjoy my baby.    I was in recovery and separated from my 1st baby for 3 hours post birth which was awful.  :(  


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#21 of 38 Old 06-07-2011, 05:33 AM
 
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Would you need to be induced?  I don't mean to get personal but is the issue just long labors or do you have another factors going on that you know will require an induction or delivery by a certain time?   I'm trying to figure out if you really just need a patient care provider or you really need someone that can do the cesarean you are looking for.   

DLM-  From her posts, it sounds like the OP has a medical condition/medical history which limits her options.  Whether or not those limits are reasonable probably isn't a factor, or something she can control.  For example, around here homebirth midwives will not take on vbac mothers... it may not be reasonable, but it means that women in my ICAN group who want an HBAC must rent a cabin ~3 hours away and get there during labor IF they want a "home"birth.  If you can't afford the rent, the gas, the darn high oop cost, or the time it takes to get there routinely as well as in labor then a midwife attended HBAC just isn't an option.  And although I had one successful VBAC under my belt already, it took me much of my next pregnancy to find a care provider who would "allow" me to vbac again due to the birth complications that developed during my first vbac.  I've now had my second vbac and am preparing for my third... thankfully I was able to use the same provider this time because I've learned that the other two local practices would not take me as a vbac client, only as a rc/s client.  And even the practice/hospital that I'm using places restrictions on vbac moms that require some "pre-planning".

 

Sometimes the available choices all kind of stink and planning on how to make a "best case worst case scenario" is crucial.  It sounds to me like this is what the OP is trying to do.  And it sounds like the OP doesn't "want" a c/s, but knows that her chances of having surgery are pretty high so she's trying to find the best possible c/s practice out there so IF she ends up with that birth scenario it'll be the best birth possible in the circumstances.

 

Personally, I think the hypnobabies c/s program might help since there is a lot of focus on staying calm/focused/present and then recovering quickly... so that might be something to explore.  Especially if one goal is to avoid extra medication and be "parentally active" as soon as possible.


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#22 of 38 Old 06-07-2011, 06:42 AM - Thread Starter
 
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"Sometimes the available choices all kind of stink and planning on how to make a "best case worst case scenario" is crucial.  It sounds to me like this is what the OP is trying to do.  And it sounds like the OP doesn't "want" a c/s, but knows that her chances of having surgery are pretty high so she's trying to find the best possible c/s practice out there so IF she ends up with that birth scenario it'll be the best birth possible in the circumstances."

 

This is exactly what I am trying to do.  With my son's birth I developed preeclampsia at 36 wk 4 days.  The drs I have met with have told me that because of this, my advancing maternal age, my short stature, and my weight that my likelihood for having a cs is 75% even though I previously was able to give birth vaginally with all of the same conditions.  The fact that they won't let me labor through an induction for more than 12 hours means that there is a huge likelihood this will be true given that with my previous induction started Saturday afternoon and I didn't have baby until Monday mid-morning.  It was an extremely difficult birth with many challenges including me loosing consciousness when given the epidural and the medical staff scrambling to stabilize both of us.  It almost ended in an emergency cs.  However, as difficult as it was I am thankful that the staff at the time allowed the opportunity to give birth vaginally.  I still would not exchange the difficult time I had for a cs for all of the money in the world.  Obviously the risk of having the same reaction to an epidural exists in the future, which makes having a cs even scarier.  My lo was born not breathing and had an apgar of 2.  They were able to revive him in the delivery room and I was able to briefly hold him before he was taken to the nicu. We were separated for nearly two days after that.  Knowing what I know now I should have fought harder to see him during those two days.  I have daily nightmares about not being able to get to him. I have started to have nightmares about having a cs and not being able to hold my new lo as well.

 

 I also know how difficult a traditional cs can make both bonding and breastfeeding.  Both of which I was NEVER able to do with my son.  Every decision in my previous birth plan was set up to try to make breastfeeding as easy as possible.  I know that there are a lot of woman who can have a cs and overcome these issues, but there are some who aren't able to.  The ones that can should feel extremely lucky.  Knowing now what I know, I know that I would not be able to do either with a traditional cs.  I am unwilling to let this happen to a future child when it can be prevented with some minor accommodations by the medical staff.  (Yes, I the hospital did have a lactation consultant that I met with, but was still not able to given all of the delays)  OBVIOUSLY this would change if the child would need emergency medical care and I would deal with that. It is a lot easier emotionally to deal with being separated if it is for a true medical reason.  Interestingly, although the thought of surgery, the epidural, recovery, etc makes me nervous I really don't have strong reaction to it. (Weird given what happened with the last epidural I know)  I know that I could be able to peacefully have a cs if I was able to hold lo. I also know that if I am not able to hold lo, then the risk that my blood pressure would spike to an unhealthy level causing me to have other health issues is an extremely likely possibility.  Also I know that it would lead to a reoccurring of the PTSD which would also endanger my emotional health making it difficult to care for both children.  All of these risks are unacceptable to me personally.  I am willing to travel to the ends of the earth if needed to accomplish this, to do otherwise would just cost me too much.         

