If you haven’t already, please check out PART 1 of this post: Writing Your Birth Plan: Tips from an L&D Nurse. Also, at the end of this post check out a birth plan written and sent to me by one of my blog’s readers who is due any day now!
#1 DO keep your birth plan short, simple, and easy to understand (1-2 pages max).
“Keep [your birth plan] short. If you need to spell out a long list of points, you may not be with the right caregiver. If most of the things you want aren’t things your caregiver is used to doing (in which case you don’t need to put them in a birth plan!), you are unlikely to get them. For maximum effectiveness, keep your birth plan to a single page.”
Writing a Birth Plan by findadoula.com
#2 DO keep the language of your birth plan assertive and clear.
“Remember to keep your language assertive – polite but clearly stating what you want. Use phrases like “I am planning” and “I would like” rather than “if it is ok” or “I would prefer.
Be specific. Avoid words and phrases such as “not unless necessary” or “keep to a minimum.” What one person thinks is “necessary” is not what another does. What one person defines as the minimum is not what the next person does. Instead, use numbers or specific situations, for example: “I am happy to have 20 minutes of electronic monitoring and if all is well then intermittent monitoring every hour for five minutes after that” or “I am happy to have a vaginal examination on arrival in hospital and after that every four hours or on my request.”
Writing a Birth Plan by findadoula.com
“Be sure to be assertive, but not aggressive when discussing your options. Do not allow your caregiver to brush off your decisions or suggest that this is unimportant. At the same time, don’t assume your caregiver [or nurses] will be hostile or uninterested in hearing what you have to say.”
How to write a Birth Plan by birthingnaturally.net
#3 DO use your birth plan as an impetus for doing your own personal research about your preferences for childbirth.
One great place to start is at MothersAdvocate.com who, in partnership with Lamaze International and Lamaze’s Six Steps to A Healthy Birth, have created a website that offers FREE, evidenced-based, educational video clips and print materials to educate and inform childbearing families on how to have a safe and healthy birth for both you and your baby. These extremely well reserached and produced materials are a MUST READ for all expecting moms!!!
The introduction handout for these video clips and print-outs entitled Introduction: Birth–As Safe and Healthy As It Can Be reads:
“While no one can promise you what kind of birth experience you will have, common sense tells us and research confirms that there are two tried-and-true ways to make birth as safe and healthy as possible:
• First, make choices that support and assist your natural ability to give birth.
• Second, avoid practices that work against your body’s natural ability, unless there is a good medical reason for them.
Lamaze International, the leading childbirth education and advocacy organization, has used recommendations from the World Health Organization to develop the Six Lamaze Healthy Birth Practices that support and assist a woman’s ability to give birth. Years of research have proven that each of these practices increases safety for mothers and babies.
The Six Lamaze Healthy Birth Practices are:
1. Let labor begin on its own.
2. Walk, move around, and change positions throughout labor.
3. Bring a loved one, friend, or doula for continuous support.
4. Avoid interventions that are not medically necessary.
5. Avoid giving birth on your back, and follow your body’s urges to push.
6. Keep your baby with you—it’s best for you, your baby, and breastfeeding.”
The topics of the print materials include:
Maintaining Freedom of Movement,
and even a Birth Planning Worksheet!!
“We cannot know the day or week labor will begin, how long it will last, exactly how it will feel, how we will react, or the health and sizes of our babies. What we can do, however, is educate ourselves about the vast array of possibilities and learn which are more likely to occur. We can decide what is ideal and what we will strive for, what are the means to creating the most conducive environment for such a birth, and which people can best help us to attain those birth arrangements. Finally, we can prepare our own bodies and hearts for the process.”
Eyes-Open Childbirth: Writing a Meaningful Plan for a Gentle Birth
by Amy Scott
#4 DO include your fears, concerns, and helpful things for the nurse to know.
