Tuesday, May 5, 2015

What If I Say No?

I really like my ob's office. They've been great about working with Dr. Braverman, continuing to prescribe necessary medications, referring me out when needed, and getting me in for appointments. I originally picked them with my twin pregnancy in mind. I knew I wanted to deliver at Crouse Hospital where they have a level 3 NICU. I asked multiple people (including my primary doctor) for recommendations. The overwhelming response was this practice. 

The practice has 5 drs in it, 2 of them being men. The youngest and newest Dr in the practice was the one to deliver my girls. Even though she wasn't my favorite, she did a great job and would even track me down in the NICU to check up on me the days after delivery. 

All in all, when I look back I know I want this delivery to be nothing like my last one. Getting into a car accident and being on Lovenox all meant I needed a emergency c section under general anesthesia. I think having the most conservative doctor on call that day also dictated the way things went. 

I'm not going to lie, recovery was rough. I'm sure part of it was that I was in a car accident and was super sore from that, but it was so much worse than I expected. I remember thinking that first night (and beyond to be honest) that I was so grateful someone else was taking care of my babies. 

I'd say it took me two weeks before I felt like I could move in bed without abdominal pain or ride in the car without wincing in pain every time we went over a bump. I also stayed 5 nights in the hospital.

Recently I found out about a group called ICAN. This stands for the International Cesarean Awareness Network and one of their goals it to prevent unnecessary cesareans. As crazy as it is, this international group was started here in Syracuse, NY. 

I've been in contact with one of the leaders as she teaches both pre-natal and mama baby yoga classes that I have attended many times. She attempted a home VBAC (vaginal birth after cesarean) this past fall. She ended up being transferred to the hospital for delivery, but didn't have a c section. She also didn't go into labor until she was 42+ weeks. When I found out I was pregnant I contacted her and we got together with our kiddos for lunch. 

She gave me the name of providers that were known to be VBAC friendly. At the time, I was still really early in my pregnancy and under the care of Dr. Braverman. I wasn't ready to make any changes to my care due to my level of comfort with my current provider. 

A few weeks ago I attended my first ICAN meeting. They showed a documentary called Trial of Labor which really resonated with me. The biggest take home message I got from the movie is that the provider is the biggest factor in VBAC success.  

With each of my appointments I've mentioned it. I've tried to talk to all of the different providers in my office to get their opinion. Basically, what I've been told is that if I make it to 41 weeks they will want to schedule a c section. Induction options are limited due to the risk of a uterine rupture, and to be honest, I don't want any unnecessary interventions. 

I don't think I realized how traumatic the birth of my girls really was to me until I watched that documentary. They didn't allow my husband in the room so neither of us heard them cry for the first time or saw them enter the world. The anesthesiologist held his hands on my throat as I went under to "keep my airway open", and I woke up disoriented and in a lot of pain. I wasn't able to see my girls for hours after they were born and wasn't able to even hold Lucy until the following day. I'm not sure I'd remember those first encounters if it weren't for the pictures. 

I know this time around, if I can control it at all, I don't want my birth experience to be like that. 

So, I started calling talking to more people and calling other providers last week. I found another practice that was highly recommended that delivers at Crouse Hospital but is also extremely VBAC friendly. They have an 80% VBAC success rate. I've even heard they try to avoid using the word cesarean. So, I sucked it up and called on Friday. I was so bummed and discouraged when they told me they weren't accepting any patients delivering between May and October. 

When I heard that I started thinking. I remembered that one of the Drs in that practice is also a member of our local Multiple Mom's Mingle Group. So, on a whim I wrote her a private message on Facebook. She said she likely wouldn't be able to help to get me in, but we discussed my impressions of my practice and then some alternatives. A few days later I got a new message from her stating that she spoke with her nurse manager. She gave me her name and told me to call her on Tuesday. I haven't made that call yet but I hopeful I may actually be able to get in there. 

So, yesterday I had another appointment with my OB to get a B6 injection. I was very upfront with the Dr I saw and told him I was debating switching practices. I asked him what would happen if I reached 41 weeks and so no to a scheduled c section. He then told me they couldn't make me do anything I didn't want. He said they would likely have to monitor me more closely with non-stress tests and inform me of the risks and document that in my chart. In those 5 minutes he used the words "stillborn" and "expired". They couldn't refuse to treat me even if I refused their recommendations. 

