So my adorable niece (who nursed until she was almost 2 years old) was taking a shower with her mom the other day (who is currently nursing my 3 month old nephew). She looks up at her mom and says,
“”Oh wow mommy, your minnums are so fat. When I was a kid I usually drank those.”
By the way, she is only 2 1/2 years old now. As if she isn’t a kid anymore! Haha! She seriously cracks me up on a regular basis! I especially love the use of the word “usually”. Ahhh, kids….
I have written before about my aspirations of becoming a midwife. The more and more I care for birthing women as an L&D nurse, the more I meet moms out in the community at birth circles, ICAN meetings, etc., the more I read and see and hear about birth and birth politics, the more midwives I meet, the more and more clear it is to me that becoming a midwife is something that I need to do…someday.
I stumbled upon a blog post entitled “Apprentice Midwife Material?” over at Navelgazing Midwife the other day and it really spoke to me. Throughout the beginning of the post the author goes into detail about the many sacrifices that midwives make in order to do what they love to do. While reading them over, none came as a surprise to me. However, no one can really understand what its like to experience them until they become an apprentice and even then your world is still a bit sheltered.
The author then writes:
“I imagine women’s spirits sagging by this point, those sitting in front of me and those reading this, but there are AMAZING parts of being a midwife, too. But if you don’t want… no, CRAVE… all that I said above, then reconsideration of this career is called for.”
I reflected on this statement for a while and I realized that I DO indeed CRAVE it all….the good, the bad, the ugly, the awesome! But it is still undecided when exactly my time will come to put myself to the test. Until then I must continue to form relationships with birthing women through my work as an L&D nurse and through my blog.
Thanks for listening 🙂
This one is for all you VBAC mommas out there!!!
In October of 2009 I posted a letter sent to me by Kelly, a mother who, at 35 weeks of pregnancy, was startled, hurt, confused, angry, and scared to find out that her supposedly VBAC friendly obstetrician was actually leading her on the whole time….
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Dear Nursing Birth,
I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)
I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!
And how does the doc get away with not telling me something important like this until NOW? Unbelievable!! My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time. I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!
If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.
I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!
I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!
Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).
Sincerely,
Kelly
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I replied to Kelly in my post entitled “The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On” with words of encouragment and some information about other scare tactics that some health care providers use to intimidate VBAC planning mommas. My main message was this:
“You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for. Your desires for said unmedicated, intervention-free VBAC are well supported by the research. You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC. You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE. You deserve it for THIS birth. “
Fast forward 4 months. I was struggling with the thought of returning back to blogging as NursingBirth. I was working for a hosptial with a 40% C-section rate. I was feeling powerless. Until I saw this in my inbox…..
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Hi Nursing Birth!
Hope you still plan to come back after you settle in from your move- we miss your great posts!
Also, just wanted to say thank you -again- for posting about my comment awhile back! I wanted to update you and tell you that I had a successful VBAC! Thanks for your suggestions, resources, and support!
You can read my story over at my blog: http://chun-beeks.blogspot.com/2009/12/happy-birthday-john-carl-fischer.html
Hugs and best wishes,
Kelly
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Needless to say I was touched, proud, empowered, honored, and ESTATIC!!! There is no doubt in my mind that Kelly’s email was a main factor in my decision to return to blogging as well as take the plunge and start yet another new job! So thank you Kelly for being just as much of an inspiration to me as I was to you!!! I am so lucky to be a part of this awesome community we call the “birth blogosphere” 🙂
Congrats again Kelly!! You rock!!
NursingBirth
“Hey did you hear what happened to Nursing Birth? I heard she was struck down by a bolt of lightning when she encouraged one of her patients to push in an upright position instead of on her back in stirrups! She hasn’t been the same since!!
“No, no no…you’ve got the story all wrong! I heard that the government had to put her into the witness protection program after she suggested to a room full of obstetrical residents that a woman could indeed deliver a baby WITHOUT pitocin! And it didn’t help matters when she then told the group that women do not have to have a vaginal exam every two hours while in labor! That really set them over the edge!!
“I heard she was captured by an angry mob of obstetricians after mentioning the possibility of a TOLAC for a woman who showed up on the ward in labor after 5pm at night! They held her captive on a deserted island where she was forced to listen to lectures touting the “benefits” of elective primary cesarean sections for all pregnant women!!”
“You know what I heard? I heard she had a nervous breakdown after hearing 20 maternity nurses simultaneously utter the phrase “Why don’t you just let us take the baby to the nursery tonight and give him a bottle so that you can get some rest” while at the same time shoving a box of pacifiers into her mouth!
“No, you all have it wrong! I heard that she had to flee the country after a group of anesthesiologists overheard her admit to a patient that indeed epidurals do carry some RISKS to both mothers and babies! Rumor has it they chased after her screaming “HERETIC! BLASPHEMY!”
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No you are not seeing things! It’s really ME! Your old friend NursingBirth! I’m sure you all just did a double take when you saw my post pop up on your google reader but it is true, I am back! However as hard as it is to believe, none of the above scenarios are true!
