Saturday, March 19, 2011

My Uterus, My Choice: Part 2, The Unnecesarean

Can you believe I made it to 35 weeks of pregnancy without a single VBAC mention? I'm surprised. Especially since I was obsessed with the idea throughout my last pregnancy. It was all I could think about, all I could blog about. I'm still pro-VBAC-for-Margaret and plan on attempting a vaginal delivery in a few weeks, but since I've done it once before the pressure to have a successful VBAC this time around is not quite so intense. At least that's how I felt until my doctor's appointment the other day.

Time for anyone who is not pregnant or marginally interested in VBACs to tune out.

Let me start by saying that I really love my doctor. He has promised me that, for the most part, he'll treat me like any other patient, i.e. one who hasn't had a cesarean before. He supports my decision to have a VBAC and feels confident that I have a good shot. Unlike other pro-VBAC OB/GYNs (who are few and far between), he is willing to let me go past my due date and is even willing to use very small amounts of pitocin if my labor stalls out. The problem is that he can't guarantee that he'll be on call when I deliver. He shares call duty with several other doctors, two of which will not deliver a VBAC under any circumstances. If I happen to go into labor and show up at the hospital with one of those doctors on call, well frankly, I'm not sure what would happen. I know I have the right to refuse a c-section. I think that doctor would have the right to refuse to treat me as their patient. We'd be at a standstill. I'm not sure what would happen at that point. Anyone care to speculate?

I've danced around the subject with my doctor. He suggests laboring at home for as long as I can and coming into the hospital at a point of no return. As in, this baby is coming out vaginally whether you want it to or not. Which scares me. I don't tolerate pain very well. He also suggests calling the hospital when I go into labor to find out exactly who is on call and when the shifts change. It's disheartening that I might have to do this. In an ideal world (one free of petty law suits and crazy Michael Jackson doctors), I'd be able to show up at the hospital ready to have the birth experience of my choosing. I wouldn't have to worry about who's on call, which forms I can and cannot consent to and whether or not a doctor will "dump" me over something his or her malpractice insurance doesn't cover. I'm interested to see what happens.

In the meantime, I've got a few weeks left with the doctor I like. My doctor. The one who refuses to give me his cell phone number and home address. What?!? I can't show up at his house in labor and have him personally deliver me right then and there? Maybe I'll get lucky and he'll be the guy on call and all this worrying will be for naught.

Yesterday, he apologetically asked me to sign that damned informed consent...

Initial here if you understand that I have the option of an elective repeat cesarean or to attempt a vaginal birth after a cesarean (VBAC).

Initial here if you understand that the risk of uterine rupture during VBAC in someone like me who has a prior low transverse incision is around 1%.

Initial here if you understand that VBAC is associated with a higher risk of harm to my baby than to me.

Initial here if you understand the risk of your uterus transforming into a baby consuming alien from outer space resulting in hysterectomy, blood transfusion, infection, injury to internal organs, blood coagulation problems, death and major embarrassment.

After about the 20th initial, you can't help but have some doubts. Especially over that "more harm to the baby than to me" one. That one kills me. But I still feel like it's the right decision for me, for my baby, for my family. It's not right for everyone. I've had friends/family opt for the repeat c-section over a VBAC. I've had friends opt for an elective c-section over the possibility of delivering a large baby. I've had countless friends/family who have had successful inductions. I've had incredible superwoman friends who have opted for drug free deliveries. To each her own. The point is, shouldn't YOU be the one to make an informed decision about your birth experience and not a doctor, particularly not a doctor you've just met for the first time?

If you're someone who has previously had a cesarean, I highly recommend checking out the ICAN (International Cesarean Awareness Network) site. It's not just for potential VBAC candidates. If you're pregnant and expecting to deliver soon, check out some things you can do to avoid an unnecessary cesarean. And if you're still reading at this point, here are a couple of interesting articles about the concept of defensive medicine, one from a doctor and one from a patient. Knowledge is power, ladies. I plan on arming myself with loads of information and a good epidural once labor starts. Hopefully it will be enough to grant me the birth experience I want.


Melissa Proffitt said...

You go, girl. Good luck with having your own doctor around when you deliver. I've never regretted going for the VBAC (three times) despite having large babies, but I'm starting to be grateful that I was giving birth before this current insanity of C-sections uber alles.

Carbonneau said...

You can do it Margaret! way to keep yourself educated and to be completely non-judgmental of other woman when talking about what is right for you. What kills me is when woman think that their way is the best way and everyone else is making the bad decision. Way to stay positive! prayers your doctor will be there!

Cherise said...

Don't mess with the pregnant woman!! You can do it! I am sure it will all work out. I am excited for this baby to get here!

Emily said...

Just for the record, I think you are amazing. You will do great! Can't wait to see the new little guy and hopefully hold him (when you come visit). :)

Dan and Jan said...

You're 35 weeks already? Wow that pregnancy just flew by (for me). We'll hope for your doctor to be there when you need him. I'm glad you're not afraid to do what is best for you. Good luck!

Amelia said...

Would be interesting to find a study about the difference in midwife led care, almost all prenatal, delivery and postnatal care is done by midwives in this country (a recognised and trained for position) and I have had three very positive experiences with it. Good luck to you and may all go smoothly!