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Discussion Starter · #1 ·
I had an emergency c/s with DS bc the cord was wrapped around his neck and his heartrate dropped and wouldnt recover (it was in the 50's and dropping). Anyway, I'm scheduled for a repeat c/s on July 9th (EDD is July 16th). CWC does NOT do VBAC's. I have asked. I never really thought about it until now but I hate that I dont at least have the option to have one. To be honest, I would probably rather have the c/s bc I had such an easy recovery but I'm bummed that I wont be able to go into labor on my own (unless I'm early) and then to be able to make the decison at the time whether or not to go ahead with a VBAC or not. I really dont want to switch practices either. I really do love my OB BUT I'm wondering what sort of "policy" they have if I were to go into labor and show up at the hospital in pretty active labor. I ask bc when I went into labor with my DS, it was in full-blown active labor and I was 7cm when I got to the hospital and got my epi right away. So it all happened pretty quickly. So would they stop labor? Would they rush me back for an "emergency" c/s at that point? Anyone know?

Sorry to ramble!
 

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I'm a CWC patient too, and have been for almost 6 years. I really like the OBs and nurses, but I have a real problem with some of their policies. As you might guess from my siggie. I got prenatal care from them until about week 34, then showed up for an IUD a couple of months later. They seemed pretty willing to let me "try" for a vaginal birth as a twin mom, but I had my doubts. When I heard from an L&D nurse that AAMC had a 80% twin c/s rate, I opted for a safe and fabulous homebirth.

It's a little schizophrenic. I like the CWC folks a lot, especially Dr. Penn, who's currently my OB, but there's a lot I don't respect about their policies. VBAC's are one of them. Rumor that I heard is that for malpractice insurance reasons CWC doesn't do them. They pay lower premiums with that policy. Now where that leaves you is not clear to me. I'd try to delicately talk to your OB about it. Does that mean they couldn't attend you if you show up pushing? Maybe. You'd be getting into a delicate area for them.

OB's prefer scheduled c/s to having a woman go into labor first. Can't say I know whether any of the reasons for it are worth respecting. Some might be worth you considering. Generally I think it's better to let the babe choose his or her own time, but I haven't done all the research.

THis is a bit of a stretch, but if you choose to go for a VBAC, you might get parallel care with a Special Beginnings midwife. I believe they have AAMC privileges. That way, if you need a c/s, you can get one of the CWC OBs. Or maybe you stay with CWC exclusively, then show up to the hospital ready to push and the on-call OB might be able to help you with a VBAC.

Some options to weigh.
 

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Discussion Starter · #4 ·
Thank you both for the responses!

Gena So they agreed to let you "try" for a VBAC? Bc thats ALL I want. I just want to be able to make the decision when I go into labor. I have no idea what the right answer is (c/s vs vbac) but it seems a VBAC would be SOOOO much better with a toddler running around. Also, they never even asked you about giving birth?? So basically you were their patient but had your babies elsewhere and then just came back? My dr is Dr. Wells FWIW and I love her. Thats why I really dont want to switch.

eta- Gena, I just read your response over in VBAC section so no need to repeat yourself. BUT i was wondering about them agreeing to let you "try".
 

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Sorry, let me clarify and confess: I'm a VBAC lurker. Never had a c/s.

I'm still processing issues around my birth: I'm happy with how things ended up, very happy, but I feel like I was hit by a truck. At 19 weeks along (my first pregnancy) I found out I was having twins. Total shock, there had been no real signs and the twins were spontaneous (not IVF.) While getting over how the twins news would affect my life and family, I realized how this changed my treatment by the hospital and OBs.

I had be skeptical before, knowing about my mother's tendency to go past 40 weeks and have longer labors. I was pretty focused on avoiding a c/s when I thought I was carrying just one baby. When I knew it was two, I did my research and realized there no chance I would get a vaginal delivery with CWC. As much as I liked them, including Dr. Wells who was more open minded in some ways that I could have expected, all the CWC OBs would stick to certain policies which would end in surgery for me. They mentioned my "unproven pelvis" and would have induced at 37 or 38 weeks, long before my body was ready. Yes, they would let me TRY for a vaginal TWIN birth, but I knew I wouldn't get it. AAMC has an 80% twin c/s rate, and since it was my first birth and I could count on a long labor, I knew I'd time out, react badly to induction, etc. So I went the homebirth route, which I really liked and am now an advocate for.

But I'm still reeling from the situation. I also like CWC. I am young and healthy, went full term with no problems. Why did that guarantee a c/s I clearly didn't need? Why did I have to pay out of pocket for an underground midwife? (no birth centers or CNMs will take twin moms.) It's not my fault and the system isn't set up to help me or my babies.

I've found that these thoughts are closest shared by VBAC moms. Many VBAC'ers ended up with a c/s they didn't really need or want, but now leaves them in a "high risk" category, when they're not really high risk.

Here's the point though: the CWC OBs will not let you try for a VBAC. As I understand it, a VBAC would violate their malpractice insurance, and you can imagine how important that is for them. Their hands are tied, they can't do it.
 

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Discussion Starter · #6 ·
AHHHH! I get it now. For some reason, I thought the twins were a VBAC and I thought, "Well, if they were going to let her then why not me?" LOL But I get it now. I just misread your response.

