Re: Why women choose VBAC (very long)
From: Anna Meenan, MD (annam@uic.edu)
Wed Oct 26 16:42:56 2005
Lori, I am truly sorry that you had a bad birth experience, and i agree
that the doctor should have rechecked the BP himself and the whole
scenario could have been different, but i resent your statement that
doctors are more concerned about malpractice than truly taking care of
the patient. Some doctors might have sent you home when the BP was
normal and no protein was found, but most of them would not have slept
very well the next couple of nights, wondering what your BP was doing at
home, wondering if you are one of those primigravidas who will go from
one questionably elevated BP to full-blown seizures with a dead baby in
a matter of hours. We are all concerned about malpractice AND taking
care of the patients, but while one doctor's questionable decision got
you an emergency surgery and a healthy baby, another doctor agreeing
with a patient's questionable decision can get his/her career ruined and
life savings bankrupted. It's amazing how quickly the intelligent,
informed patient will turn on the doc and deny making the bad decision
when things don't turn out just perfect. That is what we fear more than
anything. If you find a doctor who will engage in mutual discussion and
shared decision-making with you, treat him/her with great respect,
because they will often be going out on a limb for you, and at the very
least will be spending way more time with you than what your insurance
company pays them to do.
I used to feel much more strongly about patient choice, but it involved
me fighting with nurses, hospital administration, and insurance
companies, and with all the time i spent fighting the powers that be and
listening and hand-holding with patients, i got severely burnt-out. Now
i work one day a week at an outreach clinic and will deliver my last two
babies before the end of this year.
I hope you are still able to find a doc who will allow you to VBAC (my
advice: don't wait too long to have the next baby....it's getting harder
and harder to find same) and I hope your next experience goes better.
--
Anna Meenan, MD
At Tue, 25 Oct 2005, Lori Almindo wrote:
>
>Hello, I wanted to write you all to perhaps shed some light on why women choose to have a VBAC. I realize this is a posting forum for medical professionals, however I feel that if you can gain some insight into the mind of a woman who wishes to have a VBAC, you will be able to better understand your own patients when this issue arises. I will begin with some basic information. I am a 26 year old woman, married, well educated and I gave birth to my first child by cesarean on 1/21/05. We waited until the right time in our lives to get pregnant. At my 38 week checkup, the nurse in my OB's office took my blood pressure and it was 160/100, very high. This was the first time my pressure was high at all and my doctor had told me throughout my entire pregnancy that I was the picture of health. After the nurse left and the doctor came in I asked him to retake it and he said there was no point. I should just go over to the hospital for further testing. The hospital is across the street. I would like to say at this point that earlier in my pregnancy my doctor had mentioned scheduling an induction, just because, once I was 38 weeks, he likes to do that with all of his patients. I told him I didn't like that idea, while I am in no way a 'nature freak', I did believe that my baby should be able to pick his own birthday and come when he was ready. Once at the hospital, they tested for protein in my urine, there was none, and my blood pressure was back to normal, right around 129/72 (I have my medical records in front of me as I type this.) I also had very little swelling. A few hours went by and they continued to monitor me, everything was fine, my pressure never went up again. When I first got to the hospital it was 3:30pm on a Thursday. My doctor came into to see me around 6:00pm to see how I was. I figured when he saw everything was back to normal he would send me home and have me back to his office the following week to continue to monitor me or at the very worst have me stay
> at the hospital for monitoring. He said neither of those. He told me that he wanted to induce, because with my pressure being so high that one time, it could spike again and all of these terrible things could happen to the baby or I. I asked him about the possibility of just being monitored rather than rushing the induction, since I didn't seem to be in any immediate danger. He said he would rather induce. I started to cry, because I didn't like the idea of an induction. I had read about how difficult the contractions were and being a first time mom, I was scared. But I was always the type to be a 'good patient.' I trusted my doctor and didn't want to question him. If he said this was best, then it must be so. I was 70% effaced, and not dilated at all. I have learned since my c-section that given those statistics, I was not a good candidate for induction and with those statistics, most inductions will fail, leading to a c-section. My doctor never discussed with me that the induction could fail and that the result of that would be a c-section. He told me that with the induction, my baby would be out by the morning and that was it. So although I was scared, we went ahead with the induction. They used PG gel on me and started the Pitocin a few hours later. Throughout the night, my baby's heart rate began to drop rather drastically, and then come back up. They were concerned that the cord could be wrapped around his neck and they kept trying different positions, but nothing seemed to help. Finally at 5:30am, they stopped the Pitocin, assuming that he was having a reaction to the medication and they were right. Almost immediately after stopping the Pitocin his heart rate stabilized and it never dropped again. My doctor came in around 8:00am and said the only thing left to do was do a c-section for failure to progress. I only got to 1 cm. I couldn't believe that less than 24 hours earlier, everything seemed fine and now here I was headed into surgery. I want to share wi
