"Not on my shift!" was his words.
Sigh.
I wasn't her nurse. Sadly, you know how this story ends.
Repeat C/S.
Why, oh why do the MDs continue to deny women the right to a VBAC attempt? We have 24 hour immediate in-house anesthesia coverage. We have 24 hour in-house MD coverage. We have a level 3 NICU. We have awesome nurses with oodles of L&D experience.
Why deny a woman a right to a trial of labor? Because the MD doesn't want the responsibility or liability if the dreaded "something goes wrong", namely, a ruptured uterus.
Why, oh why then, do we have an extensive consent form for VBACs? A form where the woman needs to read and initial each line on the form? (There are probably 15 or more lines she needs to initial.)
Why bother "offering" a VBAC in the hospital, if the MDs are not going to "offer" it to the women under their care?
On a side note, if you are wanting a VBAC, and need to have your baby in a hospital, please check things out before you give birth.
- Does the hospital allow VBACs?
- Is there 24 hour in-house anesthesia?
- Is there 24 hour in-house MD coverage?
- How does your doctor/midwife group feel about VBAC?
- Are you brushed off by your MD/CNM when you bring up VBAC at prenatal visits?
- Are you "highly encouraged" to have a repeat C/S?
- What are the statistics for VBAC versus repeat C/S for your MD/CNM group?
- What are you plans for pain management in labor?
- No plans for an epidural? Stay home as long as you can!!
- If you come in completely dilated, it's more difficult to be denied a VBAC.
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17 comments:
How about refusing to consent to the C? Is that an option still? I've heard you could go in, and refuse the C or any other procedures. Unless they wake up a judge to sign an order to protect the child with a risky major surgical intervention.
Thank you for this- but feeling so awful for the new momma. *SIGH*
How frustrating for her. If that doctor had had a c-section done on his own body before, he might have understood why a woman would want to do a VBAC instead. It's not fun.
Was she caught by surprise? Did they not discuss this during all her months of prenatal care???
I'd be livid if I expected a VBAC and the OB didn't even let me attempt it out of his own stubbornness. Jerk.
Has anyone seriously refused to sign an RC/S consent? Under EMTALA wouldn't you be somewhat stuck with doing a VBAC? Has anyone threatened the provider/hospital with assault and battery charges?
Seems like they can't bodily toss you from the building after you're in active labor.
I'm an instigator I know...
It's easy to say that people shouldn't sign the c-section consent, or threaten assault charges, but when you're there... man, it's tough. I know the doc I had for my first pregnancy used a lot of pressure to get me to consent to the induction... which of course led to a c-section. At that point (the end of pregnancy) you'd do anything to keep your baby safe and the docs will make it seem like you're in so much danger if you don't do as they say. Looking back, I know I should have listened to my gut and ignored my doctors... but they made it incredibly hard.
Knowing how the docs at my maternity clinic acted when it came down to the wire, I switched to a supportive midwife group for the second pregnancy and had a lovely VBAC. Hooray!
Here is a website, ICAN, that lists VBAC hospital policies and doctors that support them: http://ican-online.org/vbac-ban-map?filter0[]=**ALL**&op1=5&filter1=
I also would have called and asked who was on service at the time and waited the usually less then 12 hours when the on call changes. At the hospital that I use the change is at 7am, and I have done just that several times for checks - once to avoid a doc in the clinic that had doubts and then the avoid a doc at another clinic I know is very interventional. And always have a doula.
I wish so badly that women could all be given the chance for a VBAC. I think it's so important to have the right to choose.
We had a woman who's first C-section involved a classical (instead of a low-transverse) incision, which has a much higher rate of rupture, and is generally considered an absolute contraindication for a VBAC. She refused to sign the consent for a repeat C-section after her water broke. After much discussion, and signing of paperwork, she labored. The attending on call figured that if she was going to rupture her uterus better here than out in the community. She did end up with a section after starting to spike temps. Interesting how things fall out.
My opinion?
This whole thing f*cking sucks. Informed consent is a joke, and OB's like this one are pompous a**holes.
But that's just me.
There was a case in my community where a woman in active labor, desiring a VBAC, was kicked out of a hospital.
