Take the time to get and read your records.  You may find that your “emergency” cesarean was no rush at all.

Medical Records Copying Charges by State

As I read this victorious, inspiring birth story, I kept on wondering if I would have been able to be as strong, fight as hard, and actually VBAC against the odds. 

She is pressured a couple times to augment her labor with Pitocin.  I find it so ironic that OBs and hospitals present VBAC as such a risky “procedure,” but then voluntarily increase that risk augmenting labor.  The Landon 2004 study found that uterine rupture rates for spontaneous (starting naturally with no drugs to hasten dilation) labor to be 0.4%, but when labors were augmented, the rates went up to 0.9% and when women were induced it was 1.0%.  (Click here for the chart.)  So, if 0.4% is already such a big risk, why increase that risk?  Especially when, as her OB ultimately admits, both her and her baby were fine, so there was no reason to “move things along” or perform a repeat cesarean.  Well, there was a reason, but it just wasn’t a medical one.  The clock was ticking and the OB had given her a “chance” to VBAC, but now the jig was up and it was time to be “realistic” and just have the cesarean.  Her story could have ended like thousands of other women who ended up with a repeat cesarean due to the unrelenting pressure, and sometimes lies, they received from their OBs and L&D nurses.

It’s a great birth story, and an excellent read, but if you want the quick version, I’ve included my favorite excerpts below.  This woman is a fighter and anyone who is planning a hospital birth can learn a lot from her experience!  I especially love her announcement of the baby’s birth.  She has such wonderful things to say about, and to, the hospital…

On lying to patients:

The new resident came in to check me and said I was at 5 cm.  I said “but the last doctor just said I was 7 cm – did I go backward?”  He said “No, that can’t happen.  She was wrong, you were never at 7 cm.”

On augmenting her labor:

Then, my actual OB came in to see me for the first time and started telling me that we needed to consider augmenting my labor or giving me another c-section.  Then I started getting panicky.  I could see where this was going.

On having another cesarean for the OB’s convenience & scare tactics:

He said something about him having been there “all day” and wanting to go home, so I told him he better go on home and come back to check on me in the morning because I wasn’t going to end my labor just because his day was over.  Things started to get heated and I couldn’t believe I was even having that conversation.  It was obvious that he was annoyed with me, but I didn’t care.  So then he started with the scare tactics – “but the baby is becoming tachycardic” and “your water has been ruptured for more than 8 hours, you both might get an infection.”

Pressure to augment, again, and more scare tactics:

… just then a nurse came in who completely ruined our mood.  She asked me if I had considered Pitocin to get things moving.  I told her I wasn’t getting Pitocin, and she started arguing with me.   She said I should think about getting the baby out healthy, and I told her he was healthy.  I watched his heart tones all night long and he was perfect.  Then she said “Well, I’ve seen fetuses with good heart tones be born with APGARs of zero” – meaning dead.  I got pissed.  I couldn’t believe this woman just tried to throw a “dead baby” scenario in my face, especially when nobody is in any danger.

On being “on the clock” and “your body doesn’t work:”

Around 10-ish, my doc came back and said I’d had enough time and he wanted to do an internal pressure catheter.  I told him I was making progress and he said I hadn’t because I had been 7 cm since 5 pm the day before.  Now, that didn’t even make sense because he was the one who agreed with the resident the night before that I had never gotten to 7 cm.  Now he was saying that I had “stalled” at 7 all night.  He was getting very heated with me and kept trying to say that I needed to listen to him.  He said that my uterus – I kid you not – “just might not work” so I needed to have a c-section.  He said I’d had enough time and my “trial of labor” had failed.  He said it was a case of “failure to progress” at which point I shot back “No! It’s a failure to WAIT.”  He wanted to do an internal pressure catheter to measure the strength of my contractions, and if they were adequate it would mean that they obviously weren’t effective so I needed to be sectioned.  The other side of the coin was that my contractions were inadequate, which meant that he would give me 6 hours for them to become adequate or I needed to be sectioned.  Well, I didn’t like either of his scenarios.  I told him I just needed for people to stop stressing me out and let me labor.  He thought I was being “reckless.”

On arguing during labor, intimidation, waivers, and more scare tactics:

After 10 minutes or so of arguing back and forth, I told him I just wanted more time.  He left in a huff, and came back about an hour later with another doctor, telling me he had spoken to every doctor at that hospital, along with a doctor from another nearby hospital, and the hospital administration and I only had one of two “options.”  I either had to sign the c-section consent form, or sign a “Waiver of Liability” meaning that the hospital was no longer liable for whatever happened to me and the baby.  I couldn’t believe he was standing there threatening me.  I know my rights, and I told him so.  Nobody could force me to sign anything. 

I couldn’t believe that there I was, having to deal with that while I’m trying to birth a baby.

John basically told him that I wasn’t signing anything, and that’s all there was to it.  The doctor then said that I was pretty much asking for my baby to be born with “cerebral palsy,” and started scaring John into submission.  He spouted off “statistics” to John about everything that may go wrong to cause us to have an unhealthy baby. 