 

 

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#23 of 38 Old 06-07-2011, 07:31 AM
 
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Wombatclay ~ Trust me, living in a state where it is illegal for midwives to attend HBACs and having had a CBAC after a VBAC, nothing you said is lost on me and I'm not glossing over anything.   ;)

 

Stongwoman ~ I understand much better what you are trying to do.  I think you are taking the right approach.  Plan for the best and the worst.  I'm just not sure how easy it is going to be to have the best of the worst if that scenario pans out.  Does that make sense?  I guess I'm not sure how committed you are to having a vaginal birth. Obviously, an intervention free vaginal birth would be ideal for you so that you can hold the baby right away and bond.  I understand that you have other medical conditions going on but I'd be hard pressed to give you a 75% chance of a c-section.  Even women who have had a c-section in a similar situation go on to have VBACs.  You won't necessarily have pre-e again.  Without pre-e, you probably don't need to expect an induction.  Even with an induction, putting a time limit on your labor doesn't make sense (assuming you and the baby are fine throughout labor).  You are obviously working through a lot of issues.  Do you *want* a c-section?  Do you want a c-section if you labor takes more than 12 hours?  I almost think you need to prioritize your desires for your birth.  Are you first looking for a patient OB that will give you all the time you need but will honor a family centered cesarean?  Or are you more committed to finding an OB who will honor a family centered cesarean regardless of his/her stance on vaginal birth in your situation.  My personal thought is that you need a hospital-based midwife with a good back up doctor.  It sounds like you need a midwife that will be patient with your labor (and can perhaps advise you on keeping your pregnancy as healthy as possible to avoid complications if possible) but can then advocate for you if it comes down to needing a cesarean.  The reason I suggest a midwife to attempt a vaginal birth is because she can usually come into the OR with you.  Obviously she won't have a part in the surgery so she can focus on you and making the experience better for you whereas a doctor will mostly focus on the surgery. 

 

Central PA is huge but there are some ICAN groups out there that may have some suggestions.  My midwives for my VBAC (I'm in NJ) recently attended a family centered cesarean but I believe the mom went to 42 weeks and opted for a repeat c-section instead of an induced VBAC.  I understand the cesarean was well planned out but they mom.  I'm not sure how it would have been handled on an emergency basis (I didn't go there for my CBAC; I was at a different hospital where my dh took over giving orders on how things needed to happen). 

 

That's my 2 cents anyway!  ;) 


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#24 of 38 Old 06-07-2011, 09:22 AM - Thread Starter
 
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I would absolutely love another vaginal birth and would welcome everything and anything I could do to accomplish this.  I am working on trying to control and correct those things with my health that I can so I can be as healthy as possible and try to avoid complications that could possibly lead to needing more interventions.  I am, just as was said, trying to plan for both eventualities given my current situation.  The dr I met with was the perinatologist that works at the local hospital.  If I was to develop preeclampsia and admitted to this hospital I would be transfered to his care.  This is also what happened at the other hospital I delivered at, my ob was taken off my case and I was reassigned to the hospital's perinatologist.  I totally agree that putting a time limit on the induction of labor doesn't make sense, but that is their policy and I was told I would be forced to have a cs at the end of 12 hours.  His reasoning was that after 12 hours everyone is ' too sick'  to deliver if an induction was necessary in the first place.  Obviously given my previous birth experience I know this not to be true, but I really wouldn't have the ability to fight at that point.  I would rather have the ability to labor as long as needed given obviously the health of my lo.   I would love to have a hospital based midwife with a back up OB who would be willing to to work with me and my situation allowing me to hold lo.  Obviously if it was an emergency cs this wouldn't be possible and all the points would be all out the window.  But most cs aren't emergency but emergent.  Meaning that you have already gone into labor, you need cs but it's not like you have to be rushed down the hall either which is where I am trying to focus.  I have not found any hospital based midwives in my area, I have found a few midwives who will do home/center births but not hospital births.  Both local hospitals will only allow one other person in the OR so at that point the choice would have to be the midwife or my hubby.  Obviously my hubby would win out.   

