This will be a serious one.
I posted this link today on Facebook and so far have only had 1 comment. Not that I think I'm exceptionally popular or what-not but I thought for sure it'd start some more discussion. Then I got to thinking (and really over-analyzing) and decided that I bet most of my friends are scared, just like this article talks about. Go read it if you haven't already.
My hubby and I were talking about it a little bit and he brought up such a great point after I said something about how society gives women who choose a ERCS (elective repeat cesarean sections) such a hard time for choosing that versus a VBAC (vaginal birth after c-section) or sometimes called a TOLAC (trial of labor after C-section). Then he said, "But society gives women who choose the opposite a really hard time too" (speaking of home births). It kind of stopped me in my tracks. It's absolutely true.
Having had a C-Section (for a brow presentation baby, among other things) and then having a vaginal birth successfully, and NOW being pregnant once again, I'm being faced with a decision once again. Although a different kind of one. We're adding in the home birth choice too!
It's still SO hard for me to decide what to do. I've had a lot of pain this time around and am somewhat tired of it. I've thought about a C-section. After all, who would or could blame me? I'm STILL considering a home birth versus a hospital birth. Technically I'm not even a good candidate for a home birth because of the VBAC and I'll have to do it under the table so to speak. Which is lame. The midwife in my area is not allowed to see me as a patient if she knows I've had a VBAC. There are laws against it. REALLY? there are laws against my choice in how to birth? I'm an angry mama which is not good for me or my baby. lol
At my most recent doctors appoinment I had to sign my TOLAC waiver with all the risks and warnings of doing a VBAC. I can't wait to show it to you. Towards the bottom I had to initial such statements as, "I understand that having a VBAC presents less risk than a ERCS" And, "I understand that I am more likely to have success with a VBAC than a ERCS" and "I understand that that risk of uteren rupture is less than one percent" and "I understand that recovery will be less complicated with a VBAC than that of a ERCS". Just so you know, 60-80% of VBACs are successful [1].
That made me feel happy. And sad too because I sometime think we skip the fine print of all this ERCS versus VBAC. And that is, information! And options!
I'm not going to sit here and try and convince you to change your mind about either choice. I just want women to be informed! I mostly want women to realize that if they are seeing a doctor who refuses to do VBACs or lives near a hospital that won't do them either, that their choice as birthing woman is being taken away! The American College of Obstetrics and Gynecology (ACOG) has issued guidelines stating that "[2]it “should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”[3] In practice, this translated into 24-hour in-house anesthesia and OB coverage, a requirement that often only large, tertiary hospitals could guarantee." Therefore many hospitals, including the one I live near have chosen to not to offer the option of it! In fact, after I visited my local hospital for the first emergency visit I had, I called the hospital to ask if they deliver VBACs there. The nurse i spoke to said this, "I haven't seen a VBAC here in at least 16 years.". I then called a doctor in the area and at first was told that no, this doctor did not deliver VBACs. I then added that I have already had a successful one. She put me on hold and after several minutes came back on the line and said, "Yes, he'll see you as a patient if you've had a previous successful VBAC" then added that I'd need to come in to be seen first.
The second time I went to this same hospital, it was as if I was a leper. They asked me who my doctor was. I said I didn't have one here because I am a VBAC patient. "Oooooh", they would all say and not even ask more questions. So then I asked one nurse why it was that they didn't offer them there. She said it was because of things like, funding, and the problem with not having a 24 hour anesthesiologist, etc. But she didn't really know! This is where the problem lies! Let us be informed!
With my second baby, I was pretty determined to try a TOLAC and went on an adventure to find a doctor in the Phoenix/Mesa area that would take me as a patient. My sister used a resource she had to ask around and recieved only 2 referrals for doctors. I called the first and she only took 2 VBAC patients a month. And that quota had been filled. That's when I found Dr. Kells at Boojum Obstetrics. He did my 2nd and he's been my doctor for this pregnancy as well. But should it be this hard?
