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Sunday
Feb272011

With No Local VBAC Options, Leah Considers Unassisted Birth

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By Jill Arnold


The decision to give birth without a midwife or doctor in attendance is often a philosophical choice. Other times, it is borne from hitting too many dead ends while looking for access to VBAC (vaginal birth after cesarean). After hitting roadblock after roadblock, Leah is ready to have a friend help her give birth.

Born with De Morsier’s Syndrome or Septo-Optic Nerve dysplasia (SOD), Leah’s mother was told that her daughter would never surpass the intelligence level of a three-year-old. When Leah was a teenager, a doctor told her that she would probably never have a child.

Years later, at age 22, Leah was out to dinner with her husband, who asked if she was pregnant because she ate more than he did. She assured him that she wasn’t, but went to the doctor anyway. When Leah was informed that she was indeed pregnant, she began to shake because, as she says, “it was something [she] thought [she] could never have.”

Her pregnancy was “textbook normal” and the baby showed no signs of genetic abnormalities. On October 14, 2004, at 4 a.m., Leah’s water broke to their excitement. After just five hours of labor in the hospital, a doctor took her husband aside told him that he would not deliver her baby unless it was by c-section. According to Leah, they stopped her labor without her consent.

Her husband refused to sign the surgical consent form for her and told her that she was the one who needed to make the choice. He also told her, “The doctor said he’s scared shitless if this baby is delivered naturally.” Leah signed the consent form because they had stopped her labor and her water was already broken. Because of this, she feared for the health of her baby.

Leah was placed under general anesthesia. Wrote Leah:

They put me under so I was not awake for the birth of my first child. Many hours later, I wake up in the worst pain ever. I didn’t even have the strength to hold my beautiful baby girl. I told daddy he could hold the baby first. Later to find out, my husband made everyone wait to hold the baby so I could be the first one to do it. I knew that breastfeeding was best for me and baby. The head nurse came running when she found out that I was trying because the medicine I was on, they didn’t know the side effects that it may have on the baby. I was confused because I was taking it the whole pregnancy and she came out just fine. I told her this is what I’m going to do if you like it or not. I was living in Florida at the time.

Less than three months later, Leah was surprised to find out she was pregnant again. At six months pregnant, her milk supply had dropped to the point where she had to stop nursing and she prepared to be a mother of a one-year-old and a newborn.

On November 4, 2005 at 3 a.m., Leah’s water broke. She labored for two hours and decided not to go to the hospital two hours away where her OB-GYN worked, opting for the local hospital instead. She informed the hospital about her previous c-section from about a year ago and, to her surprise, the doctor offered to do a VBAC. Scared and not having been informed of the risks and benefits of VBAC, Leah refused the offer to VBAC.

Four years later, Leah went to a neurologist and asked him about her SOD and pregnancy. He told Leah, “If you can walk straight and don’t have any headaches, you could have had them naturally.”

Leah was angry. After that, Leah researched the disorder and pregnancy. She located a relevant study and contacted the researcher, who confirmed that vaginal birth is not contraindicated with her condition.

Now, five years after her last cesarean, Leah is pregnant again and was pleased to find in her research of VBAC that ACOG changed its guidelines, issuing a press release in July 2010 that stated, “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”

Leah has searched up and down the state of Maine (and part of New Hampshire) for a provider willing to attend a VBA2C (vaginal birth after two cesareans). The only two places that accept MaineCare and are willing to let her try a VBA2C are Maine Medical Center (MMC) in Portland and Blue Hill Women’s Healthcare in Blue Hill. Leah has been unable to find a home birth midwife who will accept MaineCare as a form of payment because, according to Leah, MaineCare does not reimburse for home birth.

Leah says she was refused by MMC because she lives too far for them to monitor her. She lives one hour away. Blue Hill is willing to take her but the drive would be two hours one way, which will prove too difficult in terms of arranging rides for prenatals. She doesn’t drive due to impaired vision and the four hours of driving in addition to waiting for appointments is too much for her friends, most of whom Leah says are low-income, too, and simply do not have the means, childcare or time to support her. The few family members in town whom she could ask will not support her, as they don’t see a problem with going to the local hospital and having a cesarean to get the baby out.

