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Saturday
Mar062010

Why VBACs Should Be the Norm, Not the Deviant Care Pattern

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Guest post by Allison Phayre, Ph.D.

 

 

There are so many problems with the “best standard of care” according to obstetricians.  My experience is so typical.  I assumed that my medical care was evidence-based, and that the advice given to me by my OB was based on what was best for ME & MY BABY, not what was best for HER.  I was dangerously uninformed, assuming that my doctor had my best interests at heart…I WAS WRONG.  And it happens every day to so many women.  It doesn’t matter what level of education or socioeconomic status a woman holds—the minute she entrusts her care to an OB following the “best practice” model, she signs away her right to her intelligence, her possession of her own body, her health, and the best interests of her family. 

Because I was a sheeple, I followed along with my OB’s advice to have my 2nd child via c-section, even though the ONLY REASON GIVEN was that he was “measuring big”.  It did not matter that I had successfully birthed my first child of 8 lb, 10 oz two years prior—now he was “too big” for me to birth, and I was fear-mongered into a c-section with discussion of shoulder dystocia.  I hated it.  Words cannot express how violated I felt, and how disconnected I felt from my son.  My arms were strapped down, and I felt trapped.  I was not allowed to wear my glasses in the OR, and never got a good look at him when he was born.  They took him away to the nursery, and even though they told me they were going to do this, I did not realize how it would make me feel.  All I wanted was my baby, and they kept him from me for over an hour.  I just wanted my child, and I had to wait, alone, in the OR, while they stitched me back together…my husband was with our son.  They bathed him without me, weighed him without me.  When I finally got to hold him, I wondered whose child this was—he was all cleaned up, and I just did not feel like this was the baby who was a part of me for nine months.  Looking back, I see how it impacted my bond with him.  I got so frustrated with him when he was gassy as a newborn—I had to let my husband take over caring for him several times in the middle of the night because I just didn’t care why he was crying.  I was NEVER like that with my first child.  I am sure in retrospect that I was suffering from postpartum depression.  I now had a ‘fat shelf’ over my scar, and I was horrified to discover that if I didn’t carefully dry off my skin, I developed yeast rashes.  My own body had been deformed permanently by this decision.  Wow.

With my third child, I desperately wanted a VBAC.  I read and read and read…I knew it was the safest, best choice for me and my baby.  My OB, the same OB, said she supported me with my VBAC plans.  I should have known better, and should have sought care elsewhere.  But then we hit 36 weeks, and after an ultrasound I was told that again my baby was “too big”, and she “wouldn’t allow me” to have a VBAC attempt.  I was SHOCKED.  Did this woman not already know that I had big babies?  8 lb 10 oz for my first at 37 weeks, and then my c-section birth of my son, who was 10 lb 4 oz.  So how was it that I was allowed to think that she would support me in my VBAC plans when all along, she had the evidence right in front of her that my third baby was probably going to be “big” too?  I was left scrambling at 37 weeks, trying to find someone, ANYONE, who would let me try a VBAC.  All I wanted was the safety provided by the hospital in case I was one of those very rare women who have problems.  And NOT ONE OB within 2 hours of me would take me as a patient at that late stage of pregnancy.  Even the perinatology group that my OB (after professing her shock that I would still want a VBAC knowing how “big” this baby was) referred me to, would not accept me as a patient.  I had an emotional hour long meeting with my OB and my husband, where he clearly outlined the EVIDENCE that I had read about how much safer VBAC was, and how concerned I was about possible health effects of c-section birth on my baby (increased risks of allergies, asthma, eczema, etc).  And my OB told me she “didn’t believe” the studies in the medical allergy journals about asthma, even though she hadn’t seen them herself.  And she admitted that her rationale for denying my VBAC attempt was based on fear of litigation and restrictions from the hospital and her practice.  I am still boggled at this admission, that the medical care she provides to her patients is dictated first by insurance and hospital policy, and not by medical data.  WOW. 

I lost sleep.  I was so stressed there was no way I was going to go into labor naturally—and what options did I have?  I knew of no midwife who would attend a homebirth VBAC, and my husband was terrified that something would happen and he would lose me & the baby.  I could try to labor at home, not knowing if the baby was doing okay (we wanted fetal monitoring in labor), and show up ready to push and insist on the opportunity.  But what women need in labor is support, not arguments.  And I had to face this terrible surgery, knowing that the risks fall more heavily on me, the mom—and I already had two living, breathing kids who needed me!  How could anyone ask me to willingly make a choice that I KNEW was riskier for me, when I had those other children to consider?  It’s as if any living children are irrelevant to these decisions, and only the baby is important!  And that is just WRONG!  I was so afraid of feeling disconnected again from my baby, I couldn’t bear the thought of this surgery. 

