Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On October 21, 2009

Submitted on 2009/10/20 at 3:24pm

Comment under: Urgent Message from ICAN! Please Spread the Word!!

Dear Nursing Birth,

 

I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)

 

I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!

 

And how does the doc get away with not telling me something important like this until NOW? Unbelievable!!  My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time.  I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!

 

If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.

 

I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!

 

I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time! 

 

Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).

 

Sincerely,

Kelly

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dear Kelly,

WOW!  I am so sorry that this is happening to you.  You story deeply saddens, frustrates, and angers me because unfortunately YOU ARE NOT ALONE!  Women all over this country have to fight everyday for their VBACs.  Too many are unsuccessful.

First off I want you to know that your gut is absolutely right; 40 weeks is NOT too late and the research does NOT support your obstetrician’s claims.

Second, if that hospital is actually considering revising their entire VBAC “policy” in response to one mother who, as it sounds to me, shook the boat a little bit by demanding better care as well as exercising her right to informed refusal, they are absolutely outrageous and ridiculous!  I would be skeptical of that story if I hadn’t recently read this about the sign placed at the entrance of the Aspen’s Women Center in Provo, Utah.

Third, sounds to me like you did everything right!  You found what you thought was a VBAC supportive care provider, you researched your options and decided you wanted to stack as many cards in your favor as you could for a successful VBAC by planning a drug-free/intervention-free childbirth, you wrote up a birth planthat you painstakingly went through “line by line” with your physician early on in your pregnancy, you have sought out and taken childbirth preparation classes that are geared towards not only providing knowledge about how to have a successful natural childbirth but also help in preparing mentally and emotionally for such an important journey (and on top of that you took those classes with your husband!), and you even hired a doula.  (Yup!  Just as I suspected…you did everything you could!)  So what happened?!?!…

Unfortunately you are a victim of the ol’ bait and switch.

It happens to women everyday around this country.  And its existence is further proof that our maternity system is broken, in shambles really.  There are some obstetricians, family practice physicians, and yes, even midwives that have become really friggin’ good at this awful game.  Women write in to me all the time with similar frustrations and complaints as yours, Kelly.  And I always find myself helpless and speechless.  I don’t know how to help women avoid it and I struggle everyday in my own professional life with how to fight it and stop it!

The worst part of the ol’ bait and switch is the feeling of betrayal that most women report experiencing after they have been victimized they this outrageous action.  (I want to note that I used the terms “betrayal” and “victimized” on purpose.  I understand that they are very strong words but I feel they are the best to describe this very serious phenomenon).  So why does it happen?  Both from what I have personally experienced as a labor and delivery nurse as well as what I have read (for example: Born in the U.S.A by Marsden Wagner and Pushed by Jennifer Block) there is not one simple answer for why some healthcare providers use this “technique.”  But there is no doubt in my mind that money, greed, fear of litigation, fear of losing patients, competition, superciliousness, willful ignorance, impatience, convenience, blatant disregard for evidenced based medicine, favoritism for the “because we’ve always done it this way” model of practice as well as favoritism for the paternalistic provider-patient model of practice (that is, the care provider only presents information on risks and benefits of a procedure/test etc. that he or she thinks will lead the patient to make the “right” decision (i.e. the provider supported decision) regarding health care) all have something to do with it.  Providers who practice the ol’ bait and switch fall somewhere on the, what I like to call “Asshole to Apathy,” spectrum.   Some may be bigger assholes than others, but in the end, they all fall somewhere on that spectrum in my experience.

[PHEW!  Okay, WOW!  Now I’m all worked up!  Sorry, sorry!  I don’t know where that rant just came from!  But this kind of thing really burns by britches!]

So Kelly, you must be thinking, “Where does this leave me?”  The good news is that Kristen, a philosophical doula blogger friend of mine over at BirthingBeautifulIdeas is author of an amazing series she calls “VBAC Scare Tactics” which I think is a resource that you, and other moms in your situation, might find very helpful.  What you are describing sounds to me like VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

In each post she identifies one particular scare tactic, supplies a list of questions that a mother can ask her care provider in response to this scare tactic, and then provides an analysis and/or summary of the research that either challenges or even debunks the scare tactic and its insinuations.  In the introduction to the series she writes,

 

“Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in this country have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.