Leah has been receiving prenatal care from a local OB-GYN practice, although they refuse to attend a VBA2C. Leah says that if she doesn’t find local, accessible place where she can have a TOLAC (trial of labor after cesarean), she is “willing to do a UBAC.”

Leah’s struggles remind us that an unwanted unassisted birth and an unwanted repeat cesarean are two sides of the same coin. Approximately 30% of hospitals refuse to provide services to women who won’t submit to repeat cesarean surgery. Still more practitioners routinely discourage VBAC. No woman should be condemned for her birthing choices, but it is hypocritical to condemn women for going with what is, for many, their only option for a vaginal birth. 

 

Photo credit: MMC.org

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Reader Comments (14)

A few things in this article just don't make sense:
1) There is no way to "stop" labor, especially after the bag of waters breaks.
2) She refused a VBAC 5 years ago, but now she wants and even riskier VBA2C.
3) NO hospital can refuse to care for a laboring woman, but SHE can refuse a c-section.

February 28, 2011 | Unregistered CommenterPam

I think she should educate herself as much as possible and look for freinds to support her who are not midwives but know about birth. (or an off duty midwife, lol) Doulas, her husband, a friendly veternatian, all of these could support her in her decision.

Women birth babies whether someone is there or not.

I don't recommend going out alone into the forest, but if a woman wants to have her baby safely, I believe home is safer than the hospital for most births. Good for her for not succumbing to the lies about VBACs being dangerous.

February 28, 2011 | Unregistered CommenterBonnie B Matheson

I really feel for Leah here. I've had a similar experience myself, and when you can't find someone to help while you're pregnant, you really feel like a ticking time bomb. When faced with the decision to either undergo an unnecessary cesarean or a UBAC, I went with the unnecessary cesarean (this was after I was promised a VBAC, and then the hospital banned VBAC 3 weeks before I was due). I won't go into the consequences I suffered for that decision, because they are different for every woman. It suffices me to say that my experience was unpleasant and life-changing.

While it's true that a hospital cannot deny care to a laboring woman, they CAN and usually DO harass and threaten you if you refuse the cesarean. That's something no woman should have to deal with. And with the constant harassment, the time may come that a cesarean really IS necessary, but you would have no way of knowing the difference between proper medical advice, and the constant harassment you've received since check-in. That isn't a reasonable option for women, nor is it very safe for their babies.

And to Pam, there ARE things they can do to seriously slow labor, almost to the point of stopping. They did it to my SIL when she birthed a twin (who sadly didn't survive) at 23 weeks. They were able to stop her labor enough that she kept the second twin in for 2 more weeks, and he's now a healthy (especially for a micro-premie) 1-year-old. Also, Leah refused the VBAC before because she didn't realize her condition didn't contraindicate a VBAC. Likely, she was lied to. And a VBA2C is only marginally more risky, and significantly LESS risky than a CBA2C. So please hold your judgmental tongue. Not everyone's circumstances are the same as yours.

I'm so sorry you're in this position, Leah. Some days I'm sure it feels like you crash into these dead ends at 60 mph. For me, if I could make my previous decisions again, I think I would've chosen UBAC, but that's only because I've since had time to learn what I need to know to make that a safe option. At the time, the repeat cesarean really was the best choice...boy that's hard to say, because I hated every minute of it, and still hate it to this day. I'm a different person now because of it.

Perhaps you can find another way. It may be a long shot. I understand money is an issue, is there a midwife who would be willing to barter services as part of her fee? Some work on a sliding scale to pay out of pocket. I'm paying for mine out of pocket right now, but I know that's not economically feasible for everyone (and my midwife is very affordable to begin with). You've probably already asked these questions though.