Quote:

"Are you first looking for a patient OB that will give you all the time you need but will honor a family centered cesarean?  Or are you more committed to finding an OB who will honor a family centered cesarean regardless of his/her stance on vaginal birth in your situation. " 

 

 

 

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I would definately prefer a patient OB that will give me all the time needed and honor a family centered cesarean.  If that is not possible I think that a family centered cs would be best, because the likelihood that I would be able to delay it until absolutely necessary would be greater except of course at the local hospital.  

 

Given that I also don't know if I will or will not develop preeclampsia again, I need to plan for getting it again while praying that I don't.  

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#25 of 38 Old 06-07-2011, 01:43 PM
 
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It's been several years since i did any research about hospitals/midwives/doctors in the central PA area. When I did, I was specifically looking for VBAC friendly but a VBAC friendly care provider should be even more vaginal birth friendly to a woman who already had a vaginal birth.

Most hospitals will allow midwives who are on staff in the OR with her patient. Even the baby factory I used with my 1st birth let the midwife in.  Doulas and CPMs are not often allowed in the OR.

Anyway, the suggestions I got several years ago were the Birth Care midwives who attend out of Ephrata hospital (the have a birth center too), Center for WOmen's Health and Wellness in Camp Hill, and May Grant Associates with Lancaster General. I don't have current info about these practices but you might ask in the finding your tribe section.

I might be overstepping my suggestions a bit here but it sounds like you've talked to a couple crappy OBs who are knife-happy and trying to get you to believe that you are broken when there isn't enough evidence to suggest that you can't have a vaginal birth (especially since you already did; that's what really blows my mind).  The 12 hour limit on an induction is silly.  It sounds like you need to be delivered by the end of a shift or you get sectioned.

I realize most c-sections are not done emergent cases but I would still ask about the family centered cesarean during the course of labor.  Once the call is made for a cesarean, they often try to fit you in as soon as they can.  My 1st baby was born on a pretty busy day so they were rushing about.

 

 


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#26 of 38 Old 06-08-2011, 01:35 PM - Thread Starter
 
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Warning: Spoiler! (Click to show)

I might be overstepping my suggestions a bit here but it sounds like you've talked to a couple crappy OBs who are knife-happy and trying to get you to believe that you are broken when there isn't enough evidence to suggest that you can't have a vaginal birth (especially since you already did; that's what really blows my mind).  The 12 hour limit on an induction is silly.  It sounds like you need to be delivered by the end of a shift or you get sectioned.

I would agree with your assessment in general, but I do also know that I at a higher risk so I want to plan for that given my past history.  In general, I think that obs who are willing to do a family centered cs get the whole birthing dynamic.  I don't want to get into the situation where I am in my third trimester and it becomes apparent I will need a cs and not have a provider who is willing to do a family centered one.  It is important enough to me that I am willing to do what needs to be done to ensure that it happens if I need a cs.

 

And obviously trying to avoid these knife-happy providers would be a great benefit to going elsewhere since I would most likely be switched to their care immediately upon check-in at the hospital.  

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#27 of 38 Old 06-09-2011, 03:17 AM - Thread Starter
 
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I found a hospital in Brooklyn, New York that has allowed a mother in the past to hold and nurse in the OR after she had gone through an unsuccessful induction of labor for preeclampsia. She had a midwife advocating for her.  Sounds like a good solution if I can't find anyone closer. And they only have a 20% cs rate. joy.gif

 

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#28 of 38 Old 06-10-2011, 07:01 PM
 
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I have a friend who had a previous c-section, and pre- negotiated her c-section to include all of her wishes ( if her try at vaginal birth should fail.)

I wrote her story here.


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#29 of 38 Old 06-12-2011, 07:58 AM - Thread Starter
 
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That is such a wonderful story!!!!! Thanks for sharing! 

 

Can you give me the name of the hospital/OB where she delivered? I am trying to compose a list to share with other women hospitals that have allowed this in the past.  I may have found one semi-close to me that although they have not done one in the past are willing to work with me.  smile.gif  I would like to provide them also with a list of hospitals/obs that have done it for possible resources.  I can provide you with my email off of the message board if needed.  Thanks again!!!!

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#30 of 38 Old 06-13-2011, 08:46 PM
 
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So try a CNM with hospital privileges,who you remain under their care even for a c/s,who will have you meet the ob that works with us,tour the unit,have a talk with the anesthesiologists about lowering drapes,mirror so you can see and a midwife who goes through all of this with you helps to place lo on chest and spend time with you in recovery as much as they can sounds like the best of both worlds,even helps to initiate breastfeeding.I hope this helps{consultation maybe worthwhile at Special Beginnings in Arnold md. good luck

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