A huge red flag for me is when an OB states upfront at the first prenatal visit, “the main goal is a healthy baby and mom.” Why would the OB say something that is really so obvious, it should go without saying? Because by explicitly vocalizing it as a response to a VBAC inquiry, the OB infers that the goal of VBAC and the goal of a healthy baby are incompatible. It’s a way of distracting the mom. It’s a way to wear down her confidence. It’s a way to slowly erode her desire to VBAC until she can’t, or doesn’t want, to fight anymore and schedules that cesarean or crumbles during labor and consents to a cesarean. The OB behaves as if you can only have one thing: a VBAC or a healthy baby. This philosophy makes the distinct connection between CS = healthy baby and VBAC = dead baby and, given those options, who would pick a VBAC, right? What insane woman would chose a VBAC if it meant her baby would die? But the fact is, 1 in 2000 VBAC babies have a “bad outcome.” (Landon 2004) But by stating that a healthy baby is the goal, the OB implies that “the VBAC issue” has to remain “flexible” and thus the seed of doubt is planted at the very first prenatal visit. Throughout the pregnancy, the OB nurtures this seed of doubt through VBAC consent forms, repeated discussions on the “risks of VBAC,” and even scheduling a cesarean at 40 weeks, “just in case.” Ultimately, the mom is lead to believe that she will get a “chance to VBAC” when in reality, her OB knows that all he has to do is refer to that seed of doubt to get quick consent to a repeat cesarean.
I can’t tell you how many birth stories I have read where the “supportive” OB starts out saying this and then the mom ends up with another CS after a barrage of scare tactics. Some women are able to fight, amazingly, like this woman, and others aren’t, which is what the birth story below illustrates. Note that the exact same tactics are used in both birth stories. The question is, will the OB be able to wear you down or not? Unfortunately, there are more stories that end just like the one below. The key difference I see between the two birth stories is that the woman who VBACed had a doula and she called BS on the OB several times.
But, it’s understandable that women, like the one below, would consent to a repeat CS. I can’t imagine being in labor and arguing with hospital personnel. And even if you know if the OB has a penchant for lying, how do you know when your baby is truly in distress or not? How do you know if that CS is medically necessary or not when your OB lies to you throughout your pregnancy and labor? No one wants a dead or injured baby and it’s a very sad state of affairs when OBs lie to us and play the “dead baby card” in order to get us to consent to another CS.
My heart goes out to this woman. Many women believe that just because their OB will “allow” them a trial of labor, that this means their OB is supportive of VBAC. However, OBs like this are the worst kind. The kind that act like they are supportive, but are not.
I’m going through her birth story for the benefit of other pregnant women seeking VBAC. I write about the stuff that happens in hospitals, but, for a lot of women, it’s really helpful to actually read a birth story where this stuff actually happens to a real, live birthing mom at the hands of a real, live OB.
This woman believed that she would get a fighting chance to VBAC, but there were so many red flags. I want to highlight these warning signs so other women will recognize them when their own OB uses the same tactics on them.
You can read the whole birth story here, but below is the nitty gritty:
On scare tactics starting the first OB visit:
I was instructed to read through the risks of VBAC and give in my consent in writing…. this during my first visit to the doctor. (Oct 26th 2007). I was very surprised at first, but didn’t want to rush at things… so postponed the decision making by a couple of weeks. All the while, my heart was set on the VBAC option.
Note that the form did not list the risks and benefits of VBAC versus the risks and benefits of cesareans. It only discussed the risks of VBAC. Now, is that true informed consent? No, it’s not. It’s a scare tactic. Plain and simple. What is incredible is, as we will learn, this OB is the “best VBAC OB in town.” Frightening that this is how the “best” OB behaves. This is why it’s so important to find a truly supportive OB or midwife.
So while I postponed my decision (rather I postponed handing over the written consent to the doctor), my gyno always seem to scare me with the risks and hardly highlighted the benefits of the normal delivery.
This is another red flag. If your OB is constantly trying to scare you about the risks of VBAC, this is not a supportive provider and the search should commence for a new one. If an OB is so preoccupied with the risks of VBAC, they will find some reason, valid or not, to section you.
Even before I gave my written consent on my preference I got a call from doctor’s office about scheduling my C-section for the 13th May. (my due date was 26th May). This irritated me to great levels. While one of the major benefits I was going to get by opting for C-section was a date of my choice, the doctor had deprived me of the same by just giving me one option. Besides, I knew that I was making good progress and could go in for VBAC.
Another red flag is scheduling a cesarean “just in case.” If an OB does this, they are not supportive of VBAC. Rather than giving you the opportunity to go into labor, they would rather perform surgery. This is not an OB who is supportive of vaginal birth period let alone VBAC.
After a lot of discussion with BP [her husband] and my family doctor, I opted for VBAC and gave in my written consent for the same. The doctor did not seem very pleased with the option though.
The fact that the OB was “not pleased” further illustrates how even though they gave the mom the “choice” to VBAC, the OB was not really going to support the mom’s choice if it was for VBAC. But, since the OB gave her the “choice,” the mom feels like she will really be given the opportunity to VBAC. What she doesn’t realize is that the OB will find some reason to section her. I can tell this woman is a nice woman and she trusts her OB. She really thinks she is going to be given the opportunity to VBAC and it’s very, very sad.
The following exams went smooth with the doctor saying that the baby had started to descend. But my cervix remained closed till 37 weeks.
This is completely normal for a cervix to be closed at 37 weeks. It means nothing in terms of when the baby will be born. The fact that the mom even mentions this makes me think she was told his information in the context of, “Well, your body isn’t even dilating, so we will probably have to have a cesarean.”