Despite the fact of me being back, however, being “better than ever” is unfortunately debatable. The last 5 months have been a whirlwind of highs and lows, with Christmas time with my family, a newborn nephew, and more than double the amount of sunny days being a few of the “highs” and the selling of my first home, moving TWICE and to a new state, dealing with the bureaucracy of multi-state boards of nursing, a panicked job search, a husband out of work, moving away from my very best friend, and starting a new job as being some of the, well… “lows.”
When I wrote my last post back at the end of October, (WOW, I haven been “gone” for 5 months. No wonder why my readers have been getting frantic!!) I truly did think that I would be back in action at the computer in only a few weeks. But the multiple moves really took a lot out of me especially since we spent one of those months without the internet. (AAHHH! NO INTERNET! Lame I know but I am crippled without it!! Haha!) However, the biggest hurdle that I had to overcome in order to return as “NursingBirth” was my “new” job.
Why was my “new” job a hurdle you ask? Seems like a new job would bring an endless amount of new material. And in reality it absolutely has. However as I stated in my last post, when my husband and I decided to move and hence leave behind my “old” job (which hereby will be referred to as “Big High-Risk Urban Hospital” or BHRUH) I started out on a quest to find and work for a hospital or birth center that was both truly mother-friendly as well as baby friendly in their philosophy, attitudes, actions, and outcomes. I did not want “more of the same.”
But what happened is that I, NursingBirth, became a victim of the Ol’ Bait and Switch!!!!
What was supposed to be a beautiful beginning to a long career at a nice community hospital turned into a deep depression as day by day I realized more and more that I was in waaaaaaaay over my head. However, I wasn’t in “over my head” as far as my nursing skills or knowledge was concerned. In fact, I saw, experienced, and managed situations at BHRUH daily that the nurses at my new job (which will be henceforth referred to as “Bait and Switch Community Hospital” or B&SCH) experienced monthly or even yearly. (Not that that is good or bad. No value judgements here. I also fully acknowledge that there is still much I have to learn and have yet to experience as a nurse.) I was in way over my head because the “mother friendly/baby friendly” hospital that I thougth I was working for was actually a:
“Don’t under any circumstances rock the boat or the nursing leadership will throw you under the bus–We do things here this way because that is the way we have always done them so don’t confuse me with the facts– If you don’t give me my way I’ll just take my patients to your biggest rival instead– Look at all our big screen TVs and SHINY THINGS while we distract you and seperate your baby from you at every possible opportunity– Your nursing license and the safety of the patients comes second to keeping doctors happy– Give them all an epidural at the door to keep them quiet– My C/S rate goes up when I am in a bad mood– Every admission to the nursery= More money for the hospital–No midwives allowed–You can’t do anything to change things here because nurses are not an equal member of the healthcare team” hospital.
And it wasn’t until I made the very hard decision to leave B&SCH that I have had the motivation and inspiration to start writing again.
But today I also come to you with good news!!! As of May 3rd I will be starting a yet another NEW job at community hospital #2 which I will from here-on-out be referring to as “Birth Center in Disguise” or BCID!! Luckily my decision to leave B&SCH coincided with a random, word-of-mouth, unlisted job opportunity at BCID that lead to an interview and job offer last Thursday!!! I feel revitalized and excited and nervous and joyful as well as so many other emotions that I just had to write about them all!!
I hope you will all stick with me over the next few posts as I process and debreif the last 5 months of my life. I feel like there is so much I want to share with you about what I have been going through and I haven’t had anyone else to process all this with! I also want to appologize for going MIA for so long. It was so hard for me to come back but I hope that I am back for a long time. I didn’t realize how much I really got out of blogging and I really missed how much I learned from all of you!
Thanks again for all your words of encouragement and pleas for me to return over the past 5 months. There is no doubt that without them I would never have returned! You all rock!!
Sincerely,
NursingBirth
Hello Everyone!
I just wanted to give everyone a heads up that I will not be posting for a week or so since last time I went missing (in August) I almost had a few readers call in a “missing persons” report on me! My husband and I are moving to a new state so that we may both pursue better job opportunities. I am very excited about this change and will be sure to keep you all in the loop once we are more settled.
All My Best,
NursingBirth
Science and Sensibility’s Healthy Birth Blog Carnival #2: Walk, move around, and change positions throughout labor
This month’s Healthy Birth Blog Carnival is “Walk, move around, and change positions throughout labor.” This is a repost from a story I wrote back in March however, I feel like it is a really great example of how important movement and position changes are to a successful labor and birth, especially a vaginal birth after cesarean (VBAC)! This story has been a popular posts with my readers in the past and I hope by participating in this blog carnival it reaches and helps empower more and more expecting women out there!! In reposting this story I have highlighted all the times where Alyssa used upright positions and movement to cope with pain, help her uterus contract more efficiently, help her baby find the best position in her birth canal, use gravity to her advantage, and be an active participant in her labor! And there is no doubt in my mind that all of these things helped her have a safe, positive and empowering VBAC experience!