Maybe you can compromise? Are there birth-savy people in the community that maybe aren't midwives, but would be willing to be with you while you labored, just as an extra pair of hands and eyes? Before I found my midwife, I was considering using a woman who used to be an apprentice midwife in another State, but wasn't currently practicing. It's not the best, but it might be better than the other options. Maybe there's a doula you can hire. They're much cheaper, and while she probably won't catch your baby or anything, if she's seen enough births, she would probably at least know if a transfer were necessary. Again, I'm sorry for your situation. I wish people would take people like us into account when they make up their crap and take away otherwise safe options. I wish you well.

February 28, 2011 | Unregistered CommenterHeather

She's probably considered this option, but what about continuing to see her local practice for prenatal care, then transferring to one of the VBAC-friendly providers at 37 weeks? It wouldn't eliminate driving, but it would drastically reduce it.

February 28, 2011 | Unregistered CommenterBethany Wagler, CPM

Leah,
Sounds like you've gone through so much to get where you are. I wish you all the best. There are UBAC support groups online. Perhaps your local ICAN chapter can be of help http://ican-online.org/. They may be aware of professionals or literature that would be helpful to you in your time of need. I am expecting baby#3 this summer and fully intend to do my VBA2C somehow, someway. I've considered going to OB's for prenatal care and UBAC ing myself. Another resource may be the moms of La Leche League http://www.llli.org/ , my experience is they tend to be more natural minded than mainstream moms. If what you needed to birth your baby naturally didn't exist then neither would your circumstances. If you need it then it's out there.
Namaste,
Selena

February 28, 2011 | Unregistered CommenterSelena

My local hospital would not take Medicaid for a VBAC... said it wouldn't pay but this hospital had a special code so they could charge extra for the anesthesiologist that would be sitting by your bed just in case and the OR they had just for you *eyeroll*, we're talking 10's of thousands of $$$ is what they said. 2nd practice in another county said I probably had CPD (not knowing I had a previous vaginal birth, no pelvic exam and nothing in my surgical record that questioned my pelvis) and that we could talk about it but not likely. 3rd practice pulled the bait and switch and compared me to a heart attack waiting to happen, all this with a healthy pregnancy. They chided me for wanting a natural birth. I fired them at 38 weeks and stayed home. Would it be great to go to the hospital if you desire for that safety net and have your wishes respected, absolutely. But how often does that happen? Very rare. Would it be nice to have a midwife there , yes but it's not always possible financially or even legally. The doula I talked to wouldn't attend me at home at all. So options were RCS, VBAC with a massive fight which would have probably ended in RCS or stay home unassisted. Best option was unassisted by far.
I found that one of the greatest tools women have is their own intuition, you will know when something is wrong, get in tune with your body and baby. Be knowledgeable and confident in your decision, do what is best for you. Get your husband to be your support and research things together. Watch birth videos. There are so many ways to prepare yourself.

