Continuation of the “Injustice in Maternity Care” Series
Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?! Are you SERIOUS!? Oh come ON!” Because of this I was inspired to start the “Injustice in Maternity Care” blog series, or more appropriately the “Don’t Let This Happen to You” series. If you are pregnant or planning on becoming pregnant, this series is dedicated to you! If haven’t already read it, I invite you to check out the first addition to the countdown: DLTHTY #25: Sarah & John’s Unnecessary Induction.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I was recently part of what I consider to be an absolutely unnecessary repeat cesarean section and a true example of what I consider the “control phenomenon” in today’s maternity care culture. This very real trend stems from the fact that obstetricians (trained surgeons who are the only birth attendants capable of performing a cesarean section) have professional motivation and incentive to promote and perform interventions that only they can provide, hence increasing their control (e.g. vacuum or forceps deliveries and cesarean sections) as well as discourage and lobby against choices in childbirth that decrease their control and increase the control of the childbearing family (e.g. homebirth, natural/unmedicated birth, and VBAC). After all, any properly trained birth attendant can attend a VBAC (including midwives and family practice physicians) but ONLY obstetricians can perform cesarean sections. In their groundbreaking book Silent Knife: Cesarean Prevention & Vaginal Birth After Cesarean, authors Nancy Wainer Cohen & Lois J. Estner describe this phenomenon,
“Cesareans are done for many reasons. In addition to the legitimate ones, they include power, control, money, fear, and prestige. However, we believe that the most important reason is that most physicians totally lack understanding and respect for women and for birth. [Routine] Repeat cesareans are done for the same reasons, with risk of uterine rupture the excuse for this deplorable crime. Vaginal birth after cesarean (VBAC) is not only safe, but generally safer than its alternative. In spite of the research and evidence and documentation that appear on this subject, most obstetricians in this country continue to perform repeat cesareans simply because a woman has been previously sectioned. There is always an excuse, it seems, why a woman cannot be a candidate for VBAC. We know that most women who have had a cesarean are capable of delivering vaginally. This includes women with a diagnosis of cephalo-pelvic disproportion (CPD), prolonged labor (failure to progress), or more than one previous cesarean.”
Now that the stage is set, let’s begin the story…
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It was a beautiful and sunny weekend morning and I arrived to the hospital, changed into scrubs, and punched in at 11:00am as usual. As I was looking over the patient assignment sheet, a young Russian** couple came to the desk. Both had very thick accents and it was quickly evident that the husband spoke better English than his wife. The husband described a “large gush of water” that fell all over the floor as she was making breakfast. The young woman stated that she had put a towel in her pants that was now “very wet” and that she started having “pains” about 10 minutes after the leaking started, which happened to be around 10:40. While at their house they then called their doctor who instructed them to come right to the hospital since, if she did break her water, she was going to be sent for a cesarean section today because she had a history of a previous cesarean section. (In fact her “repeat” date was scheduled for the next week where she would be 39 weeks in gestation.)
I was asked by the charge nurse to escort the patient and her husband down to one of the triage rooms near the operating room (OR) (just incase she was indeed ruptured) and to pass her off to another nurse who would be waiting for her there. I introduced myself to both the woman and her husband and asked the woman if she wanted a wheelchair. She declined and although she was very quiet, almost stoic during our short journey, I could tell by her walk that she was very uncomfortable. After I gave the woman a gown and assisted her into the bathroom, I told all I knew to her nurse Sally and went back to the main desk.
For the next hour I was unassigned to any patients so I spent that time assisting other nurses. Around noon I was assisting a fellow nurse whose patient was delivering when I got called out of the room by the charge nurse. “We’ve got to run two rooms in the back and I’m going to need you to be ‘baby nurse’ for Dr. W’s case, the patient in room 2.”