 

Sometimes this opposition is blatant.  Sometimes this opposition becomes obvious only at the end of the third trimester. (Many VBAC-ing moms refer to this tactic as a “bait-and-switch” since it involves a supposedly VBAC-supportive care provider rescinding this support once the actual VBAC is imminent.)  Sometimes even a care provider’s “support” of VBAC is instead a conditional, half-hearted, or perhaps sneakily-disguised opposition to VBAC.  These “scare tactics” are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean.  (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)

 

If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way.  And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.”

Things I love about BirthingBeautifulIdeas’ VBAC scare tactic posts include:

#1    Her writing is organized and clear.  (You know how much I love organization and lists!)

#2    She respects research and understands the importance of evidenced based medicine. (In fact, the reason BirthingBeautifulIdeas is aware of much of the research she cites is because she actually used said research studies in weighing her own decision about whether to have an elective repeat cesarean section or instead prepare and plan for a VBAC.)

#3    She has personal experience with this subject.  (In fact she not only experienced a VBAC scare tactic and the “bait-and-switch” with her former OB, but also made the difficult decision to and successfully did transfer her care to a VBAC supportive care provider late in her pregnancy (at 37 weeks to be exact!) as well as experienced a subsequent and successful VBAC hospital water birth.  Check out her story “My very own VBAC waterbirth”.)

#4    She does not provide advice.  As she said herself, she is NOT anti-OB nor is she telling women to do anything.  Instead she provides tools that allow women to make their own decisions and stick up for their own decisions about the birth of their babies hoping that in doing so women come out of their birth experiences feeling positive and empowered, regardless of the outcome.

Kelly, please check out the post VBAC scare tactics (#3): An early eviction dateI was going to write to you about the research and such on the topic but BirthingBeautifulIdeas has already done such a fantastic job herself that it wouldn’t even be worth it to summarize her article.

While I’m at it, here’s the entire VBAC scare tactics series:

VBAC scare tactics (#1): VBAC = uterine rupture = dead baby (aka “Why would you want to risk a VBAC only to have a ruptured uterus and a dead baby?”)

VBAC scare tactics (#2): When bad outcomes in the past affect patient options in the future (aka “I’ve seen a bad VBAC outcome, and it was terrible.  You really don’t want to choose a VBAC over a repeat cesarean.”)

VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

VBAC scare tactics (#4): No pre-labor dilatation = no VBAC (aka “Since you are 39 weeks pregnant and your cervix isn’t dilated or effaced, it looks like you probably won’t go into labor on your own ‘in time.’   We need to schedule a repeat cesarean and forgo a VBAC attempt.”)

VBAC scare tactics (#5): VBACs aren’t as safe as we thought they were (aka “You know, VBACs aren’t as safe as we thought they were.  They are much more dangerous to you and your baby.  A repeat cesarean is the safer route.”)

A VBAC scare tactic interlude (Thoughts and resources on transferring your care to a VBAC supportive care provider, inducing labor when you have a history of a cesarean and weighing the pros and cons of pain medications and interventions if you are planning a VBAC.)

 

VBAC scare tactics (#6): CPD or FTP = no VBAC (aka“Here in your chart, it says that your cesarean was for failure to progress (FTP).  Oh, and there’s also a note here about cephalopelvic disproportion (CPD).  You’re not really an ideal VBAC candidate since your cesarean wasn’t for fetal distress or breech presentation, so we need to schedule a repeat cesarean.”)

 

VBAC scare tactics (#7): Playing the epidural card (aka “An epidural can mask the signs of uterine rupture, so I do not permit my VBAC patients to have an epidural during their labors.” OR “In case of an emergency cesarean, I require all of my VBAC patients to have an epidural in place in early labor.  That way, we will not have to wait for the anesthesiologist to get the epidural in place if a uterine rupture occurs.”)