February 28, 2011 | Unregistered CommenterMychel

I have been where you are, and not long ago. I want a vaginal with my first but it wasn't meant to be. I wanted a VBAC but again do to babies fast heart rate they didn't think my very small 38 weeker would tolerate labor. I got a new doctor for number 3 and she never even told me that I was a candidate for VBA2C. Number 4, I was educated and totally ready for the bait and switch. I got good prenatal care from my previous doc found a midwife willing to take on a VBA3C. I had my birth kit my pool. The only thing I had to wait on was, making sure that my placenta wasn't covering my scar at my 30 week appointment before I fired my OB.
I went in for the appointment and everything was great with the OB. But then I had the U/S with the peri... My placenta was GOOD! Close to the scar but good no accreta either! My happy day ended there. The peri started a fight with me. She put things in my file about getting a court order to force me into a very unwanted c/s. My midwife new to the area (not new to home birth or HBAC she had attended over 140 births) got worried when they finally transferred my records from my 30 week visit at 34 weeks, with all of the legal not medical stuff and she had to risk me out of her care.
So there I was at 34 weeks and now I had no doctor and no midwife. I had my information and I decided to go for it and UBA3C. But I had no support, My family was unsupportive, my husband was scared and I had no one. No one would touch me with a ten foot poll. I ended up back in the hospital with another unwanted C/S. I was never even allowed to labor with him. He was born on his due date I had to fudge the dates to get him that far. I just had this feeling he wasn't ready yet. But Doctors all feel that they know better and the took him to soon. He had trouble breathing and never normalized until they brought him to me. I still haven't really dealt with the emotions from his birth. he was the only baby I never cried when I heard him cry. Mainly due to the panic attack I had in the O/R because they immediately sedated me once the cord was cut before they let him cry.
If I could go back I would ignore everyone else and just go with my instincts and UBAC like I had wanted to. But now all I have is horrible memories from all 4 of my births. Go for it Leah you can do it and don't let anyone tell you different. If you would prefer a hospital birth, There is a was to do it if your careful and keep your own counsil.
Tell the docs where you are at that you want the opportunity to go into labor before you deliver. Most docs will bite on that one. They still think they can control everything. This will buy you time and take theirs away! When you do go into labor STAY HOME! Right up to the point you start to feel pressure then go and refuse to sign the papers for a repeat C/S, sign nothing before hand either. Pre-registration papers are fine but not relating to a c/s. Read everything carefully so that you don't. If you go that route they can't refuse to treat you when you are in labor and they won't have the time to get a court order forcing you into a c/s. If they try call your local ACLU and news stations.
This doesn't guarantee that you will be treated well, just that you will be treated.
GOOD LUCK and keep us posted!

P.S. to whoever said they can't stop labor, they can and they do it all the time when they are preparing for a c/s. I know I have been there.

February 28, 2011 | Unregistered CommenterStephanie Colvin

I don't think Pam was having a "judgemental tongue." It seemed she was stating facts. I am getting more confused about this homebirth and UA birth movement because it seems to be have a birth outside the hospital at any costs movement.

What happened to Leah was unfortunate and stemmed from a lack of knowledge on her part in combination with maybe lack of knowledge on the doctor's part, or, intentional misrepresentation. We cannot know. This is life. Women have babies all the time with little to no knowledge about this in that...This is to be expected. That's why we have professionals. When we do not, cannot trust the professionals is the problem we have run into.

But the facts remain.

What I don't understand is why the commenters here are trying to involve other people in Leah's decision. If she wants a UA then it is a UA...not a UA with a doula, ex-midwife, apprentice etc...That's not a UA, or if it is, UA keeps getting redefined (which is fine, I guess). It is between her and her partner. Involving other people "just in case" seems plain wrong.

The hospital is your just in case scenario.

Understanding that in the hospital that you can't have it exactly your way. She can manipulate it and set up things best as she can, but how much can you accomplish while you are in labor?

Its not a nice situation but she can only deal with what is in her control and what is not and accept the consequences of any choice.

February 28, 2011 | Unregistered Commenterconfused

I had two unassisted births. Both were because of limited options in hospitals, though not for VBACs. I am glad I went the way that I did with my births, but I did not really like being put in that position either. My plan was always: read everything I can on complications and be prepared to recognize red flags, be prepared to go to the hospital if necessary, don't talk about it with people who are unsupportive and be totally prepared to deal with any and all potential consequences if things don't go the way you planned.

As it stands, I had a very uneventful first UC, followed by a UC with shoulder dystocia that needed some extra manipulation to resolve. In hindsight, I am so glad I prepared myself to recognize problems. I do not think things could have possibly gone any better in the hospital. However, it was very sobering after the fact to realize that all the weight of my decision to UC was on ME. I had no backup and that is a very scary place to be. In other words, it's not a decision to take lightly. But, I would do it again if I thought it was my best option.

February 28, 2011 | Unregistered CommenterAugusta

Thank you for your comments. Like Confused said, it is between my husband and me. I do appreciate the ideas and suggestions though.

A VBA2C is not that much more risky. It's almost non-existing to even mention. I had 5 years to heal as well.

February 28, 2011 | Unregistered CommenterLeah
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