If appropriate, a birth plan can also include a few sentences regarding things you just want the nurse to know about and are important enough to make sure that every shift is aware of. For example, I once had a patient who wrote the following in her birth plan:
“My husband is a type I diabetic and at times suffers from episodes of hypoglycemia where he does not have any warning signs or symptoms. So if my husband starts to act inappropriate or seems ‘out of it’ or ‘drunk’ please offer him some juice!! I am afraid that if I am in the throws of labor that I will not notice and this is something that I am very concerned about!”
Although this information wasn’t necessarily birth related, as a nurse taking care of this family I found this information EXTREMELY helpful to have in the birth plan!! By putting it in her birth plan, this mother felt more at ease knowing that she did not have to waste any time worrying about forgetting to tell each new nurse that took care of her. Having this in her birth plan also served as a reminder for me to pass along this important information when I was giving report to the next shift.
#5 DO review your birth plan with your birth attendant and ask him/her to sign off that he/she read and understands it.
“Add a line at the bottom of your birth plan for your doctor or midwife, and other caregivers, to sign your plan under the statement ‘I have read this plan and understand it.’ When caregivers sign your plan, they are only acknowledging to you—on the record- that they have read and understood it. They do not have to sign and say: ‘I agree.’ No matter what you tell them, they are always responsible for offering you their best judgment and skills as different circumstances arise, and then together you and your caregivers can agree on your care. This benefits you. Your birth plan will help you take responsibility for your decisions and ask to be fully informed.”
Creating Your Birth Plan, page 219
By Marsden Wagner & Stephanie Gunning
#6 DO make your birth plan personal (don’t just copy paste) and DO make sure that you understand and can elaborate on everything in the birth plan if asked.
In my humble opinion (regarding birth plans), there is nothing more frustrating for a nurse (and nothing more detrimental to a nurse’s overall attitude and view of birth plans) than to have a patient just copy and paste a general, “all-purpose” birth plan off the internet, check the boxes that “sound good”, and pass it in to a nurse with her name typed in at the top. Why? Because when a nurse (like myself) sits down to review the birth plan with the mother and her labor companions in order to start a dialogue about how the nursing staff can assist in adhering to the birth plan, it will most certainly become obvious to the nurse that the patient has done little to no research on any of her choices making it almost impossible to help the patient follow her birth plan when the birth attendant comes in and wants to do things differently.
Let me give you a few examples:
Example 1: One time I had a patient who had the following statement on her birth plan: “Regarding an episiotomy, I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage.” Now don’t get me wrong, this statement is great and it is one that I personally believe in and try to promote. So while reviewing the patient’s birth plan with her and her husband I enthusiastically said the following, “Oh, I see here you have been doing perineal massage and Kegel exercises and wish to avoid an episiotomy. That is great! How many weeks have you been doing perineal massage for?” The patient looked blankly at me and said, “What? Oh I don’t even know what that is! My sister just told me that I shouldn’t get an episiotomy so I checked that box.”
Ladies, it is really hard for a nurse to advocate for you if you don’t even understand what you are asking for!
Example 2: Almost all the birth plans I have seen make some statement about pain relief and pain medications. Again, I think that this is a great thing, especially if the mother was inspired to research all of her pain relief options (both pharmacological and non-pharmacological) and make an informed pain relief plan during the writing of her birth plan. One time I had a patient who had the following statement in her birth plan, “Regarding pain management, I have studied and understand the types of pain medications available. I will ask for them if I need them.” Again, I was very enthusiastic when I read this and said to the mother, “I see here that you have done some research on pain management. Wonderful! Have you taken any childbirth preparation classes or read any books?” The mother responded, “What do you mean?” I replied, “Well you know, like any classes or books by Lamaze, Bradley, Birthing From Within, Hypnobabies, etc.” The mother responded, “No.” I then said, “Oh, did you do any research on the internet or talk to anyone?” To which she replied, “No, not really. I mean, it’s my first time so I don’t know what to expect. My best friend just said she hated her epidural so I don’t really want one of those. Unless , of course, I really need it. We’re just going to wing it.”