I guess I'm feeling frustrated at my lack of options and choices. I live in Paulden. I'm 45 minutes from the nearest hospital which doesn't even technically do VBACS. So then my choice is to go to a hospital 2.5 hours away to deliver with my current doctor which would be fine if all goes well and I'm overdue and have my membranes stripped (as it was with my 2nd baby). But what if that doesn't happen? I also don't really have the option to do a HBAC (home birth after C-section) because in the state of Arizona, I can't even have a midwife! I'm lucky enough to have a friend who is studying to become a midwife and has offered her services to me. I also have a sister in law who is a nurse and has 5 kids of her own that I might ask to attend as well. But really? I have to go all Mission Impossible style just to have my baby the way I like! I like my friends recommendation. She said to deliver at home, and call the ambulance when I'm crowning. lol!
Anyway, this really turned into a jumbled mess. I really want to know what your thoughts are. Let's have a discussion here. Please?
[1] Mayoclinic.com VBAC. 04/30/10
[2] Stand and Deliver: Risk Calculus of VBAC and ERCS. 04/01/08
[3] ACOG Practice Bulletin No. 5, July 1999, “Vaginal Birth After Previous Cesarean Section.” According to the International Cesarean Awareness Network (ICAN), over 300 hospitals have banned VBACs since 1999. ICAN is currently compiling a comprehensive list of the status of VBAC in every U.S. hospital. See ICAN's VBAC Policy Database.
I posted this link today on Facebook and so far have only had 1 comment. Not that I think I'm exceptionally popular or what-not but I thought for sure it'd start some more discussion. Then I got to thinking (and really over-analyzing) and decided that I bet most of my friends are scared, just like this article talks about. Go read it if you haven't already.
My hubby and I were talking about it a little bit and he brought up such a great point after I said something about how society gives women who choose a ERCS (elective repeat cesarean sections) such a hard time for choosing that versus a VBAC (vaginal birth after c-section) or sometimes called a TOLAC (trial of labor after C-section). Then he said, "But society gives women who choose the opposite a really hard time too" (speaking of home births). It kind of stopped me in my tracks. It's absolutely true.
Having had a C-Section (for a brow presentation baby, among other things) and then having a vaginal birth successfully, and NOW being pregnant once again, I'm being faced with a decision once again. Although a different kind of one. We're adding in the home birth choice too!
It's still SO hard for me to decide what to do. I've had a lot of pain this time around and am somewhat tired of it. I've thought about a C-section. After all, who would or could blame me? I'm STILL considering a home birth versus a hospital birth. Technically I'm not even a good candidate for a home birth because of the VBAC and I'll have to do it under the table so to speak. Which is lame. The midwife in my area is not allowed to see me as a patient if she knows I've had a VBAC. There are laws against it. REALLY? there are laws against my choice in how to birth? I'm an angry mama which is not good for me or my baby. lol
At my most recent doctors appoinment I had to sign my TOLAC waiver with all the risks and warnings of doing a VBAC. I can't wait to show it to you. Towards the bottom I had to initial such statements as, "I understand that having a VBAC presents less risk than a ERCS" And, "I understand that I am more likely to have success with a VBAC than a ERCS" and "I understand that that risk of uteren rupture is less than one percent" and "I understand that recovery will be less complicated with a VBAC than that of a ERCS". Just so you know, 60-80% of VBACs are successful [1].
That made me feel happy. And sad too because I sometime think we skip the fine print of all this ERCS versus VBAC. And that is, information! And options!
I'm not going to sit here and try and convince you to change your mind about either choice. I just want women to be informed! I mostly want women to realize that if they are seeing a doctor who refuses to do VBACs or lives near a hospital that won't do them either, that their choice as birthing woman is being taken away! The American College of Obstetrics and Gynecology (ACOG) has issued guidelines stating that "[2]it “should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”[3] In practice, this translated into 24-hour in-house anesthesia and OB coverage, a requirement that often only large, tertiary hospitals could guarantee." Therefore many hospitals, including the one I live near have chosen to not to offer the option of it! In fact, after I visited my local hospital for the first emergency visit I had, I called the hospital to ask if they deliver VBACs there. The nurse i spoke to said this, "I haven't seen a VBAC here in at least 16 years.". I then called a doctor in the area and at first was told that no, this doctor did not deliver VBACs. I then added that I have already had a successful one. She put me on hold and after several minutes came back on the line and said, "Yes, he'll see you as a patient if you've had a previous successful VBAC" then added that I'd need to come in to be seen first.