I was monitored for “Non Stress Test” for 2 weeks.
She does not mention why this is done. Were these tests performed simply because she was a VBAC? NSTs are notorious “fishing expeditions”… they find reasons to perform that cesarean. Whether it’s your amniotic fluid is low, your amniotic fluid is high, your baby is big, your baby is small… if your OB isn’t supportive, and anyone who routinely has their patients on NSTs from 38-40 weeks is non-supportive, they will find a reason to section you.
During my 40th week appointment, the doctor examined me and said that I had made no progress at all since 37th week. The baby’s position and the cervix measured the same.
This is absolutely normal. This does not mean that her body won’t go into labor. A woman can walk around at 4cm for weeks or her cervix can be totally closed and she can go into labor that night. This is not a “hard sign” of labor, but rather can be used as an indicator. But the OB is twisting this fact to make this mom think that “no progress” between 37 – 40 weeks is somehow abnormal and a “bad sign.”
She also scared me that the baby was big and it could be a very hard delivery for me. (my built is rather small)
This OB is slowly whittling away at this mom’s confidence. And the big baby card is a huge one. If you read my birth story, I had a 9lb, 10oz baby at home. And there are plenty of “small women” who give birth to “big babies.” This is simply yet another scare tactic this “supportive” OB uses. Even ACOG doesn’t recommend induction or cesareans solely because a big baby is suspected. ACOG’s Practice Bulleting No. 22 on Guidelines for Fetal Macrosomia published in the November 2000 issue of Obstetrics and Gynecology states:
While the risk of birth trauma with vaginal delivery is higher with increased birth weight, cesarean delivery reduces, but does not eliminate, this risk. In addition, randomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown. Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered…. Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.
Apparently our OB is willing to go against ACOG guidelines to scare this woman into another cesarean… and it worked.
I was just 6 days away from my due date and still there was no sign of labor and the baby was supposedly big … thats when my fears got me and we decided to schedule a C-section. So the next day was chosen for the baby’s arrival.
The OB wins. After months of non-support, scare tactics and, frankly, BS, this “supportive” OB finally achieves their goal: a scheduled cesarean. But then this mom gets a lucky break…
Anyways, we went to the hospital as per plan around 9:30am. I was hooked on to the monitor. As luck would have it, I started contracting within minutes. The contractions were regular and were about 3 mins apart. Yep … I started having labor contractions. The nurses who were monitoring me repeatedly started asking me if I really wanted to go in for C-section which was scheduled at 11:30am. They felt I was making good progress in the short span I was hooked. My cervix was examined and turned out I had dilated to 2 cms. All these changes in less than 24 hrs of my check up with the doctor.
As I said, the fact that her cervix was closed meant nothing.
The hospital nurse explained to me that I still had the option to change my mind to VBAC if I wanted. She said, that they could monitor me for a couple of more hours and see my progress. The idea suited me and BP (my mom was completely opposed to this idea) and we decided to wait for a few hours.
Yeah for supportive nurses! They can make such a difference! But, now more scare tactics, but they are of a different nature. They are scare tactics and outright lies tied to doctor’s convenience.
I got a call from the doctor immediately … I must say it almost sounded like a threatening call. She said if I didn’t go for C-sec at the decided time, she was not going to be available for the entire week and that some random doctor from the hospital. We still continued to go with the VBAC option.
And the OB caught in a lie, she was not leaving the hospital…
When I asked the hospital nurse who my doctor would be, she said your gyno has asked to be informed about your progress. She will continue to be there for you. So all the phone talk that the doctor had with me was just to scare me ?????
… isn’t that despicable? I can’t believe OBs lie like that and then show up without being completely embarrassed that they are caught in a lie. But this OB gets a buddy to go in…
A couple of minutes later, another hospital doctor came to examine me. She said though my contractions were regular, since this was going to be my first vaginal delivery, it could take hours before I delivered. She also confidently said that the baby’s head was big and the baby would be at least 8 lbs. She was sure it was going to be a very tough delivery.
This must be yet another “supportive OB” trying to scare her about pain, length of labor, and size of baby. Where is the support? And I love how the OB equates 8 lbs with “big baby.” ACOG doesn’t support cesareans for big baby unless the baby is at least 11 lbs. But, I’m sure this OB neglected to mention that.
She also said, she was not a specialist in VBAC and that my regular doctor was the best doctor in town. (even better than her). Basically she scared us
Yeap, her regular OB was the “best doctor in town.” What a sad fact for that town. And that final scare tactic worked… and even more lies from her OB… turns out she was available after all.
And there we gave in to the pressure and decided to go with C-section. I was wheeled to the Operation theatre within minutes and my doctor arrived in less than 5 minutes. (don’t ask me where she was all this while ….wasn’t she supposed to be unavailable after 11:45am??? )
And yet more lies revealed…
She was weighed to be 7.2 lbs and measured 19.5in (not a very big baby you said … well I thought the same too … so I was tricked to believe it was a very big baby).
This woman is not the first, and unfortunately not the last, woman to be tricked into a cesarean due to the “big baby” BS. It makes me so mad and sad.
Anyways she was healthy and that mattered most to BP and I.
… just like the OB set up the mom to think in the beginning despite the fact that a healthy baby can be born via VBAC or via cesarean. The fact that the “options” are posed in such a way to make you think otherwise is a disgusting word game complements of “supportive” OBs. They act as if the only way to have a healthy baby is via cesarean. At least, that is what they want you to believe.
I really hope that if you are pregnant, and your care provider is treating you the same as the one detailed above, you will look for a truly supportive care provider.
And to this mom, I’m sending her big hugs. I’m so sorry this happened to you. Yet another unnecessary cesarean.