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Last week I had the honor to be a part of one of the most beautiful VBAC(Vaginal Birth After Cesarean) hospital births I have ever witnessed. I would like to share that couple’s story with you today as both a feel-good tale of personal triumph and a story of inspiration for all those moms planning a VBAC out there that might stumble upon my blog. Since this is a blog about “a nurse’s view from the inside” this story is probably much different than any other birth story you might have read from the mother or father’s point of view. But then again, maybe that isn’t so bad! Enjoy!
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It was ten to 11 o’clock am as I walked through the lobby doors of the hospital I work at, rushing towards the elevator so I could punch in on time. As the elevator doors started to close, a hand shoved through the crack, forcing the doors back open. “Please make room!”said the woman, a phlebotomist who works in the hospital, in a shaky voice, “Woman in labor here!!”Following behind was a very pregnant woman, huffing and puffing as she waddled into the elevator, followed by what looked like her husband and her mother. “Don’t touch any buttons!”said the phlebotomist, “We’re going right up to labor & delivery!” Since that was where I was headed too, I smiled at the husband and said, “Don’t worry, you’re here now and she won’t have the baby in your car! I work up on L&D so I’ll show you were to register.” Something told me that if this woman was truly in labor then she would be assigned to me since I was just starting my shift. But she had to “pass” triage first, so after helping the family to the registration desk, I hurried into the locker room to change into my scrubs.
Fifteen minutes later the triage nurse came to the main desk, “I’ve got a term mom, 40 weeks 5 days, who’s five centimeters,” she said, “We’re gonna need to put her in a room…. And she’s a VBAC with a ‘birth plan’.” “I’ll take her!,” I said excitingly, knowing that I have my bestdays when I can assist a woman through labor, as opposed to getting stuck on the OR team or in the high risk ward running magnesium. (Not that those women don’t need a lot of TLC too, it’s just that I like labor the most!) Birth plans, natural unmedicated labor, and getting my patients out of bed…those are my specialties!
I quickly set up the room across the hall as the resident finished the patient’s history and physical in the triage room. Then I quietly knocked on the triage room door and let myself in. The patient, Alyssa*, was standing by the bed, rocking her hips back and forth, as the continuous monitors strapped to her abdomen traced the baby’s heart rate and her contraction pattern. It looked like she was contracting every 3 minutes, and the baby’s heart rate was beautiful and reassuring. Her husband, Jared, was leaning nervously against the wall and her mom, Deb, was sitting quietly in the corner. I could really tell that Alyssa was lost in “Laborland” and I wanted to make the transition to her room as seamless as possible as to not break her rhythm and concentration too much. I quietly introduced myself and with the help of Jared and Deb, moved all of their belongings across the hall as Alyssa waddled behind.
I could tell that Alyssa was coping well with the contractions while standing but a quick glance at her prenatal summary revealed that she was Group B Strep positive and would need IV antibiotics (our hospital’s policy and the midwife’s order) and hence, and IV. Now I feel that I am pretty skilled at starting IVs, but I have not yet mastered starting an IV with the patient standing and swaying! So in the two minutes between the contractions, I explained to the Alyssa what I needed to do before the admission process was complete: get 5 more minutes of continuous monitoring on the baby (to equal the “20 minute strip” my hospital’s policy requires before we can switch to intermittent auscultation), take a set of vital signs, draw three tubes of blood, start an IV, and ask a few more questions. “Give me 8 minutes sitting on the bed,” I said, “and I can have everything but the interview done. The rest of the admission can be done with you standing up.” “Okay,” she said, “I can do eight minutes.” Eight minutes later the IV was in, antibiotic running, labs drawn and sent, vital signs done, monitors were removed, and the patient was helped out of bed (Phew!! That was close!! J). And it wasn’t a moment too soon because Alyssa was having a lot of back labor and sitting in bed was just making it worse!
Then there was a knock at the door. Here’s how the subsequent conversation went down…
Me: “Who is it?”
Med Student: “It’s just the medical student,” (said as he walked right into the room)
(I hadn’t yet gotten a chance to ask Alyssa if she was okay with medical students so I just kind of looked over at her and Jared and tried to judge their reaction.)
Med Student: “Hi I’m Michael. I have to ask you a few questions.”
(Have? How about “Is it okay if I ask you a few questions? Sheesh!!)
Med Student: “Are you being induced today?” (asked as he stared down at his paper)
Alyssa: “INDUCED! DOES IT LOOK LIKE I AM BEING INDUCED!”
Med Student:“Okaaaaay. Umm, any problems with this pregnancy?”
Jared: “Do you really need to ask these questions right now? The resident already asked her that stuff.”
Med Student:“Umm yeaaaah, I do. There is a lot of repetition but we have to ask again.”
Deb: “Doesn’t her prenatal summary tell you all of that?
Med Student: “Ummmmm….”
Me: “With all do respect, Michael. But I think they are trying to tell you that they do not want any medical students. Or anymore residents for that matter. Okay? So I think we are done here.”
Med Student:“Ummm, what am I supposed to tell the resident?”