Eventually after much heartache and prayer I consented to a repeat c-section with my daughter.  But I was not done fighting.  I fought to have a better birth, even if it wasn’t what I knew was the best choice by the data.  I insisted that my daughter remain with me after birth.  I insisted they not clean her up, and that my arms were free to hold her, and that I wore my glasses so I could clearly see her.  They did no weighing in the OR—the doctors had to go without knowing her birthweight.  She was wrapped up in warm blankets, and my husband held her next to my head so I could touch her and talk to her and kiss her while I was stitched back up.  And I held her in my arms, ME, while I was wheeled into recovery, and I started breastfeeding her right away.  And it was better, but it still wasn’t right. 

Now my third child is seven months’ old and I find myself thinking, maybe I would be up for having a fourth child…maybe our family isn’t complete yet.  But I am given severe pause due to my two c-sections.  I worry about the increased risk of complications for me and any future baby.  It’s not an abstract risk.  My sister-in-law miscarried at 19 weeks with her third child, due to her baby’s placenta implanting on her scar tissue.  They are real risks, and they are scary.  And it makes me sad that I am forced to think about constraining my family’s size due to these risks.  I don’t know if we will try to have a fourth child, but the fact that that choice has been severely impacted for us, is another unnecessary side effect of unnecessary cesarean births.  I am still angry at that OB for practicing medicine the way she does, and I am mad at myself for not educating myself sooner, for not saying no to that first c-section and waiting to see what my body & baby could do.  I am working on forgiving myself, and on healing from the effects of surgeries.  I no longer see that OB.  I have switched practices to another OB with a much lower c-section rate, and a birth philosophy that more closely matches mine.  Maybe I will have a fourth child.  In my area, I don’t know if I can fight for a VBA2C.  However, I think my chances are much better with a different doctor who seems to put her patients first.  

And that is why we need to reform our maternal healthcare model.  Because medical care should be about caring, not about processing people like they are sheep.  All medical care should be evidence-based, with the best interests of patients put first.  I am a Ph.D. scientist, and when I worked in a lab (now I teach, to spend more time with my children), I was not allowed to change how I did things just because it would be easier for me, or my administrator told me to do it, or it would be more convenient for our lab if it worked a certain way.  I had to make decisions on how to proceed based on evidenceMedical care, of all types of science, ought to be based on evidence!  If I am required to practice science according to the data, then how much more so should a doctor be required to practice medicine according to data? 

I hope my daughters will have a better maternal care system in this country, when they are old enough to birth their own children.  The complete miracle of birth and new life has been lost by the obstetrical profession as a whole, and that is just another clear indicator that a reevaluation is needed.  Maybe if enough women speak up, we can effect that change. 

 

Submitted to the ICAN VBAC Blog Carnival

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Reader Comments (9)

thank you for your story here! i, too, feel powerless against the big machine of medicalized birth. i think stories like yours add to a growing cry of rage that will make a difference!

March 7, 2010 | Unregistered CommenterKaty

Thank you so much for saying this! Women need to educate themselves before they become pregnant, caregivers need to be educated, and all care choices need to be suported by our peers, by insurance companies and by law. Birthing women deserve at least the consideration outlined in a Patient's Bill of Rights.

I hope many women read this article in time to improve their own birth care. We need to stop allowing the false adverstising that so many OBs do--I'll support you, I'll support you, oops--no, I won't!

I wish you healing and peace and joy in your babies. Congratulations on working to keep another generation of women from being bullied into this abuse!

March 7, 2010 | Unregistered CommenterRosanne C

I LOVE your website. I had a traumatic birth experience ending in an emergency cesarean with my second child because I let myself be pressured by a militant and inexperienced doctor (who was not present at my induction and did not perform my cesarean). I will NEVER consent to an induction again barring proven medical necessity, and I don't mean what some doctor's opinion is. If they don't show me on an ultrasound that my baby is actually in danger, my next child is (hopefully) going to be an unmedicated VBAC. The worst part of this is that I was very educated about labor and birth, and I am the product of a homebirth myself. I hate to think about all of the women who allow themselves to be told that a Cesarean is the only way. Thank you for being an educator and advocate for women everywhere!

March 7, 2010 | Unregistered CommenterSarah

Thanks for your story. I"m sorry your OB wouldn't support your vbac and that other practitioners near you wouldn;t help either.

Here's an interesting article you might enjoy from today's New York Times on vbacs:

http://www.nytimes.com/2010/03/07/health/07birth.html

Hopefully the rest of the nation takes lessons from this Navajo hospital.

March 7, 2010 | Unregistered CommenterMaureen Moloney

This post is totally me - having two sections (although I did VBAC in between) and wondering, "Is there a fourth out there? Do I want another child for the right reasons?" I know how hard it would be to find a care provider willing to fully support me, not just pretend to. And yet, I thought maybe if I did have to have another c-section, it would be like this mom did - insist on things done on my terms, like holding the baby, nursing right away - there is NO reason they can't let you do those things already, in most cases. It's complete garbage the way they separate mother and baby, and has been shown to have NO meaningful value but in fact can do HARM. And yet they still do it. WTH?!

