NBC Chicago aired a story on November 12, 2009, about Jennifer Conneely, a Chicago-area woman who was fired by her obstetrician, Paul K. Rosenberg, at 40 weeks pregnant for refusing an unnecessary repeat cesarean.
In Jen’s birth story, which is posted on the ICAN of DuPage web site, Jen wrote that she and her husband were surprised to find out that Jen was pregnant with a sixth baby just five months after having an emergency cesarean at 34 weeks due to placenta previa.
Jen started her prenatal care with the same midwives who had provided her prenatal care for her previous three births and found out at her 20 week ultrasound that she had another low lying placenta and placenta was anterior:
What did this mean? [The midwife] said, let’s pray that this placenta moves up b/c a c-section isn’t the best option for an anterior placenta. Rescan would be scheduled at 33 weeks, and around 30 weeks, found out I had gestational diabetes. Oh great, something else to worry about. It felt like one thing after another. So 33 weeks rolls around and the placenta moved up to 2cm from a 1.5cm. Same exact situation that happened with my last. I was on high alert, freaking out thinking the same situation was going to happen. I went back to the doctor who had performed my c-section, which I thought were great. I was told by the nurse in the ER that “this doc wasn’t c-section happy” at the time.
Jen transferred care to an obstetric practice, Female Healthcare Associates, at 33 weeks and scheduled a c-section for August 28, 2009, which would have been just over a week before her estimated due date of September 6, 2009. However, things changed after her 33 week ultrasound appointment.
Well, at my 33 week ultrasound (I was having level 2 u/s at Hinsdale with the high-risk OBs) the baby’s head was measuring 4 weeks smaller than the body so one of the docs from my new practice wanted me to get an ultrasound quick in the office just to make sure everything was okay. Well the tech found that my fluid levels were at a 5.4, oh great another thing to add on to my list of problems. While she was doing the u/s, since I was now 36 weeks, I asked her if my placenta had moved any, and her response was, “ah it still looks a little low.” What kind of answer is that? So the doc now wants to check me for himself, says the levels are at an 8, but now I need to come in for NSTs twice a week and also fluid checks.
By 37 weeks, Jen’s placenta had moved and she got the go ahead from one of the doctors for a VBAC… with one caveat. The clock was ticking and Jen would need to give birth by her due date. Jen felt this was an unfair and unfounded expectation, and began calling different OB-GYN practices in an attempt to transfer care, but no one would accept her.
At 38 weeks, Jen was one centimeter dilated and 50 percent effaced and what she called the “scare tactics” began. By August 31, 2009, Jen was feeling contractions and had a very good feeling about going into labor before the cesarean appointment on September 4. Looking for support, Jen went online and met Gina from the DuPage chapter of the International Cesarean Awareness Network (ICAN).
On Gina’s personal blog, she described how she advocated for Jen.
I immediately got on the phone with the National Advocates for Pregnant Women. I wrote everyone from ICAN I could think of. I talked to the Illinois ACLU. I had half the reproductive justice community invested in her case. I did everything I could to find help - everything I could do to get attention to her case so we could find her an emergency provider, and hopefully some peace of mind.
After all my hard work, I got a text message from this mother the morning after I left my job, announcing her beautiful baby girl born by VBAC. It was one of the most triumphant feelings of my life. I could place this up there next to my own VBAC.
And this mother described me as her “angel” in her VBAC story. I was just glad I could help. But admittedly, I was so very, very proud to be thought of that way.
Jen told her doctor that a c-section would not be necessary.
I told that doc that I wasn’t having that c-section, it’s ridiculous. I’m going to go into labor any day and I want my “trial of labor.” If I end in a c-section, at least I gave myself the chance to see. I didn’t want it in the back of my mind forever eating at me, thinking “I wonder if.” So the doc let me reschedule for September 9th, but they were booked, so I felt like I got lucky and I was scheduled for the 11th now. My EDD was the 12th. And I thought for sure it was going to happen before then.
However, something was afoot at the practice and Jen got five phone calls from one of the doctors on September 4, 2009.
On that Friday, I still don’t know exactly why, my doc called me 5 times. I’m sure the doc over her probably told her she made a mistake and they needed me to have a c-section, but I never answered. She called me the next day (Saturday) and finally again that Tuesday the 8th after Labor Day. I finally called her back and one of the other docs got on the phone. The whole time they told me no induction, but now she was offering induction if I could get to the hospital in an hour. Are you kidding me? I have 5 kids and not a lot of family or friend help. So I said no.
Jen’s sister-in-law was already scheduled to take time off from work on September 11, Jen’s third “elective” c-section appointment. Like most families, Jen found herself unable to find childcare in a moment’s notice in a non-emergent situation like this. Her older children were in school and coordinating everything to report for an induction would not have been a possibility even if Jen had consented to the risky procedure of inducing a woman with a scarred uterus.
The doctor responded by telling Jen that her baby was going to die if she waited any longer.
Jen was livid.
I snapped!!! I raised my voice very loudly and said “Don’t you dare use your scare tactics on me!” And I did know I had an appointment that night to see this particular doc so I apologized, and wanted to cancel my appointment b/c I knew they really wanted to slice me open and I looked at my husband who heard our conversation and said, “Watch, they will try and get me into the hospital tonight.” I went in anyway, and she was all smiles. I do my NST, everything is great, and I’m great. I was having my usual contractions. Nothing different from my previous NST. They were all over the place nothing regular. I’m 3cm, 80% -1 station. She declares me in labor and I need to report to the hospital immediately.