Me: “Tell her I said that the next induction that comes in is all yours.”
As the med student left, Jared, Deb, and Alyssa all looked at me simultaneously and said “THANK YOU!” “I don’t think he was getting the hint,” said Jared. “Yeah,” I said, “I figured he needed it spelled out.” In hind sight, I think this was one of the moments that really helped me to bond with this family because after all, I understand how difficult it must be for families to come into the hospital and have to work with a nurse that they have even never met during one of the most intimate experiences of their lives!
I spent the next fifteen minutes finishing up the patient’s admission assessment as quickly as I could. I told Alyssa that if she was having a contraction to just ignore me, and asked Jared to help answer any questions he knew the answers to. (Unfortunately, our hospital’s pre-registration does not include performing an admission assessment and hence, it has to be done on arrival to the hospital. Usually, if a patient comes in for false/early labor a time or two, it gets done then but Alyssa had not been to the hospital her whole pregnancy, which is great, but it meant that I did have to bother her with some silly questions during labor. Kind of a bummer, but with the help of Jared, it went pretty smoothly.) It was during the admission interview that I found out some of the details of Alyssa’s pregnancy and prior cesarean section. Alyssa had an unremarkable health history and a normal, healthy, uncomplicated pregnancy. She was a G2P1, but since her first baby was born by cesarean section, she technically was considered to be a “primip” (healthcare slang a woman who is about to deliver her first baby) regarding a vaginal delivery.
Jared told me that when their son was born two years ago, Alyssa was persuaded into an induction at 39 weeks for “LGA” (a.k.a. large for gestational age, which by the way is NOT recognized as an appropriate indication for induction of labor by ACOG), was first given a few doses of misoprostol to “ripen” the cervix, followed by pitocin to stimulate contractions and continuous external fetal monitoring to monitor those contractions, then given a couple doses of Stadol and eventually an epidural for the pain, followed by artificial rupture of membranes to place a fetal scalp electrode after the epidural dropped Alyssa’s blood pressure and caused a prolonged fetal heart rate (FHR) deceleration, then an intrauterine pressure catheter to assess if the pitocin induced contractions were “adequate”, and eventually a cesarean section after 1 hour of pushing in a back-lying position for “failure to descent & cephalopelvic disproportion (CPD).” Thirty minutes later baby Kevin was born at approximately 2:00am, weighing in at 7lbs, 5 oz.
In my opinion, Alyssa was a victim of the “cascade of interventions.” Many maternity interventions, including elective induction, pain medication, artificial rupture of membranes, epidural anesthesia, back-lying positions for labor or for birth, etc. have unintended effects. Often these effects are new problems that are “solved” with further intervention causing a domino effect that ends up creating yet more problems. This chain of events has been called the “cascade of intervention” and unfortunately often leads to vacuum extraction/ forceps delivery, episiotomies or 3rd or 4thdegree tears, and even cesarean section. Many of these women are often also then mislabeled with diagnoses like “CPD,” “failure to progress,” “failure to descent,” and at the end of it all, the obstetricians turn around and say, “Thank God we were in a hospital; look at all the technology we needed! So when will your repeat cesarean be??”
This time, however, things were different. After the birth of their son, Alyssa and Jared started to research more about labor and birth, VBAC, and natural birth. They interviewed and chose a doctor (Dr. Z) that was supportive of natural birth and VBACs, with the statistics to prove it! And here they were now, at my hospital, ready and rearing to go! Alyssa said that for the past few days she had been having contractions “on and off” but that they really started to get going at 8:00 am. When the resident had checked her on admission, her water spontaneously broke during the vaginal exam at 11:15am. It was now 11:45am and Dr. Z’s midwife entered the room. Although it had only been 30 minutes since her last vaginal exam, the midwife decided she would check Alyssa again since she seemed pretty active. And boy was she ever! The midwife’s exam showed that Alyssa had progressed to 7-8 centimeters! “I don’t think I can do this anymore,” Alyssa softly whimpered to the midwife. We all reassured her that she was doing so well and that things were getting more intense for a reason and to stick with it!!
The midwife then offered to help Alyssa into the shower to help alleviate her back pain. Alyssa seemed skeptical at first but we assured her that if it wasn’t helping, that we could get her right back out. So Alyssa agreed and the midwife and I, along with Jared, helped the patient into the shower. What happened for the next hour was one of the most beautiful displays of love, perseverance, hard work, and dedication I have ever witnessed. Alyssa turned her back to us and rested her hands on the grab bar on the shower and her head on the shower wall. Her cadence was this: Between contractions she would sway side to side, as if she was slow dancing. During contractions she would squat up and down, up and down, moaning in a low tone as she carried out her ritual. She just moved with the rhythm of her labor, listening so instinctively to what her baby and her body were telling her to do.Jared used the hand held shower head to spray Alyssa gently with a stream of warm water up and down her body, concentrating mostly on her lower back. I quietly entered the bathroom a few times that hour to check the baby’s heart rate with the portable doptone, trying hard not to disturb Alyssa’s concentration. Mostly, however, the midwife, her mother, and I stayed outside the bathroom door as to give Alyssa & Jared the privacy they needed to facilitate the progress of her labor.