The second time I went to this same hospital, it was as if I was a leper. They asked me who my doctor was. I said I didn't have one here because I am a VBAC patient. "Oooooh", they would all say and not even ask more questions. So then I asked one nurse why it was that they didn't offer them there. She said it was because of things like, funding, and the problem with not having a 24 hour anesthesiologist, etc. But she didn't really know! This is where the problem lies! Let us be informed!
With my second baby, I was pretty determined to try a TOLAC and went on an adventure to find a doctor in the Phoenix/Mesa area that would take me as a patient. My sister used a resource she had to ask around and recieved only 2 referrals for doctors. I called the first and she only took 2 VBAC patients a month. And that quota had been filled. That's when I found Dr. Kells at Boojum Obstetrics. He did my 2nd and he's been my doctor for this pregnancy as well. But should it be this hard?
I guess I'm feeling frustrated at my lack of options and choices. I live in Paulden. I'm 45 minutes from the nearest hospital which doesn't even technically do VBACS. So then my choice is to go to a hospital 2.5 hours away to deliver with my current doctor which would be fine if all goes well and I'm overdue and have my membranes stripped (as it was with my 2nd baby). But what if that doesn't happen? I also don't really have the option to do a HBAC (home birth after C-section) because in the state of Arizona, I can't even have a midwife! I'm lucky enough to have a friend who is studying to become a midwife and has offered her services to me. I also have a sister in law who is a nurse and has 5 kids of her own that I might ask to attend as well. But really? I have to go all Mission Impossible style just to have my baby the way I like! I like my friends recommendation. She said to deliver at home, and call the ambulance when I'm crowning. lol!
Anyway, this really turned into a jumbled mess. I really want to know what your thoughts are. Let's have a discussion here. Please?
[1] Mayoclinic.com VBAC. 04/30/10
[2] Stand and Deliver: Risk Calculus of VBAC and ERCS. 04/01/08
[3] ACOG Practice Bulletin No. 5, July 1999, “Vaginal Birth After Previous Cesarean Section.” According to the International Cesarean Awareness Network (ICAN), over 300 hospitals have banned VBACs since 1999. ICAN is currently compiling a comprehensive list of the status of VBAC in every U.S. hospital. See ICAN's VBAC Policy Database.
I did not know it was so difficult for you to just have a baby. I gotta think, though, that the midwife/VBAC laws are for the midwife's legal protection. People have babies in cars and by accident and in toilets. Having one at home doesn't have to make you feel all Mission Impossibly (unless you like that). It's just a baby, not a planned disaster. And you've got women around you who you know and love and trust. You're in good hands regardless of your decision.
ReplyDeleteHi. I found your blog from Terina's. I have 5 kids and two of them were delivered by emergency c-section and one vbac. I totally agree with you that it can be difficult to find doctors who are willing to be flexible with your options. It's frustrating. I have found when I really push my desires they have generally been heard and doctors have been willing to make compromises despite not necessarily wanting to. Having said that, don't let all this frustration get in the way of having a healthy baby arrive safely, which is your ultimate goal, no matter how it may have to happen. Had I not been in the hospital with my two babies that arrived via emergency c-section they would not have made it. For that reason, I would NEVER opt to have a home birth, especially when you have other complications/considerations. I didn't want a c-section either time, but I am certainly glad I was able to have one. Both times they had to have the baby out within a matter of minutes. I don't love hospitals or c-sections, but in the end you need to do what is best for the health of your baby and then yourself. That is going to be different for different people but I just wanted to share with you my experiences.
ReplyDeleteThank you so much for your comment! I think I would opt for a hospital but I've had a successful VBAC and my reason for the first C-section was brow presentation which is not something that is likely to repeat itself. In fact, only about 4% of moms have babies with a brow presentation. Most come out with their head tucked towards their chest. Anyway, what I got most out of your comment was this, "Don't let all this frustration get in the way of having a healthy baby arrive safely." I so appreciate that because I was doing that until I decided that doing a home birth is the best way for us to go. I feel so much more at peace now. So much so! Thank you!
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