March 7, 2010 | Unregistered CommenterThe Deranged Housewife

I can't express how sad and scared these stories make me, how suspicious and downright hostile to OBs I've become based on them and on my own experiences. I'm actually *afraid* to put myself in their hands and in the hands of a hospital. And it isn't their complete ignoring of evidence-based care that's the worst of it for me, it's the abuse and bullying they heap on you for daring to want to conform to medical evidence. I'm particularly outraged that there appears to be no OVERSIGHT MECHANISM. These OBs are essentially engaged in MALPRACTICE every time they chose hospital policy or personal fear of litigation over evidence-based care. The ACOG is hardly woman friendly or birth friendly, but even their moderate recommendations are routinely ignored by OBs everywhere - and NOTHING is done about this. Where is the oversight? Is an OB allowed to do whatever s/he wants as recklessly and thoughtlessly as they can until their malpractice starts killing babies? It's ridiculous. And in return midwives and homebirthing moms are treated like garbage for daring to follow evidence-based guidelines and procedures. (As a sidenote, I just had an appalling experience myself - had to go to the hospital for a really nasty stomach bug and severe dehydration and was treated like a pirraha by the OBs because I was visiting another state. Thus I didn't have a local doctor, and when they realized that my "doctor" back home was a midwife (a CNM affiliated with an OB and a hospital, mind you) they 'punished' me in all kinds of ways from belligerent questions to disbelief that I had received prenatal care to undertreating me.)

My cousin is going to have a baby in a few weeks and the doctor is already started to give her "warnings" about her baby being too big. Now she and her family are all worried about this "problem" (in spite of the fact that they did the same thing to her sister, who was induced and whose "huge" baby ended up being six and a half pounds!). I can see already she's being set up for a c-section, or an induction at least and they will go along with it because they don't know about evidence on suspected fetal macrosomia. It's disgusting. I'm praying that she and her baby are fine when all is said and done. It makes me so angry.

March 8, 2010 | Unregistered CommenterErin

I'm so sorry you OB did this to you. I wonder if you can shed some light on a question I've had for a while. You said you didn't want to labor at home until you were ready to push to avoid the c-section. Did you consider waiting for labor to start naturally, going to the hospital and just not consenting to a c-section? I'm sure that would have meant a lot of battling with the doc to continue to say no, but I wonder what she and doctors like her would do if more of their patients started telling them "no". "No I will not schedule an induction or c-section", "No I will not consent to this [intervention] because of the risks", etc.

My only c-section experience is different because I had a planned homebirth that turned transfer. There was no emergency, my baby was safe and I had wonderful support from my midwife and labor nurse to continue laboring. However, I told the attending OB I wasn't ready for a c-section 3 or 4 times before I consented (I had pushed for 3 hrs and was just DONE with labor).

I think the doc was surprised the first time I said I needed to discuss it with my husband, but each time he said, "It may be time for a c-section," my support team and I pointed out the baby's strong heart rate, and my continued dialation and said, "Not yet." I really wonder if more women and their support people started calmly saying no, more doctors would have to start listening.

March 8, 2010 | Unregistered CommenterOlivia

Thank you for this post. I continue to learn and be horrified by the way that women are pushed into c-sections. I had my baby at a birth center, and was measuring 41cm at about 37 or 38 weeks. I also just looked HUGE, to the point that all of my co-workers were saying there was no way I'd make it to my due date before giving birth (I went 3 days past before going into labor). So I have a sort of "there but for the grace of G-d" feeling about your post. I'm so glad that I had supportive midwives who weren't trying to scare me into thinking my baby was too big for me to birth. We are so vulnerable, especially as first time mothers going through it all for the first time, it's just so disheartening to hear how doctors take advantage of that.

March 8, 2010 | Unregistered CommenterEmily

<<And I had to face this terrible surgery, knowing that the risks fall more heavily on me, the mom—and I already had two living, breathing kids who needed me! How could anyone ask me to willingly make a choice that I KNEW was riskier for me, when I had those other children to consider? It’s as if any living children are irrelevant to these decisions, and only the baby is important! And that is just WRONG!>>

Not to hijack the comments, but this attitude exists because we're moving to a world where parents don't matter...all they do is mess up their kids anyway, right? In Europe and the UK, there's a huge fight brewing over homeschooling, and even parents of under 5's are persecuted for not taking the entitlements granted by the gov't and putting their kids in daycare, choosing to stay home instead. This is kids UNDER 5 we're talking about...so not even school age...being visited by social services because they are not using day care services. You see, just as Monty Python movie told the woman she was not qualified to give birth, it seems that we are moving to a world where parents are not qualified to raise their children (even little ones)....and in that world, mom surviving the birth or ending up healthy truly doesn't matter.

And *that* right there is why birth matters, even for those that are done having kids. If we allow mothers to be devalued in the way they are currently being it (a) affects our daughters and DILs and (b) affects our rights to raise our kids in a non-mainstream way as well. It's a huge feminist /women's rights issue...I hope as discussed in previous posts we can move to getting all these groups together.

Allison ~ I'm sorry for your experience....if they'd do this to you, who have a PhD (so they'd know you had the background to find out when they are bs'ing you), then who *wouldn't* they do it to?! I'm so, so sorry.

March 8, 2010 | Unregistered CommenterRachel
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