At 12:35pm Alyssa told me that she was starting to feel a strong urge to push. The midwife entered the room and as Alyssa knelt in a hands and knees position in the tub, the midwife checked her cervix. To everyone’s surprise Alyssa only had an anterior lip of cervix left to go (this means she was about 9 ½ centimeters dilated)! After the next contraction, Jared and I helped Alyssa out of the shower to the toilet where we both used warm towels to dry her off. Then Alyssa walked over to the bed, “Can I kneel on my hands and knees?” she asked. “Sure!” we all said in unison, as we helped her up onto the bed. “I feel like I have to push!” Alyssa said convincingly and when the midwife checked her cervix, the anterior lip was gone…Alyssa was fully dilated at 12:45pm, only 1 hour and 55 minutes after arriving at the hospital! “You can start to push anytime,” said the midwife.
One of the best things about being a part of this experience was the fact that it was one of the only times that I have been present at a delivery where that a birth attendant has allowed the mother to use spontaneous or mother-directed pushing, as opposed to directed pushing. I knew that Alyssa was interested in using a variety of pushing positions for the second stage of labor from her birth plan and for the next hour and a half the midwife, Jared, Deb, and I helped Alyssa get into a variety of positions including right/left side lying, squatting, hands and knees, and kneeling.
(Side Note: I would like to digress for a moment to point out how important it is to be physically fit during your pregnancy whether you are planning for a natural birth or not. Many a woman I take care of blindly fills out a “birth plan” they find online where they can click on the boxes for options that sound “good” to them, without actually researching or thinking over what they are writing down. For example, they say that they want to try squatting during labor and birth, but couldn’t even do a squat at the gym pre-pregnancy. Although it is definitely true that a woman can sum up and realize an incredible amount of strength during labor and birth related to not only hormones but also sheer will power, it should also be known that labor is HARD WORK and pushing out a baby is HARD WORK which both require a great deal of physical strength and stamina. This is yet another reason why it is so important to follow a modified exercise plan and eat a healthy well balanced diet rich in protein and omega-3 fatty acids before, during, and even after your pregnancy.) Let’s continue with Alyssa’s story…
What was so amazing was that although there were plenty of times during the labor and pushing phase that Alyssa would doubt her ability to go on (“I can’t do this anymore!” “The baby isn’t moving?” “Is the baby moving?” “I am so tired!”), she never gave up on herself. Each time she made a comment like that, we all took it as a request for more support. And every time we gave her more encouragement, cheers, and reminders of her progress and goals, (“Keep going!”, “You are doing so well!”, “We can see so much more of the baby’s head!”, “She has lots of hair!”, “Just a few pushes more”, “You are so strong, you are going to do this!”, “You can do this!”), she found the ability to keep going! Towards the end of the pushing stage Alyssa was (understandably) exhausted and was pushing in a modified lithotomy position while Jared and I supported both of her legs. Then all of a sudden Alyssa popped up and said (and I quote)…
“I need GRAVITY! I need to be UP!” as she sat upright into a full squat and
PUSHED her baby’s head out with one gigantic ROAR!
“Whoa, whoa!” the midwife and I said almost simultaneously, “Easy, easy, baby pushes.” “Blow like you are blowing out birthday candles,” I said. The midwife checked for a cord around the neck (which there was none) and cleared the baby’s mouth and nose. And with only a few more “baby pushes” Addison Joy was born at 2:27pm!
The room erupted into cheers of excitement and tears of happiness! I put the baby skin to skin on mom as I dried her off with warm blankets and cleared her mouth and nose with the bulb suction. A quick palpation of the baby’s cord revealed that her heart rate was nice and strong and she was pinking right up! Jared and Alyssa kept hugging and kissing each other and talking to their new baby girl, “Hi Addison! Hi baby girl! I am so glad to finally meet you!” The midwife waited until the cord stopped pulsating before she cut it (per mom and dad’s birth plan) and then checked Alyssa for any tears. Except for some swelling, she only had a small tear on her right labia that didn’t even require any stitches!! We kept mom and baby skin to skin for a full hour after birth and baby Addison nursed almost the whole time. When she was an hour old, I weighed her to satisfy mom’s curiosity and to everyone’s surprise the baby weighed 9 lbs 3 ozs!!!
So much for “cephalopelvic disproportion” huh!!
And it was as I handed baby Addison back to Alyssa that she looked up at me and said softly, “I needed to know my body could do it. I knew my body could do it! I really needed this. Thank you.” So as you can imagine, I started to well up. I have never felt so honored to be a part of something so special. What a privilege to have a job where I witness the miracle of birth and the miracle of motherhood every week!
