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 Posted: Wed Nov 12, 2008 6:15 pm
I went in for my medical history appointment today and was told that the hospital (only one in town) recently changed policies and will no longer allow VBACs (Vaginal Birth After Cesarean) and requires that once a woman's had a c-section, they have to have it again. They said I can transfer to another hospital (out of town, which would be either 1 hour or 2 hours drive depending where I go) and that they would have to handle my prenatal care too. I can't have prenatal care up here and then deliver somewhere else.
I had my first delivery vaginally, the second by emergency c-section, and I really wanted to try delivering vaginally again this time, and hopefully experience what it's like without Pitocin. I don't know if I'd be willing to drive out of town for every appointment, or be driven, having hubby take lots of time off work (which is a financial burden.) And since my last delivery was preterm and she was SGA (small for gestational age) and in the NICU for a month, there are both advantages and disadvantages to delivering out of town in case it happens again.
Does anybody know why some practices forbid VBAC? Is it to cover their butt against lawsuit in case there's a complication? I've known of plenty of people to deliver vaginally following a Cesarean, but there's also the possibility that I'd do all I can to avoid one and wind up with an emergency c-section again anyway. I have other concerns I want to talk to my OB about, but this is already long and I know it may be a while before someone comes in to respond!
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Posted: Thu Nov 13, 2008 6:12 am
Not being an expert...
It might be because they worry that what ever caused you to have to have your first c-section might happen with this pregnancy. So, in a way it is covering their butt, but in a way they're trying to look out for what might be best for you and the baby.
Why did you need the c-section last time?
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Posted: Thu Nov 13, 2008 3:50 pm
According to Fit Pregnancy there are a number of reasons. Skimming the answer, it seems to be the small chance of uterine rupture, lack of insurance, inability to do 24 hour anesthesia, and inability for the OB to be by you 100% of the time are among the culprits.
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Posted: Thu Nov 13, 2008 4:30 pm
Last time I had a c-section because Amber was preterm, underweight, and wasn't handling contractions well. Her heart rate was dropping with contractions, signaling she was in distress and wanted out (she wasn't getting proper nutrition or growing properly for some reason,) and they didn't think she'd handle the labor and pushing very well. They say if she hadn't come out when she did, she may not have survived. neutral
I'm thinking that since this policy was kind of forced upon them by the hospital, and they resisted for a long time, that the staff in women's health don't agree with forcing this upon their patients, so I'm guessing it's less likely the last two reasons and more likely the first two. I'll ask when I go in again if they know the various reasons.
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Posted: Thu Nov 13, 2008 5:22 pm
I just read the article, and let me sum up what I understood of it. The small reason is that there is a 0.08% chance of uterine rupture, but more importantly The American College of Obstetrics and Gynecology requires that in order for a hospital/practice to do VBACs, they have to have both a 24/7 anethesiologist and the obstetrician there during the entire labor in case of emergency c-section (I guess that's what would have to happen, and quickly, in case there was a rupture.) Some hospitals cannot afford a 24/7 anethesiologist, and OBs usually come and go during a woman's labor and aren't there the whole time. A lot of insurance companies say that they'll only give the hospital insurance coverage if they meet these requirements, or if they won't do VBACs at all.
This hospital has always been kind of behind standard (you'd think with all the technology in this National Lab town, and all the money and scientists, some of it would do to their medical facility, but it seems to be the opposite!) so it kind of doesn't surprise me that I'd need to go to Santa Fe or Albuquerque to have the care I want (they had to fly Amber to the NICU in Albuquerque after she was born, and she was there a month!) But I think I'm feeling less and less confident that I'd wind up with a VBAC even if I did everything possible to try to get one. Who knows if this baby will have the same slow growth problems, or any other reasons.
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Posted: Sat Nov 15, 2008 7:02 pm
I share your sentiments about c-sections. I know they are life-saving and can be very important, but to not be able to give birth in the environment and circumstances you want has got to be very hard. Even understanding the reasons behind some doctors/hospitals deciding not to allow VBAC's, it's still hard to accept.
Personally I hope to have a water birth when I have kids, but living in a small town means small hospital, and since I work there I know they have no such thing available in the delivery ward. I'd have to travel to the city, or try to have a home birth with a midwife. I'll see if the local midwives have more information available, but I don't feel warranted in taking up their time to ask them before I'm actually pregnant.
MysticfawN, I hope your can get the birth you want, even more so, I hope your baby will be in tip top shape and get to go home with you the next day. smile
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Posted: Tue Nov 18, 2008 8:20 am
Thanks Gemstone. smile I'm hoping to have more of a regular uneventful time with this one too like I did with my first. Even if I have another c-section, having it on time and with no complications and being able to take baby home with me would be much easier! At least with a c-section, I can ask the OB to put clips on my tubes while she's in there, as I think 3 is my limit! Then I won't even notice that additional procedure.
My older sis wanted to have a water birth, and our hospital didn't have them either, so a few days before giving birth, she up and decided to go with a midwifery 3 hours away. She tried the water birth, but the warm water slowed her contractions and she wound up giving birth on the bed anyway. But she still liked the relaxed feel of the midwives and didn't want to be in a hospital.
I was up for the idea of an accidental home birth (or car birth!) with my second one, but with the way she was, that wouldn't have worked because she needed some major resuscitation afterward, so I'm not willing to risk it this time!
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Posted: Wed Nov 19, 2008 12:03 pm
That's weird that they absolutely say no. I've heard it be suggested before that you only do c-sections after you've had one, but I've never heard it as a rule. I know it's a good idea to continue with c-sections if you've had more than one, but if you've only had one I didn't think there'd be a problem with it. Huh.
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