>th you a woman's perspective of what goes on in the OR. First they wheel me into the operating room and it is very cold. There is music blasting in the room and everyone is going about their business talking as I lay there. I am alone. I am naked and laying there exposed for everyone in the room to see. Not exactly what I pictured for such a special moment in my life. My husband is not brought in yet, they almost forgot to bring him in until the doctor started cutting me and someone said "hey, go get the husband." My son, due to some sort of reaction to the Pitocin had actually risen up high inside of me under my chest and once I was cut open the doctor couldn't get him out. The nurse was laying her entire body on me and pushing as hard as she could to get him to come down. Eventually, the doctor had to use a vacuum to remove my son. His apgars were 6 and 8. The 6 was due to a heart rate under 100, irregular respiratory efforts, grimacing rather than coughing and blue extremities. He had to be bagged for a minute and a half. He came around just fine and other than being jaundice, he has never had any problems. After he was born, he was whisked away and I got to take one glance at him all bundled up already before he was taken away. My husband went with the baby (which I wanted) and I was sent to recovery, where I laid alone. I was shaking terribly from some reaction to the medication they had given me and was pretty much in la la land. I had enough sense to ask the nurse when she came what my son's apgar scores were, but when she told me 6 and 8, I had very little reaction due to all of the medication I had. Again, not exactly the beautiful birth experience a woman imagines. I was in recovery for about 2 hours and then sent to a room. Shortly after that I got to see my son for the first time, and found out the nursery had already fed him a bottle, just in case, even though I had made it very clear to everyone that I wanted to breastfeed my son. Holding him was diff
>icult due to the pain I felt in my stomach and breastfeeding was also very difficult to work around not applying pressure to my incision. He also had trouble latching on and the nurses were so busy, they were of little help. I stayed in the hospital for the next 4 days, with no physical complications and then went home. I suppose in a doctor's eyes, this was a routine c-section with a perfect outcome, baby and mother are fine. However, I see it COMPLETELY different. As a young girl I dreamed about the day I would have my first baby, how wonderfully magical and special it would be. I am also a realist and understand most of the time life doesn't work out the way we plan, but I can't help but question, did it really have to end up this way for me?? Why did the doctor rush the induction? My pressure never went up again, I had NO other PE symptoms, not even high blood pressure. What if the nurse took the pressure wrong? Why didn't the doctor retake it in his office? The weekend was approaching, did he have plans and not want to be bothered if something did go wrong? Did he have his own agenda and not really have my best interest in mind? Since I was younger, I imagined how the birth of my child would be, a beautiful moment where my child emerges from my body and is placed upon my chest for me to feed. Where my child is not taken from me, the only person he has known, and I can't see him for hours. Where he is not extracted from my body in a process where I have no involvement other than to lay there. I grieve that while I should have been the first to hold my baby, I was actually among the last. Virtually every staff member and family member got to hold him and be with him before I did. This was a deep and very primal loss, and it should not be underestimated by others. I have learned that biologically and emotionally, women are strongly programmed to interact with their children right after birth, to make sure their baby is all right, and to cement their prenatal bond
>. Losing this period after birth is a deep emotional wound, one which is difficult to heal. Not only was I deprived of not giving my baby his first meal, but also his first bath and his first diaper change and all of the other sentimental, but oh-so-important firsts. I also felt very disconnected from my son in those first few weeks after he was born. I have learned that this is very common among c-section mothers, and this of course causes great guilt. To not be able to see the baby emerging from my body, made it all in a way seem unreal or as if it's the wrong baby. The lack of that primal knowledge of feeling and seeing my baby emerge from my body, of holding it right away afterwards, of knowing that this is my baby, was devastating to our bonding process. I often felt more like a father than a mother. I felt like someone handed me the baby and said here is your child, just as you would show the child to a father, it didn't feel as though he had come out of me. I will FOREVER mourn those lost first few hours with my son. I should have been there with him and for him, I am his mother. Not some nurse, not a family member, not even his father, I should have been there. But I wasn't, because I was recovering from a surgery that happened due to medical interventions that I myself and two other doctors I have spoken with agree was unnecessary. There was no need to rush the induction. And now, here I am stuck between a true rock and a hard place. What do I do when I get pregnant again? Do I try my best to give birth vaginally, as nature intended? Do I have faith in my body that I can birth my child? Do I get the chance to experience the birth I dreamed of? To not lose the precious bonding time in those first few hours with my next child. To not walk around in pain for weeks from a healing scar across my stomach where I can hardly pick up my baby. To allow my child the opportunity to be born when he/she is ready, not when a doctor decides to cut me open and rip my chil