(Note: At my hospital we have three operating rooms on labor and delivery. We try our best to only run one room at a time, if urgency and time allows us, since running two rooms can really put a strain on the staff. To run two rooms at the same time you need 6 nurses total, three for each room (a scrub nurse, a circulating nurse, and a baby nurse). The scrub nurse actually scrubs into the surgery and assists the surgeon by passing him/her instruments and sutures. The circulating nurse usually is the nurse that knows the most about the patient and her job is to coordinate procedures and ensure the patient’s safety and comfort. The “baby nurse” assists the anesthesiologist with administering anesthesia, preps the patient for surgery, and the gowns up to “catch” the baby from the surgeon, and then brings him over to the warmer to assess him. Even though we have an OR team Monday through Friday during the day shift, between running the OR, staffing the recovery room, and admitting the next case, the OR team doesn’t always have enough nurses to run two rooms and in that circumstance the charge nurse has to pull nurses from the floor. Therefore if we were running two rooms, I knew that something must be happening with one or both of the cases that increased their urgency.)
I grabbed my OR hat and mask and walked down towards the OR to talk to the circulating nurse and re-introduce myself to the patient (something I try to do if at all possible before they enter the OR). The circulating nurse, Sally, was at the desk and gave me a very abbreviated report, “Her name is Alona. She is a G2P1 at 37 weeks and 6 days and her first baby was delivered via cesarean for ‘failure to progress/failure to descent’ per her prenatal summary. Her husband, Dmitry, told me that the doctor told them the reason she needed a cesarean the first time was that his wife’s ‘vagina was too small.’ They are both graduate students at XU. She’s got an unremarkable history. She’s scheduled for a repeat cesarean next week so we’re going to the OR. We’re gonna move in about five minutes.”
As I walked into the patient’s room, I quickly realized why everyone was rushing around…the patient was huffing and puffing through her contractions. She was still on the monitors at this time and I noticed that her contractions were coming every 2-3 minutes with nature as the only influence acting upon them. As I stuck out my hand to re-introduce myself to the couple I had escorted here not one our ago, I realized that the patient was uncontrollably grunting and pushing at the peak of her contractions. At this point the circulating nurse came in to administer her pre-operative antibiotic, followed by the anesthesia resident who started to unplug the bed from the wall. My mind was racing…this woman is in LABOR! This woman is PUSHING! Why is everyone ignoring this?! At this point the anesthesia resident and the circulating nurse started to wheel the patient out of the room and I was having none of that!
Me: “Sally, she’s pushing.”
Sally: “What?”
Me: “She’s pushing! We need to get her checked. We can’t wheel her back there like this.”
Sally: “We just checked her 20 minutes ago and she was 5cm/90%/0 station.”
Me: “Was she pushing 20 minutes ago?”
Sally: “Well no but…”
Me: “Well then I don’t care how long it has been since you last checked her! We need a resident in here to check her!!!” (Note: At our hospital, because we have residents, we are actually not allowed to check our own patients even if we have the skills to do it! I am not exaggerating. The head of the residency program feels that if nurses check their own patients then residents won’t get enough “experience.” Therefore new nurses are not even taught how to perform a vaginal exam during orientation. I feel that this is absolutely absurd and just another way the OBGYN department attempts to maintain the utmost control over all situations. But I digress…)
At this point Sally poked her head out of the door and motioned for the resident to come in. I was holding Alona’s hand and trying to coach her breathing, in, out, in, out, in, out…
Me: “Alona, we are going to do a quick vaginal exam to make sure the baby isn’t coming, is that okay?”
Dmitry (the husband): “The baby can’t come out! Her vagina is too small!”
Me: “Sir, it’s going to be okay. Every baby is different. Her vagina is not too small.”
And then the resident said the most OUTRAGEOUS thing I have ever heard…
Kate, the resident: “She’s 8cm/100%/ +1 station and that’s without a contraction. If we don’t get her to the back right now, she’s going to have this baby! Let’s go!”
[Have you ever watched a show and the cartoon character does a “double take” where they shake their head really fast back and forth and it makes a sound like something is rattling in their head? I swear I did that when I heard the resident say that and I actually said out loud, “WHAT?!!? That is ridiculous!”]
Me: “Kate, we’ve got to get Dr. W in here to talk to her.”
Kate: “Dr. W wants to do a cesarean.”
Me: “Yeah, but don’t you think it’s more important to do what the patient wants?! I think circumstances have changed enough to where someone should reevaluate this situation with her!”
[Kate left the room to go talk to Dr. W, as I think I made her really uncomfortable by calling her out and bringing up the patient’s needs. God forbid!! I poked my head out of the room to hear his answer.]