VBAC Scare Tactics (#8): The MD trump card (aka “Look, I’m the one who has earned the medical degree and I am telling you that you cannot attempt a VBAC.  Your only choice is a repeat cesarean.  Period.”)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Kelly you wrote, “Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.”  You are right.  You don’t have to do anything they say.  You have the right as a patient to both informed consent as well as informed refusal.  However I want to say a few things.  (Here comes my cyber pep-talk, meant of course to be 100% supportive of whatever you chose and not at all meant to give you advice.  But I don’t think many women get a chance to hear from anyone what I am about to tell you.  To get the full intent of this pep talk just picture me standing behind you vigorously rubbing your shoulders as I squirt water into your mouth from a sports bottle and wipe the sweat off your face.  So here it goes…)

You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for.  Your desires for said unmedicated, intervention-free VBAC are well supported by the research.  You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC.  You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE.  You deserve it for THIS birth.

I know that it is scary to even think about transferring care to a new care provider so late in the game.  But I encourage you to at least think about it.  Even if you think that there are many limitations in your options regarding availability, insurance, distance, etc. etc, it is worth it to you to at least check it out.  I also encourage you to get in touch with your local ICAN chapter (unless, of course, you have already done that.)  Some of the members might be able to give you some suggestions on VBAC friendly care providers that they know actually attend VBACs!  Sometimes even if a VBAC friendly midwife or doctor is booked they will make an exception for a late transfer of care if a doula friend or former patient calls and asks for a favor.  (I’ve seen it happen before with my local ICAN chapter).  Also ICAN’s website has a variety of helpful articlesfor moms planning a VBAC against hospital or provider resistance.

I can tell by your story that you are a very strong woman and my gut tells me that you will indeed fight for your rights even if you stay with your current obstetrician.  You just shouldn’t have to do that and it saddens me that any your energy is going to be dedicated to defending yourself during your birth.  Even one tiny little bit of energy devoted to that is too much!  You deserve more!  You deserve better!  I think you said it perfectly when you wrote, “It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!”

 

I couldn’t agree more!

So Kelly, I wish you the best of luck!  And like many of my readers, I really wish I was going to be your labor and delivery nurse!  CONGRATULATIONS on your pregnancy and on your upcoming birth!  I will keep you in my thoughts and I hope that you will one day come back and tell us how your birth went!  I hope that this post has helped you in some way.  Oh and please apologize to your friends and family for me since you probably will be wasting a lot more time in front of the computer now that I have provided so much reading material!  Haha!

Sincerely,

NursingBirth

 

24 Responses to “The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On”

  1. Joy Says:

    Kelly- I transferred late in this pregnancy (37 weeks) from an OB who pulled the wool over my eyes to a group of midwives who support natural birth (as well as VBACs; though I’ve never had a c-section). It would serve you well to at least TRY. That’s all you can ever do. Good luck!

    • NursingBirth Says:

      Joy! So nice hearing from you (as always :) ) When is your ‘guess date” It’s always hard for me to remember who had gone into labor and who hasn’t!! THank so much for commenting! I have a post brewing in my head about your experience! I’ll email you when it finally comes to fruition!

  2. Sarah Says:

    My sis-in-law switched from hospital birth to home birth at 36 weeks and I respect her decision so much–I wish I had been brave enough to do that myself with my first birth.

    While I attended a Bradley class with my friend, I also met a couple who was due the next week who THAT WEEK had switched providers (home birth again). I kept telling them how much I respected that.

    Both they and my sis-in-law had beautiful home births and are so glad they switched. It’s never too late to switch, as long as baby’s still on the inside!

  3. wb Says:

    I switched at around 6-7 months pregnant. It was totally, totally, totally worth the hassle. I went with a much smaller hospital, and I firmly believe that without the switch I would not have had a vaginal delivery.

  4. Haa ha… Sounds like Kelly had MY doctor! And after what I put that entire maternity floor through to get my VBAC, I would not be surprised at all if they stopped allowing women to “try” VBAC because they had to deal with me.