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So let’s recap shall we. Alyssa, after having a cesarean section for her 7 lb 5oz son two years earlier for “CPD” and “failure to descent”, pushed out a 9lb 3oz baby after a 6 hour and 27 minute labor, including 1 hour and 42 minute of mother-directed pushing, without any pain medications or an epidural, monitored by intermittent auscultation, needing not a single stitch to her perineum! Her tools included good and relevant labor & birth preparation, appropriate and helpful family support, sheer strength, determination, and will power. The midwife’s arsenal included extensive knowledge of and experience with natural birth and labor support, a doptone, a trust in birth, and a belief in Alyssa’s ability to do it! No medications, no vacuums, no scalpels, no scissors, and no doubt!
Boy how I love my job sometimes 🙂
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*As always, names and any identifying information have been changed to protect privacy.
For more information on VBAC please visit: International Cesarean Awareness Network and Childbirth Connection
For more information on how you can move and groove through your labor check out:
Submitted on 2009/10/18 at 9:43pm
Comment left at: Top Ten Things Women Say/Do During Labor (And trust me… they are totally normal!)
Dear NursingBirth,
Hello, I know this is an old post, but I’ve been searching information on vomiting during labour for a few hours (lol!) and can’t quite find what I’m looking for. So with the housework waiting I thought I should just come out with it and ask! Your post is very informative and you seem lovely so I hope you are able to help me! (Or others who have been through it!)
I have emetophobia (fear of vomiting), and find I am able to calm myself about the potential of vomiting (because I have had to face that fact that I can’t just escape it!), if I
#1: Know that “everything will be ok” if I do vomit. (i.e. Mainly that people won’t be disgusted, or freaked out and that someone will be able to deal with, well, the result, if I’m not able to. Even though I’ve never vomited anywhere except in a toilet, it’s just the potential that terrifies me! My husband is a wonder, and it’s only actually since being with him that I’ve begun to get over the phobia because he’s not scared about it, and not fazed by it).
And
#2: Remember that I can handle vomiting much better if it isn’t preceded by hours and hours of painful nausea.
SO, I find myself trying to prepare mentally for the possibility of throwing up during labour, and I have some questions stemming from this for you (I know it is an irrational fear, and these questions seem trivial but they are things that really stress me out – I actually lose sleep over them – so I appreciate your answers):
#1 Will the midwives be ok if I throw up all over the place? Will the staff get disgusted or freaked out?
#2 Will the staff clean it up or will I or my husband have to?
#3 What happens if it gets in my hair?
#4 Will I choke because I might be lying down?
#5 Will everything be okay if I do vomit?
And, finally
#6 Is it a different kind of vomiting – one that just kind of happens, rather than following hours of terrible nausea?
Anyway, I don’t mean to waste your time, and many thanks in anticipation of any answers – I’m just trying to mentally calm myself so I can focus more on the really important things about labour – like my baby!!
Sincerely,
NervousMumToBe
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Dear NervousMumToBe,
First of all I am sending you one MAJOR cyber *HUG* right now complete with back patting and me saying “You can do this!!” 🙂
Second, you are NOT wasting my time so don’t mention it!! I have written before about worrying, that is that “WORRY is the WORK of pregnancy!” In her book Birthing From Within, certified nurse midwife Pam England tells the story about a patient of hers (Hannah) that worried a lot about having a natural birth experience after having had a highly medicalized birth with her first baby. She writes that Hannah longed to hear her say things like “Don’t worry” and “Everything will be alright” but instead England encouraged her to face her fears. She instructed Hannah to write down all of her worries and explore each of them with questions like “What, if anything, can you do to prepare for what you are worrying about?” and “If there is nothing you can do to prevent it, how would you like to handle the situation?”
England lists the “Ten Common Worries” of Labor as:
1) Not being able to stand the pain
2) Not being able to relax
3) Feeling rushed, or fear of taking too long
4) My pelvis not big enough
5) My cervix won’t open
6) Lack of privacy
7) Being judged for making noise
8.) Being separated from the baby
9) Having to fight for my wishes to be respected
10) Having intervention and not knowing if it is necessary or what else to do
I would like to add #11:
11) Fear of pooping in labor/Fear of embarrassment regarding bodily functions
As you know I am a labor and delivery nurse and have estimated that I have been present at over 300 births during my career and still, I would have to say that when it is my time to give birth, #1 through #6 are top on my list of worries!! And I witness the amazing power of women everyday!! So NervousMumToBe, don’t *worry* about “worrying” about vomiting! I am so happy that you are FACING YOUR FEARS!! If vomiting is something that you are really concerned about, no matter how trivial it might seem to others, it is important to you and that is all that matters! So I applaud you!
Okay now that the most important thing is out of the way (i.e. the hug) lets get down and dirty about the #2 thing on every pregnant woman’s mind…VOMITING IN LABOR!! (If you are wondering what the #1 thing on every pregnant woman’s mind is it is POOP. Don’t believe me? Check it out here.) I want to preface the following post with a few things in the interest of full disclosure:
Now to some answers!! I will take your questions one at a time:
#1 Will the midwives be ok if I throw up all over the place? Will the staff get disgusted or freaked out?