After all the scare tactics, the OB admits that everything is really fine:

The doctor had finally cracked, admitting to John that Baby’s heart tones weren’t worrisome, and said that he’d leave me alone to keep laboring as long as I promised to let them intervene if anything did become worrisome. 

On “peaceful pushing” and questioning the motives of your OB:

Pretty soon, the room was filled with equipment and people; the stirrups were out, and the doctor was in position to catch the baby.  I had always hated the idea of pushing on my back, but there I was – feet in stirrups and nurses holding my legs back – pushing as hard as I could while the doctor yelled “PushPushPushPushPush!!” 

I couldn’t concentrate on anything except how scared I was of something going wrong, and I knew that I had to get the baby out before the doctor invented another reason to section me.

On the difference between vaginal & surgical birth recoveries:

Within a couple hours I was up showering.  The difference in recovery between a vaginal and cesarean birth is like night and day.  We left the hospital 36 hours after Jules was born (the earliest possible moment that they’d let us go) and at only 3 days postpartum, I feel almost completely back to normal.  No, I feel much better than normal.  I feel like Superwoman.

On the feeling of victory:

The sheer thought that I got my VBAC, after 2 years of c-section depression and a 38-hour hard fought labor, is completely overwhelming to me still.  I wish every woman in the world could experience this feeling, and I hope all other women in my situation are able to have their VBACs too.

Rock on The Feminist Breeder!!

http://thefeministbreeder.typepad.com/the_feminist_breeder/2008/05/jules-michael-birth-story.html

Want to know if your doctor has been subject to a board hearing or disciplinary note? 

Here is a link to the State Board sites for all 50 states.

She links to another great website: “The Big Push For Midwives, launched on January 24, is a coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states and the District of Columbia. The website includes a page with links to news articles related to midwifery-related legislative efforts, and a map of states [which I've copied below] where licensure is available or where legislation is pending. Licensure is currently available to CPMs in 22 states.”

There is also a page on The Big Push for Midwives website that lists birth resources for the following states: Alabama, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Michigan, Missouri, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, West Virginia, and Wyoming.  (Might be a good place to look if you want a VBAC and are looking for a VBAC supportive provider.)

The relevance of CPM licensure to VBAC moms?  More legal options.

From Wikipedia:

No state prosecutes mothers for giving birth outside of a hospital. However, midwives who assist at such births may be prosecuted in some areas.

In the early and mid 1900s, physicians pushed to have midwifery banned throughout the United States. Childbirth became very clinical with the mother generally subdued with leather straps and ether. In 37 states it is once again legal to acquire the services of a midwife. Many midwives continue to attend mothers in states where it is illegal, while efforts are underway to change the law.

Practicing as a direct-entry midwife is still (as of May 2006) illegal under certain circumstances in Washington, D.C. and the following states: Alabama, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maryland, Missouri, North Carolina, South Dakota and Wyoming.^[12] However, Certified Nurse Midwives can legally practice in these areas.

People wishing to have a midwife-assisted home birth in the United States should always research the applicable laws in their home state.

I know homebirth sounds like a radical thing, but I have heard story after story of women who would have never considered a homebirth until they started looking for a VBAC supportive OB only to find none and then felt trapped, out of options, and scared.  And so now these women, who would have been quite happy to birth in a hospital, are hiring midwives, regardless of wether it’s legal in their state, and having a homebirth VBAC rather than face the alternative, an unwanted, unnecessary repeat cesarean in a ‘VBAC ban’ hospital.

I hope this is going to be one of the factors that swings the conventional wisdom back to supporting VBAC because when enough women start birthing at home and that an impact is felt in hospital revenues, hospital administrators and OBs might start paying attention.  Unfortunately, by the time that happens, it might be ‘to late’ for the hospitals.  Enough women would have experienced the joy, peace, privacy, and safety of homebirth to never want a hospital birth again.

More options for women

The front page of the Jan. 20 St. Louis Post-Dispatch featured women birthing at home with midwives. The legalization of home birth midwives is a hot topic around the nation. States like Missouri and Illinois are considering licensure of certified professional midwives.

The Post did a great job highlighting birth choices. I would like to see the Belleville News-Democrat report a similar story regarding local birth options as well as how choices are becoming limited.

Do newspaper readers know that three area hospitals have banned vaginal births after cesareans, essentially coercing women into surgery? In December, the Centers for Disease Control reported the 2006 figures for births by cesarean at a national high of 31.1 percent. In 2005, 32.4 percent of births in St. Clair and Madison counties were cesareans. Local VBAC bans contribute to increases.

Perhaps with mainstream media coverage of a variety of birthing environments, more consumers will request choices. Many obstetricians today do not follow the American College of Obstetricians and Gynecologists guidelines or practice evidence-based medicine with regard to labor induction or cesarean delivery for low-risk pregnancies. If malpractice concerns preclude Illinois obstetricians and hospitals from practicing evidence-based medicine, women should be referred elsewhere.

Julie Herr

Belleville