    Kelly, RUN!!!!! Run like the wind. Run screaming in the other direction, before your labor ends up looking something like this… http://thefeministbreeder.typepad.com/the_feminist_breeder/2008/05/jules-michael-birth-story.html

  5. KAS Says:

    Great post, as always!

    In my city, there are no midwives (I’ve looked), no birthing centers, just the hospital. It is the only hospital in our city, and it has a ban on VBACs in place.

    As a mother on Medicaid, who assumes she will someday have more children, this bothers me. Medicaid and insurance work on the same levels in that they now require, at least in my state, for individuals to choose primary care providers (PCPs). They have the right to deny coverage of any visit to someone who is not your PCP if it wasn’t a direct referral from your PCP.

    That being said, if I ever needed a c-section, and wanted to attempt a VBAC afterwards, I would have to go to another hospital, “out of system”, some half an hour away (if not more) to give birth under a doctor and staff I’ve never met before and will probably never see again.

    That thought terrifies me.

    Do you sincerely believe that a hospital with a ban on VBACs would attempt to section a woman late in labor who is attempting a VBAC? I realize they can’t “force” anyone into anything, but a laboring woman cannot always speak up for herself adequately, and shouldn’t have to fight for things at that stage anyway!

    I realize I’ve never had a c-section, but considering my extremely limited options, this is a concern for me “just in case”.

  6. Kelly Says:

    Wow, this outpouring of support is amazing! Thank you Nursing Birth and everyone for your kind comments and helpful suggestions!!!

    Actually my OB has mentioned most (though not all) of the scare tactics you mentioned in the Birthing Beautifully website. Funny… but not :) Mostly my OB says she doesn’t want to go to or beyond 40 weeks due to risk of uterine rupture. I do supposedly have gestational diabetes (testing myself since the diagnosis has shown fabulous blood sugar numbers, my diabetes nurse said that means my baby is doing just fine and that I probably don’t really have GD). Baby #1 was 8lbs 2 oz, but that’s not too big, and my only other risk factors are that I’m over 30 years old (and of course trying to do a VBAC). My previous pregnancy was more than 3 1/2 years ago, I have a low transverse scar, I am not having twins, my belly is measuring 35 weeks at one day before my 35 week mark, so that’s normal… what else… well my baby is not head down yet… but we’ve still got some time.

    My hubby and I talked about maybe switching to a different doc after a previous appointment, but decided to stick it out. Maybe *we* can educate *them*…? There is a hosp about 1 1/2 hours away that supposedly does midwife attended VBAC…? But I want my doula with me, too!! So we’ll talk with my doula this weekend about everything and reevaluate. (My dream would be to go to The Farm in TN with Ina May!)
    I’m counting on my husband and my doula to do the “fighting” for me, since we are all on the same page with our “birth plan”. Hopefully that will leave me time and energy to relax!
    My local ICAN chapter is 2 hours away, so maybe after this baby is born, vaginally or not, I will have to start an ICAN chapter here, to make these resources available for all the moms who come after me, and all who have struggled before me! And maybe I’ll submit this as the next “Monty Python sketch”! It would be funny, if it wasn’t happening to me!

    Mostly thank you Nursing Birth and everyone for the emotional support! I feel more prepared and more empowered when I reach out for help; “it takes a village”. I’ll send an update after baby arrives (around Thanksgiving)!

    Sincerely,
    Kelly

    • NursingBirth Says:

      Kelly, I am glad you are finding the post and comments helpful!!! If you do stick it out with your current OB I hope you do “educate them” but don’t be discouraged if you don’t. I don’t mean to sound like a downer but seems to me like too many birth attendants like yours have a “don’t confuse me with the facts I’ve already made up my mind” kinda attitude!! I agree that talking it over with your husband and doula are both very good ideas. It just makes me sad that your husband and doula might have to, again, spend any energy at all *fighting* for anything since ideally ALL of their engery should be devoted to YOU and your baby!!