I'm not sure how I feel about it all. I joked to W that I'm going to feel really dumb for making such a big deal out of all of this if I go into labor on my own before that 41 week mark. But, ultimately, I know what I want for myself and this baby and I know I don't want surgery if I don't have to have it. The thought of taking care of an infant, establishing breastfeeding, and also caring for my toddler twins while recovery from surgery is daunting to say the least. Don't get me wrong, I'm not opposed to a cesarean section is it's necessary. I just don't want to sign up one. 

I know another step I need to take is finding a doula. I've gotten a few names and plan to research that soon as well. 

In addition, I have an appointment scheduled with another VBAC friendly provider in Syracuse (according to ICAN) for this Thursday. I hope to speak with a few different doctors and pick the one I feel I am most comfortable with and that will best support my personal decisions. Why is this so difficult?


  1. I have very mixed opinions about VBAC. I do believe that when the time comes you will know what to do and make the best decision for you and baby. Regardless if it is VBAC or c-section. Wishing you the best of luck.

  2. "I'm going to feel really dumb for making such a big deal out of all of this if I go into labor on my own before that 41 week mark." <-- THIS is exactly why you should switch to a different provider. Your worries are not dumb. Your concerns are valid and important. Decisions should not be made out of fear instead of evidence based care. I'm so excited for you as you look into this!

    Also, reach out to A (https://mellowinthemidwest.wordpress.com/2013/07/26/vbac-birth-plan-in-progress/) about VBAC. She had a fantastic VBAC experience with a 11#9.5oz baby girl at 41w2d. She'll have lots of great info for you.

  3. I think it's great that you are exploring all your options. I don't understand why W wasn't able to be in the room for the girls' birth? That would be sad to me too. I hope that you are able to find a provider that will make you feel very comfortable, no matter what you decide, even if you ultimately decide to stay exactly where you are at.

  4. Repeat cesareans are no joke, I'm glad you're looking into and open to your other options. Out of the thousands of families I've worked with at this point I can only think of two bad VBAC outcomes (for mom or baby, I'm not counting having to have another cesarean as a bad outcome obviously) but too many to remember the total bad repeat cesarean outcomes. If nothing else it is smart to do research, ask questions, and get second opinions.
    I'll be thinking of you as you navigate these waters. I hope you find a provider who can have more respectful dialogue with you and really acknowledge the validity of your concerns.
    Also re: language around cesarean sections, I try to use the term "cesarean birth" or "c-birth" when talking with the mamas at work and other providers. I think it's a subtle shift in language that portrays that no matter how babies enter this world it is a birth, a start to a new life.

  5. Hi Liz - Josey sent me your way. I had a traumatic C-section with my first, though I was awake during it, so not quite as scary as yours. I was able to have an unmedicated VBAC with my second and it went better than I hoped it could. Part of that was I did a ton of interviewing OBs/midwives early on. My first OB encounter was similar to yours with "well you can try for a VBAC, but we really like to have the epidural in place because you'll probably need a C anyhow." Also, the doc didn't acknowledge my husband in that first appointment. I ended up finding an OB who was in a midwife practice. Other than my first and last appointment all of my prenatal care was with midwives and an on call OB delivered me but my doc was in the hospital, just in surgery at the time.
    After talking VBAC, what is your success rate, etc... all of my conversations in the initial appointment were in that "what if" place. Because while I delivered at 38.5 weeks I could have gone to 41.
    We talked induction possibilities. We talked risks of going beyond 41. And the greatest thing the OB I went with did was I was measuring 3 days ahead at the appointment with her, so she officially moved my due date giving me 3 more days (normally they don't move unless off more than a week).
    We talked about family friendly C-section, where I would get skin to skin in the OR. And unless a medical emergency the baby would not leave my sight.
    And I hired a doula who had VBAC experience and had worked with my doctor before (her VBACs were not with my doc - couldn't find that) and that was the best money I ever spent.
    I wish you all the best. It's really hard to find a doctor and it shouldn't be. Please feel free to email me if you have more questions or want to see the birth plan I came up with.
    (sorry if you get this multiple times)

  6. Your instincts have been RIGHT ON soooo many times - don't doubt yourself now. You want a different birth experience - and their are professionals (doc AND doula) out there who will support you and help you make that happen. It is wonderful you are looking into this now.

  7. whoops - "there are professionals" ;)