Ummmm, huh?!?! Now again, don’t get me wrong. I feel that I am very supportive of mothers that are preparing for a natural, or physiological, childbirth and I often write about the risks and benefits of common obstetrical interventions, including pain medication and epidurals. But ladies, your nurse can’t be the only one who is advocating for your natural childbirth. YOU have to be on board too and YOU have to understand your reasons for not wanting pain medication or epidural. Because if you don’t even know why you don’t want an epidural then the next person who walks into that room who feels differently, be it a nurse or your birth attendant, guess what’s going to happen?! You’re probably going to agree to anything said nurse/birth attendant tells you you should get, because you don’t know any alternatives.
I am not trying to say that taking a certain childbirth preparation class or reading certain books is required for a positive and empowering birth experience. But some type of research and preparation on the part of the mother and her labor companions/partner is EXTREMEMLY IMPORTANT!!
Now here’s one more example to give you the full perspective.
Example 3: One time I was taking care of a patient who had the following statement in her birth plan: “My husband and I have been preparing for and planning a natural childbirth. I am very interested in using the Jacuzzi tub for pain relief in labor and have been reading about other drug-free ways to cope with pain. I am not interested in pain medication or an epidural as I had both with my last baby and had a poor experience with both. I respectfully request that they not be offered to me. I have done research and feel that the risks outweigh the benefits.” When I asked her about it we embarked on a really informative discussion about her last delivery, in which she had persistent numbness in her right leg for 2 months after the epidural as well as a debilitating spinal headache that took required two blood patches and made it difficult for her to nurse or care for her baby during her hospital stay. She also told me that she did not like the way the IV narcotics made her feel, as she was “seeing things” and generally “very out of it.” After our conversation I felt confident in advocating for her with her doctor (who often insisted his patients get epidurals) because I knew that if I said anything to the doctor that she would, in a sense, back me up and likewise I would back her up!!
It is so hard when a patient has something in her birth plan like “I don’t want an epidural”, and hence I argue with the doctor about how the patient does not want an epidural, but then when he goes into the room to ask the patient himself, the patient says “Oh well, whatever you think is best doctor!” It really just makes the nurse look like she is trying to “push her own agenda” when in reality the nurse was just trying to follow the patient’s birth plan!!
One more thing…I don’t want anyone to feel like I am implying that a woman has to “prove” anything to me when I ask questions about her birth plan. That is NOT the case. I just know from personal experience how important it is for a woman to understand and agree with everything she herself puts in her birth plan! Remember, mothers, labor companions, and nurses work best when they are all on the same page and work as a team to facilitate a positive and empowering birth experience!!
#7 DO look at examples of great birth plans online to get some ideas.
The following is a list of some good places to start. Remember, while these websites provide a wealth of ideas, they should not be simply copied and pasted! The best and most effective birth plans are personal, NOT just a list of things with check marks next to them!!
b) Sample Birth Plans from BirthingNaturally.net
d) American Pregnancy Association
#8 DO run through scenarios in your mind about how labor could unfold and actually talk these scenarios out with your labor companions and doula (or perhaps even your childbirth educator or birth attendant too!)
Think about all the different ways labor could unfold and how you might react if labor was faster or slower than expected; harder or easier than expected. What would you need for comfort, support and information in each of these variations? Thinking about “worst case scenario” doesn’t mean it’s going to happen. But if it does, or if any variation does, it will make you more at ease to know that your team has already talked about it and knows your wishes.
“If you knew that something would go wrong or would pose a difficult challenge during a portion of the labor and birth, what would your ideal strategy and scenario for handling that problem be? How would you want your midwife or doctor to speak with you? How would you like your spouse or another support system to help? What alternatives would you like to try, and in what order? Again, in your mind’s eye permit yourself to have the best. What would help you relax and be able to continue labor under difficult conditions?”