Kate: “Dr. W, she is 8/100/+1. Should we counsel her about a vaginal delivery?”
Dr. W: (really frustrated and almost offended at even the thought) “NO! We’re doing a repeat! WHAT ARE YOU WAITING FOR, GET HER TO THE BACK!”
(Note: “The back” is hospital lingo for the operating room)
On that note Sally and the anesthesia resident continued to wheel her out of the room and through the double doors to the operating room. At this point I really thought I was going to start to cry. There have only been a few times that I have cried at work (I’ve cried a lot more at home!) but this situation was really hitting a cord with me. As we were wheeling the patient down the hall I looked at her and her husband and said, “Alona, you are 8 centimeters. You do not have to have surgery if you do not want to. This is your choice.” Alona just stayed silent, and kept looking at her husband. Perhaps this was a cultural thing, perhaps she was scared, perhaps she was too much in the throws of transition to hear any word I was saying. We entered the OR at 12:30pm. Sally and the resident pushed the bed up against the OR table and instructed the patient to move over. Again, I held onto Alona’s hand, looked her in the eye, and said, “Alona, it’s not too late. If you need more time to think about things we can give it to you. If you want to talk to Dr. W about your options we can do that.” Then I looked at Dmitry and said, “Dmitry, she is 8 centimeters now. We do not have to do this surgery if she want to try to have the baby vaginally.” But Alona just kept looking at her husband (who was allowed in the OR at this point because we needed him to help translate since Alona kept throwing down the language line phone during a contraction!) and he looked back at me and said “No, the doctor said she must have surgery!”
And you know what?! I don’t blame them one bit for not even listening to me. After all, I am essentially a stranger, perhaps some kooky nurse to them whom they have never even met, while Dr. W was their “trusted” doctor. If he couldn’t take (or didn’t want to take) the time to come in and talk about their options, then why should they listen to me!? I found out after the surgery, when I looked back into Alona’s prenatal summary and previous OR report, that Alona’s first cesarean was performed after a 2-day “failed induction” to where she only progressed to 3cm/50% effaced/ -3 station. A thorough review of the patient’s first OR report revealed a classic “cascade of interventions” including elective induction at 40.2 weeks with an unfavorable cervix for “postdates,” early amniotomy and pitocin administration after one cervidil placement, epidural for pain relief, fetal scalp electrode and intrauterine pressure catheter placement, and eventual cesarean section for “failure to progress/failure to descent.” Although I support women’s rights, patient autonomy, and choices in childbirth, if the only thing that Alona & Dmitry learned from their last delivery was that her vagina was “too small,” I highly refute any claim by ANYONE that this patient was provided with true informed consent and an honest debriefing on ALL the factors that did or could have contributed to her last cesarean section.
As I was assisting the anesthesiologist with the spinal by trying to keep a woman in transitional labor still (not an easy task), Dr. W burst through the OR doors, hands wet from scrubbing, and exclaimed in a most joyous way as he peered up at the clock on the wall, “Oh excellent! I can be out of here by half past one at the latest and still make it to my golf game!”
AAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!
YES! HE ACTUALLY SAID THAT! AND THE PATIENT WAS AWAKE WITH HER HUSBAND IN THE ROOM!
After that I pretty much turned my emotions off; I couldn’t handle it and I had to focus on the task at hand. “Open” time for the surgery was 12:45pm. Alona & Dmitry’s baby boy was born at 12:50pm. “Close” time was 1:16pm. As soon as the last staple was placed, Dr. W ripped his gown off, thanked the resident and anesthesia, said a quick “Congratulations” to Alona & Dmitry, and bolted out of the room, leaving the resident as the only OBGYN to escort the patient out of surgery and write all the orders.
I gave the baby Apgars of 7 & 9 but at about 7 minutes old he started to have a bit of a difficult time clearing his secretions and his oxygen saturation started to dropped so I had to suction him a couple of times. The scale showed the baby weighed 7lbs, 3oz. When it was time to leave the OR, I wrapped up the baby and walked out with the patient and her husband. I had to keep him on the warmer in the recovery room for only about 10 minutes, basically, the time it took the team to hook her up to the monitors, do a fundal (“belly”) check, and give her some pain medication. I then put the baby skin to skin with Alona under her gown and his vitals stabilized quite well after that.