      I hope you DO start a chapter!! I can’t wait to hear your update! You will be in my thoughts!!!

  7. Kelly, I just wanted to send you the best of luck with whatever you end up deciding to do! Don’t be afraid to at least get your OB to answer your questions. You have every right to ask, “You know, I haven’t been able to find any information on the inreased risk of uterine rupture after 40 weeks. Do you mind pointing me in the direction of that research?” (And I don’t think she’ll find any, by the way. :-))

    I mainly say that b/c after I left my original OB (at 37 weeks), he called me at home to say that he had gone home to “do some research” and had discovered that I WAS RIGHT about the “VBAC scare tactic” he was using on me! And that he was still willing to “let me have a trial of labor!” I didn’t end up going back to him, but I hope that I at least encouraged him to base his medical decisions on the current evidence-based medicine and not on “what he must have learned from someone in his residency or something” (his exact words).

    Wishing you an empowering and triumphant birth!

    And to Nursing Birth–THANK YOU, THANK YOU for your kind words and your absolutely awesome shout-out. You provide such a spectacular service for women, and I am honored that you have chosen to refer your readers to my VBAC Scare Tactics series.

  8. Katie C. Says:

    my advice, which i want you to know i am not a dr. is to just not show up for the induction if she insists. they can’t induce you if you aren’t there. :) seriously. i went in the day after my dd and my dr said “I know you don’t want a repeat c/s, so we need to discuss your options should you still be pregnant in a week or two” i liked how she handled it. she said she would try a little pit if i was favorable but only after 41 weeks. this was may 21st. i went into labor the 22 and had her on the 24th. honestly, i just prayed and prayed and that and believing in my body is what got me going i think. but i had already told her that i might “forget” to show up for an induction. she just laughed at me. i mean, what are they going to do, come to you house and drag you in? :)

    best of luck – do not let her scare you, and stand firm. go with you gut. i did it, even when the hospital (not my dr.) was pushing me another direction, and i am so glad i did. you have to be your own vbac advocate! :)

  9. Gretchen Says:

    Hi Kelly – I’m so sorry to hear your story and unfortunately it is a very common one. We talk about bait and switch all the time at ICAN. (Love to see you start a chapter! Sadly, we need more and more of them). I will just say a couple of things — in answer to some of the other responses — yes, woman are forcibly sectioned when they show up at a VBAC banning hospital, though most of the time, the hospital gets “consent” by saying things like “we’ll get a court order” or “we’ll call CPS” or “your baby is in trouble and we have to get him out now!” without any evidence of trouble. It is extremely difficult to VBAC at a banning hospital (and roughly 40% of all hospitals in the U.S. do ban them — and many many more are not supportive even if they don’t officially ban VBAC). Sadly, I hear these stories, as unbelievable as we’d like them to be, more and more often. Lastly, I’ve yet to meet a woman who regretted changing providers — and I know a woman who changed *in labor* but I know a lot of women (myself included) who really really wish we’d listened to ourselves and made that change. Its never too late until the baby is out. Truly. Best wishes and luck to you and your baby!

    Gretchen Humphries
    Advocacy Director, ICAN
    advocacy@ican-online.org

  10. P. Savetz Says:

    I was shocked to see that sign on the hospital in Utah! Then again, not so much. My youngest daughter is adopted, and was born in Utah, I was present when she was born. It was within a 45 minute drive of the hospital you mentioned in Provo. They had the most backward philosophy of any hospital I have ever been to. Babies were required to be taken from the room at every shift change, regardless of how you felt about it, whether the baby was feeding, etc. Babies were detained in the nursery so that nurses could exchange info on each case w/o parents present & they were bathed. This happened at every shift change, hospital policy!!!
    In our case the birth mother dozed off at one point & woke up to find her baby gone. They decided she was sleeping & the nurse just took her & parked her in the nursery. The birth mother was also refused an epidural because on admission she said she didn’t need one (this was her 3rd child). The anesthesiologist said he didn’t like her attitude & she must be ‘altered’ from the pain to change her mind. It was horrific. We had a team to support this couple: birth & (planned) adoptive parents, a friend, a social worker & another agency employee. The doctor flat out refused the epidural & there was no other anesthesiologist on site. After delivery the pain persisted & she was diagnosed with a back injury! I wonder if things had been different if she had insurance.
    I couldn’t wait to get my daughter & her first mother out of there!