Well, I called Dr Wells and left a message for her. I'm going to flat out tell her that I dont want a c/s and what are my other options. If I dont have any other ooptions (which I know I dont at this point) then I'm switching. I tossed and turned all night about it and have been reeling about it all day and the more I think about it, the more I WANT a VBAC and for some reason I'm less scared to switch practices at this point. I called SB and I have a tour next week with them and I called my insurance and the birth (including a midwife delivery) is 100% covered so no problems there. I am planning to ask her if CWC would do the c/s in the event I owuld NEED another one. However, I dont think that is an option either. I talked to SB and the attending surgeon OB/GYN is Annapolis OB/GYN (who my neighbor goes to and is pregnant with twins and loves them). SB told me that I would have to have a consult with Ann OB/GYN to make sure I'm a VBAC Candidate (how could I NOT be???) My incision is perfect and the only reason Ihad the cs is bc of DS's heartrate.

Anyway, thanks for taking the time to respond! And congarts on your twin delivery! I oculd never do that myself. hehe
 

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Congrats on your decision! Don't have personal experience with Special Beginnings, but I have only heard wonderful things about them. We're lucky to be in an area rich with good providers.

Hope all goes well with you and that you end up with a VBAC (sounds like you'd be a perfect candidate!) But even if you change your mind, or if a c/s becomes medically necessary, you know you'll be in good hands.

Best wishes, and keep us updated!
 

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I talked to SB and the attending surgeon OB/GYN is Annapolis OB/GYN (who my neighbor goes to and is pregnant with twins and loves them). SB told me that I would have to have a consult with Ann OB/GYN to make sure I'm a VBAC Candidate (how could I NOT be???) My incision is perfect and the only reason Ihad the cs is bc of DS's heartrate.

SB's backups are a pain in the asp and could very likely bait and switch her into a cesarean as they tried to with my client. I quickly got her out to Tchabo in Arlington and she had a breech/vertex vaginal twin birth that SBs backups refused to consider even though she was a multip who pushed well with her first birth and clearly the twins were on the smaller side even at term.
 

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These all sound like wonderful questions to be raised at your local ICAN chapter meeting : )

Anyone who has attended an ICAN meeting or spoken to me by phone about their birth plans knows that I'm not in this line of work to force women into any kind of birth they don't want. However, my message is that all decisions need to be made from a place of education.

Considering a repeat cesarean simply because your recovery from your first one wasn't that bad is not a decision made by educating yourself. We had three cesarean related deaths in Maryland in 2007 and another one last fall in Baltimore - and those are just out of cases that I found out about. Plus, just because your recovery went well for one cesarean in no way means it will again. For one thing you have established scar tissue now which surgeons describe as "like cutting cement" which raises the risks of the surgery. Risks to mom include infection, hemorrhage (possibly causing you to need an emergency hysterectomy), long term pain, subsequent infertililty and more. The risk of having placenta complications in a subsequent pregnancy goes up with each additional cesarean - something to seriously consider if you even have the slightest inclination that you may want another baby after this one.
Risks to the baby include physician caused prematurity, accidentally getting cut, higher rate of breastfeeding difficulties and higher risk of respiratory distress syndrome. Babies born by cesarean have been shown to have higher rates of asthma later on as well.

Risks of having a VBAC include uterine rupture. If you don't induce or augment your labor with drugs then the risk is as low as .4%. Not all ruptures are catastrophic and so one study summarized that you have to do 588 elective, repeat cesareans to prevent "one poor perinatal outcome."

A good summary of the risks/benefits of each approach to birth can be found in the publication by Childbirth Connection titled "What Every Pregnant Woman Should Know About Cesarean Section 2004." It is available for a small fee from their website.

Caregivers who refuse to offer VBAC due to financial reasons are trading the health and safety of the mothers in their practice for their own financial gain. Period. Marsden Wagner quotes that the average OB's income in our country AFTER paying taxes and office expenses is something like 350k. I think they can spare a few bucks for some higher insurance premiums in order to provide evidence based care for the women they supposedly serve.

Yes, you do have the right to refuse an unwanted cesarean although those rights have been trampled on by some caregivers who gamble that women aren't aware of those rights. We have it in writing from our own attorney general's office in Maryland that "generally" is is illegal to section a woman againts her will. Sometimes however women using this approach to birth have been treated exceptionally bad - teams of administrators sent to her hospital room to brow beat her during contractions, ficticious hospital bills created to show the woman how much money she will owe after the birth for going against medical advice (a false claim by the way). One OB threw a water pitcher against the wall in the patient's room. Why support a group of OBs who choose not to offer VBAC? You are paying them - they are your employee - why not patronize better caregivers instead? I'd bail on the practice alltogether just because they don't offer VBAC.

So I'm glad you are looking at additional options. I can email you the Maryland hospital cesarean rates if you are interested. Come to ICAN meetings and talk to other VBAC moms about what they liked and what they didn't like about their caregivers. I'll even send you my starter up "VBAC 101" email I send all new ICAN inquiries that gives you the starting point for the education necessary to pursue a VBAC in today's medical/legal climate

Our next ICAN meeting is May 9th in Baltimore. We then break for the summer and resume in Sept. I'm always available to talk by phone as well.

-Barbara Stratton
ICAN of Baltimore chapter leader
www.icanofbaltimore.org
www.ican-online.org
 
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