The "problem?" She was pregnant with twins.
When I first heard of this (from the attending midwife, who took her to another hospital where she had a vaginal birth), I said "but that violates EMTALA!" and I think the midwife was completely unaware of what "EMTALA" is based on her response of "what?"
Wow Cervix is that even allowable? I mean I am under the impression either the hospital allows it or does not depending on wether the insurance company will cover it. If you have 24 hour anesthesia and 24 hour coverage and a good decision to incison time, there is absolutely no reason not to vbac.
Even our Docs who don't like to Vbac will do it if the patient request it. We feel that it is the patients descion and we can accomodate that. Also the Chief of Ob would ream anyone out who denied a woman her very reasonable choice of a vbac just cause he/she didn't agree.
Now that is the a VBAC band and very unprofessional of the Doctor in charge.
The More I read on the internet, the more I appreciate my Docs.
pinky - I think it's interesting how much the culture of a hospital can be different depending on where you are and who works where. In some cultures (like yours I hope!) we can't imagine going against a client's wishes like that. I mean, my hospital has a de facto VBAC ban and we would have let that woman labor! We have an official policy that we can do a VBAC if the surgeon, anesthesia, and a surgery team stay in house the whole labor - and none of the OBs really want to sit in house, and I don't count because I'm a family doc, so pretty much no VBACs happen. Last year, though, I had a woman arrive a few hours before her scheduled repeat in active labor, and even my very conservation back up doc was all for letting her labor if she wanted (which she did) and she had a lovely VBAC 30 min prior to her planned repeat. And in other places docs think nothing of going against what a client wants without regard for her wishes. And in some places, much more subtle coercion would be used - you're not progressing fast enough, there's some slight chnages in the fetal heart rate, etc.
Makes me grateful to practice where I do, also (except that I wish I could offer my own VBACs outright now, instead of having to explain the de facto ban and referring people out if they don't want a repeat.)
Stories like this just tick me off. I mean, what would Dr. Jerkface do if someone actually said "no!"? As much as doctors are jerks and uninformed and force patients to make decisions, we have to be informed of our rights, the *real* risks (rather than the perceived ones) and stand up for ourselves. One of my OB's admitted me for observation a week before I gave birth because of high BP and transverse position - the on-call doc wanted to do the c-section right there and I told her flat out no. i knew the risks of high BP, the warning signs, and wanted the baby to have time to turn on his own, and was not about to play into her scare tactics. Unfortunately the baby turned completely breech, but I went into labor on my own, came in fully dilated, and didn't let her scare me into something I didn't want to do. I wish more women would ultimately have more faith in their own bodies and just flat out tell these jerks they're not going to be terrorized into something. I know ... easier said that done.
That said, any hospital that has a doc in house to do an emergency c-section under "normal" conditions can do a VBAC.
How likely is a rupture, anyway? The only ruptures I've heard of (which are few, however) involved long hours of Pit on primips.
And how do the ruptures occur? I would almost think the scar tissue on the uterus would cause a tear somewhere else on the uterus, maybe adjacent to the scar.
Thanks for the info, I had a very traumatic labor/delivery with my first, ending in a c-section and now I am determined to do VBAC the next time around. I appreciate your encouraging words.
Thought I'd add in--I had a c/s for my first becuase she was breech. I switched dr's around 30wks with #2 after getting a rec on a VBAC-friendly practice from ICAN. My water broke and labor began on it's own. No pitocin needed. Pushed and pushed and pushed. No luck. Vacuum. No luck. Dr said--I think it's time for a repeat c/s and I agreed. By the time I got the OR, my uterus had ruptured, just at the site of the previous scar. Thankfully baby was fine. I knew the risks going in and knew the chances of rupture were very low. Even though I did rupture and it did briefly put my baby at risk, I was still glad I tried the VBAC--and experienced labor. I was also glad I did my research, trusted my dr and knew the 'breaking point' and didn't insist on continuing to try to push her out after 3hrs of very little progress. #3 was just born in January--c/s of course--although I did go into labor myself and they did the c/s the next day--very little thinning of my uterus-- even with the prior rupture.
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