Jen called her on what she found to be predictable scare tactics.
I look at her and said, are you kidding me! I’ve gone into spontaneous labor 3 times and I can assure you that I’m not in labor. She said what if when I’m driving the baby’s head starts crowning? I said, “I wish it was that easy.” She is getting really ticked off. She is trying her hardest for me to agree to go in and said my doc will come in just for me if I go now. How did she know I was going to be in labor when I came into the office?” After 15 minutes going back and forth, I refuse and I left. She caught me coming out of the bathroom and told me she wanted to check my fluid levels. Red flag. I’m thinking oh great, now they got me. She checks and she measured a 9. The baby is great.
The doctor began to plead. Wrote Jen, “She walks me out she looks right at me and almost begs me to go to the hospital. Seemed really weird at the time.”
As Jen suspected, the doctor was lying and she was indeed not in labor.
Two days later on September 10, Jen called and canceled her c-section appointment for the following day. On the 11th, Jen called the doctors’ office first thing in the morning to set up an NST and was told a doctor would call her back and was again encouraged to schedule another c-section. Expecting a return call all day, Jen was shocked to arrive home and find and envelope on her doorstep that contained the letter pictured in the NBC Chicago news segment.
The text of the letter reads:
Glen Ellyn, IL 60137
I find it necessary to inform you that we are withdrawing from your professional care due to your failure to comply with medical advice. You have cancelled your scheduled c-section multiple times. We recommend that you place yourself under the care of another physician without delay.
With you written authorization we will make your records available to your new physician.
I trust that you understand that my purpose in writing this letter is out of concern for the health and well-being of your unborn child.
Paul K. Rosenberg
Wrote Jen, “Why didn’t they tell me that on the phone that Friday morning since I’m due the next day and now I have no doc? No warning, no referral, nothing.”
Jen called her midwives, who told her she was welcome to do her non-stress tests in their office. One midwife calls her on Saturday, September 12, with recommendations for different hospitals. Northwestern told her that the residents would attend her birth if she presented in labor.
The next day, Jen was still having “tons of contractions” and went to the clinic at Northwestern, where she said the resident and the nurses were shocked that I was dropped because she refused an unnecessary cesarean. They agreed that Jen did not need surgery.
On Monday, September 14, Jen was told by a doctor at the Northwestern clinic that by law she was bound to the other practice for thirty days.
…[S]he advises that I call them to receive care, but if I go into labor to come to Northwestern for a “VTOL” (vaginal trial of labor). I can’t go back to those docs. She then said that I should try and call the physicians referrals and maybe one of the practices will take me. I try 2 and both say no. I’m crying again, freaking out crying. My husband goes online looking for VBAC friendly docs and finds a message board with a name. He calls, talks to the right person, and 15 minutes later a doc calls us back Dr. Brian Foley. I tell him everything and he didn’t even hesitate and accepts me as a patient. My superman. I’m crying so hard on the phone thanking him so much for taking me. We set up an appointment for that Friday and he said I shouldn’t go past this weekend that we’ll set up an induction for Saturday if I don’t go into labor. He said if I go into labor before than just call them like I’m a patient and he’ll let all the docs know what’s going on. I’m happy but still worried.
Early in the morning on Wednesday, Jen awakened to contractions, which were coming every eight to nine minutes. She called her labor support team and her doctor’s office, who told her to come in.
After laboring at the hospital for awhile, Jen was at five centimeters and began asking about an epidural.
My response, I know I can do it I’ve done it 3 times before without drugs, but I don’t want to. I’m tired, and I don’t have the fight in me. I put up a fight of my life these past few weeks with these docs and I’m tired. The Anesthesiologist comes to answer my questions, hey Oprah is on. I say hold on I have a contraction coming, OMG, I’m screaming and crying (which I didn’t do for my other ones) I look up and said in an “Exorcist” voice, “GET ME AN EPIDURAL!” All of a sudden another contraction and the urge to push, “I HAVE TO PUSH.” The bed gets broken down, the doc has me move down and the baby’s head is crowning. The whole time, I’m thinking, I just want the epidural. I actually always thought that I would feel like I can’t push b/c of all the fear of uterine rupture, but that thought didn’t even cross my mind. So one more contraction, here’s the head, and I had a little trouble with her shoulders and out she came at 9:18 a.m.
A fast labor, an easy recovery and rave reviews for Dr. Chen… Jen got a healthy birth and did not succumb to the deceitful, faux-science scare tactics from Dr. Rosenberg’s office.
I went from 5cm to her completely out in 10 minutes from what I was told. It was so fast and furious and amazing. I was so happy. Dr. Chen was awesome. My placenta came right out without pitocin (which is normal for nurses to give you a shot of it to get the placenta out) and I was up to the bathroom by myself in an hour. Only two stitches. I felt great! I did it. I knew I could. It was the best delivery of all my girls and the fastest recovery time (I’m two weeks postpartum right now). We were made to have children and we should have the option on how we birth them. I hope my story can help just one woman out there. We can’t sit here and let these docs control our given right to birth!!
Jen, ICAN of DuPage, Northwestern Memorial Hospital and Drs. Foley and Chen… Congratulations to all of you for using the best evidence available to make health care decisions and advocate for availability of services that were appropriate for this mother and baby.