>d from me. OR do I elect a repeat cesarean where I can go through all of this again? I think not. And I know doctors are so quick to mention the uterine rupture possibility, but can you honestly sit there and tell me there are no risks with a c-section? What about infection, hemorrhage, injury to the organs, adhesions, risk of additional surgeries (hysterectomy), maternal mortality, premature birth, breathing problems for the baby and fetal injuries. It is difficult to find true honest statistics on VBAC, it seems it varies with whoever the source is. The consensus seems to be that there is around a 0.5% chance for uterine rupture after a low-transverse cesarean. According to the New England Journal of Medicine article published in July of 2000, the risk of uterine rupture when Pitocin was used was approximately double that of spontaneous labors. When prostaglandin was also used, it resulted in a 15 times greater uterine rupture rate than that of spontaneous labor. So the doctors out there who are so quick to sight uterine rupture and discourage their patients from a VBAC, I ask you - Were the bad outcomes you have witnessed from a VBAC preceded by medical interventions of PG or Pit? I am certain that when I get pregnant again I will not consent to any such medications. That is if I can get pregnant again. I have learned that after a c-section there are increased risks such as gallstones, appendicitis, entopic pregnancy, miscarriages, and possible infertility. All of this over ONE high blood pressure reading. It seems so ridiculous. And I realize that vaginal birth isn't all smiles and roses. And it can carry complications of it's own, but at this point all I know is what I have gone through with the c-section. The major rite of passage to birth my child that was taken from me. And there are thousands upon thousands of women who feel the same as I do. Google 'emotional recovery from a cesarean' and look at the results. Join the ICAN message board and read what all
>of the women on there have gone through and what their cesareans have done to them. Many women feel their cesareans were not necessary, that they were the result of too many medical interventions, and I believe that to be the absolute truth. Even in the cases where a true emergency occurred and a cesarean was truly needed, those women too, have a right to mourn the loss of the ideal birth of their child. They also have the right to attempt a VBAC next time around. So for the doctor who said that the inmates were running the asylum, I have this to say. I could very easily be your patient when I get pregnant with my next child. In the past, I would have sat their quietly and listened to everything you said and trusted your word, and your word would be all that I needed to make any decisions related to my body and to my child. But I have now learned that I make the decisions related to my body and my child. I will do my own research. Doctors are not always right and they DO NOT always have your best interest in mind. They have agendas. They have schedules that they want to keep. Weekends arise and they don't want to be bothered. They are more concerned about mal-practice than truly taking care of their patients. Of course this is not all doctors, but I will now approach all doctors in this manner. I will be demanding, and my husband will be demanding. I will tell you EXACTLY what I want from my birth experience and EXACTLY how I intend to get it. If a problem should arise, you and I together will make an INFORMED decision. You will not tell me how it is and that is that. And I ABSOLUTEY WILL NOT schedule a c-section. My child has to be in true danger before considering such an event, not just one high blood pressure reading, and not just some misreported statistics on uterine rupture. I want what is best for my child, most importantly, and for me secondly and a c-section is not it. I never used to be a difficult or demanding patient, but now I will be, and I just hope
> that by reading what I have written, you are able to better understand where women who want VBACs are coming from and why we are willing to except that small risk of uterine rupture. Why we are willing to use midwives rather than OB's, and some to have home births or completely unassisted births. We realize that birth is a natural process and should only be tampered with by doctors when absolutely necessary. Women suffer from their c-sections far greater than is recognized and I beg of you to please use caution when recommending a c-section. The emotional scar you will leave a woman with is far deeper and more painful than any physical scar could ever be.
>
>Sincerely,
>
>--
>Lori Almindo
>
>Some information has been obtained from:
>
>http://content.nejm.org/
>
>http://www.plus-size-pregnancy.org/CSANDVBAC/csemotionalrecov.htm
>