  11. Amy Says:

    After being supposedly supportive of a VBAC during my pregnancy, my OB tried to tell me at 37 weeks I had CPD and that would never deliver vaginally, I say no way. Then he said if I didn’t go into labor by my due date (which I did) that I would “have” to have a c-section. I again said no way. It’s not like your due date is “exact” anyways. Those babies come out when they are ready. Definitley scare tacticts! Do what you feel is best and good luck.!

  12. The “bait & switch” isn’t limited to VBAC.

    I know one OB in my area who employs a midwife. And women go to that practice thinking they have a 50/50 shot of the midwife attending their birth. What they aren’t told is:

    *the midwife only takes call 20 hours during the daytime M-F, and one 24 hr stretch over the weekend. Just based on numbers, that means she would only be available for 1 in 4 births…but considering that women seem to be more likely to go into labor at night than in the daytime…the odds are reduced to more like 1 in 5 or 6 births…
    *the OB has a very low threshold for what complications she feels the midwife can’t handle. GBS positive? Sorry, no midwife. Need Pitocin? Sorry, no midwife. Pregnant through IVF? Sorry, no midwife.

    Bottom line, the midwife attends about 3-4 births per year.

    Then, to top that off, the midwife told one of my clients recently–a low risk first time mom–that *HOSPITAL POLICY* is constant fetal monitoring after 5 cm. So she will be unable to walk, use the shower, or use the Jacuzzi after 5 cm. This is a blatant lie…and after verifying that nothing had changed in the hospital policy, I told my client that the midwife had lied to her.

    If the care provider will lie prenatally about something so basic, what will they lie about in labor? I can only think that they said this was hospital policy in an attempt to keep my client from switching practices–because why should she switch practices if the policy is going to be the same with everyone, right?

    Sigh. My client is staying with the practice…which makes me fearful for how her labor will play out.

    • Sigh. Yeah…I was right to be afraid. I can’t reveal much without violating client confidentiality, but lets just say that more lying DID occur in labor, and I believe some unnecessary things were done to the mother, despite her cries of pain–and I’m afraid some of those things my have a great impact on her for months in the future, if not permanently. I was nearly in tears…I felt helpless to stop what I felt was an assault because the OB did not respond AT ALL when I tried to speak to her.

      Ladies who are reading this, PLEASE don’t stay with an OB practice in hopes that you will “educate” the OB or with a thought that you can just refuse whatever you don’t want, or that your doula can protect you. Because that isn’t realistic. Your OB doesn’t want to be educated by you. There are times when you just don’t have the knowledge base to do anything but consent to what your OB suggests doing. Your doula, as much as she might have her suspicions about what is and isn’t needed, can not say anything regarding what medical treatments you should accept or reject, lest she cross the line into “practicing medicine.”

      You need to know that you trust your care provider EXPLICITYLY when you go into labor.

  13. [...] Birth – The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On, and How One Mom Walked, Moved Around, and Changed Positions to a Successful Hospital VBAC: A [...]

  14. Becky Says:

    Incredible. nursingbirth.com is my favorite site.

  15. [...] But what happened is that I, NursingBirth, became a victim of the Ol’ Bait and Switch!!!! [...]

  16. [...] replied to Kelly in my post entitled “The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On” with words of encouragment and some information about other scare tactics that some health [...]