Yes and No!! YES! The midwives and the labor and delivery nurses will be okay if you throw up all over the place and actually, they probably will not even bat an eye if you throw up! And NO! The staff will not get disgusted or freaked out if you throw up! If bodily functions bothered us, we wouldn’t be working in healthcare! I have been thrown up on before…more times than the average person for sure! I have been splashed with blood, amniotic fluid, pee, spit, and mucus. I have also cleaned up my fair share of explosive diarrhea. And if I do get splashed with something I just kept on doing what I was doing until I have a break where I can go change. (Remember L&D nurses usually have to wear hospital scrubs just in case they end up in the operating room. The other bonus to this set up is that if you get splashed with something gross then you just go in the locker room and change into a new pair of hospital scrubs!) I am sure over the course of time there has been some burnt out nurse that has said something really nasty or insensitive to a mother if she has thrown up but in reality, it’s all part of the job and the vast majority of nurses and midwives don’t get bothered by vomit!
#2 Will the staff clean it up or will I or my husband have to?
This question is assuming two thing: #1 That you are going to vomit (remember not all women vomit in labor) and #2 That if you do vomit that you will make a mess (remember not all women who vomit miss the bucket or don’t have a chance to throw up in a bucket). That being said…
I know I can’t speak for every single nurse out there but I would NEVER EVER expect a husband (or any coach for that matter, including the mother herself) to clean up something like that. After all it is the husband’s (or partner, coach) role to support the mother and if the mother did throw up, say, on the floor, I would ask the husband (partner, coach) to stay with the mother while I went to grab some towels to clean it up. And then I would clean it up quickly. And then it would be a non issue! Done!
One time I had a mother who was taken off guard by her need to vomit and accidentally threw up all over her bed. She was very apologetic but apologies were not necessary. I knew that she didn’t mean it! With the help of her husband I walked her into the bathroom and had her sit down on the toilet to pee. Her husband stayed in the bathroom with her. Within 5 minutes I had the completely remade the bed with clean sheets. Then I helped her into a fresh, new, warm gown and then back to bed. It was like it never happened! We all moved on and no one mentioned it again. After all, who was thinking about a little vomit when there was a BABY about to be born!
I learned from that experience and ever since then I always make sure that I give every mom a bath bucket when she is admitted and I put it right on her bedside table so that if she needs to throw up, it is right there for her. Because I do this, I have rarely ever had a mother throw up in labor and not use the bucket. Since you have a concern about vomiting, I would recommend that you ask your nurse for a bucket when you get to the hospital, just in case. And when I say bucket I mean bath bucket (or wash basin), not those ridiculous kidney shaped “emesis basins” that wouldn’t even be helpful to catch ladybug vomit!
Remember, although it is not rare for a mother to throw up in labor, it is rare that she throws up all over the place, or has no idea that it is coming. In my experience the vast majority of moms who vomit in labor do indeed make it into the bucket and therefore, there is nothing to clean up! Also remember that labor vomit is different that “stomach flu” vomit. That is, there is no risk to me as the nurse of getting sick from a laboring woman’s vomit because it is not caused by illness. I’d rather clean up your labor vomit over my own stomach flu vomit any day!
#3 What happens if it gets in my hair?
If you were my patient and you started to vomit I would hold your hair back. And I am sure that your husband would do the same for you too. That way you wouldn’t get any vomit in your hair at all. Have you considered putting your hair into a pony tail or clip while you are in labor? If your hair was up it would be very unlikely that it would get any vomit in it. Perhaps you can pack a few extra clips or elastics into your hospital bag just in case you need them. If you don’t usually wear your hair back you may want to consider wearing a few hair elastics around your wrist so that they are readily available if you need them to tie your hair back if you feel nauseous. I also have been known to cut the opening off a rubber glove and use it as a make-shift hair tie for just this type of circumstance!
However if a little bit of throw up did get in your hair and if I was your nurse I would probably wet a warm washcloth and clean it out. And then I would put your hair into a pony tail or clip for you to get it out of your face. If it was really bad (I have never seen this but I suppose that technically it could happen) and if your midwife allowed, I would help you into the shower. After all, many women find laboring in the shower to be extremely soothing and helpful!
#4 Will I choke because I might be lying down?
NO! You will not choke, even if you are lying down. Only people that are unconscious, have an impaired gag reflex, or are debilitated in some other way have a risk of choking on their own vomit. I have never seen a conscious laboring mother choke on her own vomit…NEVER. Why? Because every single healthy, able-bodied, conscious person sits up or leans over automatically when they start to vomit. I have never even seen a mother who was positioned flat on her back and numb from the breasts down for a cesarean choke on her own vomit. Why? Because every single healthy, able-bodied, conscious mother in that situation automatically turns their head to the side to vomit.
If necessary every hospital room and operating room has (or at least should have) a suction canister in it with a yankauer suction set just in case a mother does lose consciousness and her mouth needs to be suctioned. You might not have seen it when you toured your hospital because most birthing suites keep that kind of equipment behind pictures or in cabinets so that the room doesn’t look too “hospital like.” But they are there. I personally have only had to use the yankauer suction set ONE TIME as a labor and delivery nurse and I used it because my patient had an eclamptic seizure (a rare complication of preeclampsia) and when she came too she was really out of it (“post-ictal”) and her mouth needed to be suctioned because it was full of secretions. That’s it, one time only.