All in all despite the fact that Alona, Dmitry, and baby all appeared to be happy and healthy after surgery, my personal belief is that they were victims of medical malpractice and the current unjust maternity care system in this country. I know malpractice is a loaded term but I think it describes the situation very well: “mal” = bad practice. That is one of my biggest concerns with the rising rate of scheduled repeat cesarean sections. Once the date is set it’s like everyone has blinders on; the excuse “But she is scheduled for surgery” doesnt mean she qualifies for it now! For one, consenting a patient for major abdominal surgery PRE-LABOR in the office and treating it as the absolute only course of action regardless of what situations might arise to the contrary is WRONG. I can safely bet that when Alona “agreed” to a repeat in the office that she was mislead into thinking or mistaken that things were automatically going to go exactly the way they did last time . I can safetly bet that she did not expect to show up to the hospital after going into labor spontaneously and progress from 5 to 8 centimeters in a matter of 20 minutes when she was “counseled” (term used VERY lightly) about her options and “consented” (again, used lightly) to a repeat cesarean section months before. And you know what, if she had shown up at 10 centimeters with a head on the perineum I KNOW that her doctor would have STILL rushed her off to surgery even so because I see it happen at work ALL THE TIME. It’s outrageous, it’s meddlesome, it’s arrogant, it’s tragic, and it’s untrusting of a woman’s natural and innate ability to push her own baby out!!
In their Patient Choice Cesarean Position Statement, the International Cesarean Awareness Network (ICAN) writes,
“The International Cesarean Awareness Network opposes the use of cesarean section where there is no medical need. Birth is a normal, physiological process. Cesarean section is major abdominal surgery which exposes the mother to all the risks of major surgery, including a higher maternal mortality rate, infection, hemorrhage, complications of anesthesia, damage to internal organs, scar tissue, increased incidence of secondary infertility, longer recovery periods, increase in clinical postpartum depression, and complications in maternal-infant bonding and breastfeeding, as well as risks to the infant of respiratory distress, prematurity and injuries from the surgery.
All physicians take an oath to “Do no harm”. This means choosing the path of least risk to patients. Medically unnecessary elective cesareans increase risk to birthing women. It is unethical and inappropriate for obstetricians to perform unnecessary surgery on a healthy woman with a normal pregnancy.”
The fact of the matter is that I do not believe that Alona’s c-section was necessary and I believe that her doctor did do her harm by performing her surgery without at least revisiting her options with Alona before he ordered for her to be wheeled into the operating room. She needed to hear and deserved to hear her options from Dr. W at that time and not anyone else. Although the above position statement was written regarding patient choice elective cesarean section, I feel that it also pertains to elective repeat cesarean sections since I do NOT believe that “prior cesarean section” is an automatic indication that is well supported in the literature as being a good enough reason to just schedule another major abdominal surgery. I agree with author Norma Shulman as she was quoted in the book Silent Knife, “Those who favor repeat cesarean because of its ‘ease’ and ‘safety’ need to be reminded that ‘all the factors that make cesareans so safe nowadays also serve to make VBAC safe, and more rewarding.” To me, many other childbirth advocates, and to thousands and thousands of women in this country, the birth of a child is not the only goal of labor, it’s a very important one, but it’s not the only one. Women aren’t just “fetal vehicles” and their experiences in labor and childbirth have profound effects on their self-esteem as well as their relationship to their partners, their babies, and their families for the rest of their lives.
Are you pregnant and have a history of a previous cesarean section? Did you know that you have the right to informed consent and informed refusal regarding repeat cesarean section vs. VBAC? Did you know that there are resources out there to help you? Please check out:
(1) ICAN’s Cesarean Fact Sheet
(2) ICAN’s Vaginal Birth After Cesarean (VBAC) Fact Sheet
(3) Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean by Nancy Wainer Cohen & Lois J. Estner
(4) DON’T CUT ME AGAIN! True Stories About Vaginal Birth After Cesarean (VBAC) by Angela, J. Hoy (Editor)
And find a local ICAN support group near you!
**As always, all identifying information including names, dates, times, ethnicity, etc. have been changed or omitted to protect privacy and adhere to all HIPPA guidelines.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.”)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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