Creating Your Birth Plan, page 219
By Marsden Wagner & Stephanie Gunning
#9 DO try to treat researching and birth plan writing as a fun and exciting experience, not a chore!
Enjoy this time! Don’t be afraid to be creative and fanaticize! There are so many amazing thing that you can discover and learn about while doing research for your upcoming birth. It is never too early to start so don’t put it off till the last minute!
And finally…
#10 DO remember to bring your birth plan to the hospital!!
It won’t do much help to the nursing staff if you forget it at home on your coffee table! I encounter this very often at work and I always feel so badly because I know that there is usually a lot of work put into writing a birth plan. It might be best to make sure that you place a copy of your birth plan in the bag you have packed to take with you to the hospital. I have even had a few mothers put an extra copy in their car’s glove box so that they wouldn’t forget it!
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SAMPLE BIRTH PLAN
This birth plan was sent to me by a reader of NursingBirth who goes by the name “ContortingMom”. Contortingmom’s guess date is 7/17/09 and she is still “cooking” with her first baby 
I really like her birth plan for a variety of reasons. #1 She was inspired to add some stuff to her birth plan after reading a couple posts of mine (which I think is pretty cool and #2 I think it is a perfect example of a personalized birth plan!! No check boxes here! Thanks again to ContortingMom for allowing me to post her birth preferences for other moms to read and learn from!!
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Birth Preferences:
I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence. In all non-emergency situations, all proposed procedures are to be discussed (benefits and risks) so I can direct the decision making with informed consent.
Your help with these preferences is very much appreciated.
Labor:
• I intend to have as natural a labor as possible – including freedom of movement, intermittent monitoring, a saline lock instead of an on-going IV, and clear liquids as tolerated.
• Due to my GBS+ status, I request only very limited vaginal exams and do not want an amniotomy.
• Please accept my request that pain medication not be offered to me. For many reasons – personal and medical, I’m striving for an unmedicated labor and delivery. If I eventually want drugs or an epidural, I’ll be the first to ask for it and understand that options change as labor progresses.
• If augmentation is necessary, I would like to try non-pharmacological methods before resorting to meds. However, if my OB and I agree that pitocin is required, I request that the it be administered following the low dose protocol and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each dose increase.
Birth:
• Please do not direct my pushing with counting or yelling. I will ask for help if needed.
• I strongly prefer a tear to an episiotomy and do not want a local anesthetic administered to the perineum.
• I plan to be as active during pushing & delivery as possible, including choosing productive positions. They will be probably anything except supine, lithotomy or “sitting squats” that put pressure on my tailbone. It’s been broken several times & currently inflamed. I also have restrictive pain from spinal injury & surgery, so please allow a position suited to my medical needs. I’ll make sure the OB has comfortable access.
• I would like to have the baby brought to my chest immediately for skin-to-skin contact & initial procedures – and to try nursing to see if it works to contract my uterus, delaying pitocin until we know.
If Cesarean Is Required:
• Please use double-layer sutures when repairing my uterus. If I have a second child, I hope to attempt a VBAC and understand this is a requirement for many doctors.
• As health permits, I would like to skin-to-skin contact with the baby, to stay together during repair and recovery, and to breastfeed during the initial recovery period.
• If my husband has to leave the operating room with the baby, I would like my doula to take his place.
Baby Care:
• We would like to spend as much time as possible with our baby after birth before being taken off for procedures and will be breastfeeding, so please refrain from giving bottles/pacifiers.
We Appreciate Your Support. Thank You!
The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On October 21, 2009
Tags: birth, birth plan, c-section, doctor, hospital birth, ICAN, L&D, labor & delivery, midwife, natural birth, OBGYN, pregnancy, transfer of care, Vaginal Birth After Cesarean, VBAC
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
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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 date. I 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.”)
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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