  17. Brianna Says:

    My first daughter was born via c-s at a large military hospital in San Diego. Officially, the reason for the c-section was the fact that I have Arnold-Chiari malformation. It is ‘now known’ that AC malformation is NOT a reason to have a c-section, and the surgery was not necessary. More accurately, they scared me into ‘choosing’ a c-section.
    After my husband completed his enlistment, we moved back to rural Indiana and decided to have another child. After researching on my own, I decided to attempt a VBAC. The doctor I chose originally, apart from many other problems I had with him, was emphatically anti-VBAC. I took the advice of friends in the area and switched to a more experienced OB in town. His first words were, “You know you have to have a c-section, right?” So I gave up.
    Then, I hit the net. That’s when I realized it wasn’t the doctors. It’s the hospitals. No facility within 30 miles allowed VBAC’s to be performed. At my next appointment, I mustered the courage and asked if VBAC was an option. To which he responded, “Absolutely. I used to do VBAC’s routinely, and never had a major problem occur. Unfortunately, this hospital won’t allow me to perform one anymore. I know someone who can do it. But you’re in for a drive.” He refered me to an OB at a much larger hospital about 45 minutes from home.
    For those of you counting, this is doc #3.
    I was amazed. Finally, a doctor that was openly admitting everything I had researched about the politics involved with VBAC, and how insurance companies rather than OB’s control it’s acceptance.
    At every appointment, I was given an ultrasound to make sure my baby wasn’t getting too big and to rule out position problems, both of which would pull the plug on VBAC. I was given more and more encouragement as each hurdle was cleared. I thought it was strange that he decided to strip my membranes at 37 weeks and only 2cm dialated, but who am I to second guess a doctor? Especially one that’s on MY side!
    Last week, he drops the bomb.
    “Well, you haven’t progressed any in 5 days. Ethically, I can’t induce you. If we don’t see something happen in a week, we’ll have to pick a date.”
    At this point, I was 38 weeks, 2 days. I’m now 39 weeks, 1 day. So essentially, I have 36 hours to go into labor, or I’m getting a repeat c-section.
    This is the ONLY doctor at the ONLY facility available to me that even agreed to try. I’m stuck. I feel like this whole ordeal has been a complete waste of time. I’ve been driving 75 miles round-trip every 3 weeks, and now every 6-7 days to get a natural birth experience. Now, because my cervix hasn’t dialated EARLY, I’m going to end up with another major abdominal surgery that I don’t need, and more importantly, will effect our decisions about more children in the future. Furthermore, one that I could’ve gotten here in my hometown with the doctor everyone recommended in the first place!
    I feel betrayed and desperate. This is not how I want to feel in the days before I give birth.

    • Brianna,
      First I just want to tell you how proud I am of you for all the hard work and effort you have put in to have a VBAC! You have every reason to be angry right now! It sounds to me like you are facing the exact same scare tactic as I was: “early eviction date”. This post that Nursing Birth so graciously wrote about – was my story. (I am eternally grateful to you Nursing Birth, and for everyone who wrote such amazing supportive comments, I love you all!!!) 2 years after my VBAC I can tell you that all the stress and fighting was totally worth it. I am a changed person, my marriage is changed and I am committed to helping other moms not have to go through what I did, all alone. (by founding my own local ICAN chapter)

      What I felt like I had to do was ditch my last OB appointments after 37 weeks (which I DON’T recommend), and just showed up in labor at 41 weeks 3 days. Thankfully my labor was much shorter (only 18 hours instead of 5 days) and things went great! My hubby had to do a bit of fighting for me while we were in the hospital, but it was just to avoid having them break my bag of waters, and keep them from doing vaginal exams all the time, and to have them let me nap when I wanted to.

      Brianna, please feel free to email me if you want someone to talk to in person! You do not deserve to be bullied in the last few days/weeks of your pregnancy! You deserve a real chance at VBAC! My email address is: icanofnortheastiowa@gmail.com and I highly recommend contacting your local ICAN chapter: http://ican-online.org/chapter/search (there are chapters in Indianapolis, Fort Wayne, Northwest Indiana, and Tippecanoe County).

      Sincerely,
      Kelly Fischer
      Chapter Leader
      ICAN of Northeast Iowa
      icanofnortheastiowa@gmail.com
      neiowa.ican-online.org


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
Follow

Get every new post delivered to your Inbox.

Join 84 other followers