#5 Will everything be okay if I do vomit?
YES! In fact, labor and delivery nurses get excited when they see a patient vomit because vomiting is usually a sign of transition which is the last stage of active labor (usually 7-10 centimeters) right before a women begins the pushing phase. Remember whether or not she has been eating throughout early labor, a woman may still vomit when she enters transition so it is not necessary to starve yourself on purpose because you are afraid to vomit later on. In fact, some women vomit because they have done just that! (I know I personally get very nauseous as well as get a headache if I haven’t eaten anything all day). I always think of it as a way the body is “making more room” for the baby!
Also since vomiting, like holding your breath or making a bowel movement, is a vagal response, it inadvertently helps your cervix dilate and hence, is a great sign to a labor & delivery nurse! The body does awesome things to help the process along! So really it is not just okay if you vomit, it is GREAT if you vomit because it may help you cervix dilate! I also want you to know that you will not hurt anything if you vomit, including the baby or your cervix.
#6 Is it a different kind of vomiting – one that just kind of happens, rather than following hours of terrible nausea?
In my experience as a labor and delivery nurse most women who have a natural, unmedicated, spontaneous labor do NOT have hours and hours of nausea before they vomit. Instead, once there labor really starts to ramp up for the last few centimeters they get a feeling of nausea that gives everyone enough warning to grab the bucket and then they throw up. After throwing up, the vast majority of women have told me that they feel better. It is very rare that I have taken care of a woman who continues to throw up once they are 10 centimeters dilated and begin to push or is nauseous for hours and hours before they vomit. That being said…
Nausea and vomiting are very common side effects of narcotic pain medications (e.g. stadol, nubain, demerol, morphine etc.) as well as ALL forms of anesthesia (including labor epidurals as well as spinal blocks often performed for cesarean sections). Because of this, some physicians and midwives prescribe an anti-emetic (aka anti-nausea medication) like Phenergan, Zofran, or Reglan to be administered with the narcotic, epidural, or spinal to counter act this side-effect. Sometimes it helps, sometimes it doesn’t. Because you have such a fear of vomiting I want you to be aware of this fact.
So there you have it: the skinny on vomiting in labor! I hope this has helped calm your fears and worries however if you have any more questions about this topic please feel free to leave a comment!!
Thank you for writing in to me. You are certainly not alone in your fears!!! I know that your question will help other women out there who experience the same fears as you! GOOD LUCK with your upcoming birth and CONGRATULATIONS to you!!! And remember, although birth might be one of the messiest experiences of your life, no amount of fluids, cursing, farting, pooping, striping naked, howling, crying, peeing, bleeding, or vomiting will take away from how honestly empowering, mind blowing, and touching this experience can be for you and your family!!
Sincerely,
NursingBirth
Hello Everyone!
Please check out an urgent message sent from Gretchen Humphries, the Advocacy Director of the International Cesarean Awareness Network (ICAN). She needs our help to spread the word and send in stories about a most critical healthcare issue: insurance discrimination.
For more information on this story please check out ICAN’s website.
Thank You,
NursingBirth
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From: Gretchen Humphries <advocacy@ican-online.org>
Date: Fri, 16 Oct 2009 1
Subject: Urgent request for stories
I have sent you this request because of your connections within the Birth
Community. I hope that you will see if there is any way you can assist ICAN
with this request.
We have made this request before but now the stakes are really high. Peggy
Robertson is a woman from CO who testified yesterday before the HELP
committee (the Senate Health Education Labor and Pensions Committee) about
being denied coverage because of a previous cesarean, unless she could prove
she had been sterilized. (We managed to work in a couple of comments about
VBAC bans too! Which got some response from a couple of Senators!)
Senator Mikulski, who chaired that hearing, has asked for more stories
similar to Peggy Robertson’s. Please distribute this request as widely as
you can –
ICAN needs stories about discriminatory insurance practices based on a
previous cesarean. This can include but is not limited to demands for
sterilization, restrictions on how soon you can have another pregnancy and
be covered, higher premiums, restrictions on the total amount of benefits
they will pay, excessively high deductibles for maternity care. Even if all
you have is your name, state, contact information (email is fine) and a
description of the circumstances (with the name of the relevant insurance
company(ies) if possible) we can use it. If you have written documentation,
that would be pure gold.
There is interest about this at the highest levels of the Federal Govt. and
we will use this to open the discussion on other areas of discrimination
(like VBAC bans, lack of transparency, etc)….so please, take a moment and
get the information to ICAN. You can email me at advocacy@ican-online.org
or you can snail mail to ICAN of Ann Arbor, PO Box 48, Stockbridge, MI
49285.
Your story could make a difference that would improve the care available for
millions of women and their babies.
Thank You,
Gretchen Humphries
Advocacy Director, ICAN
advocacy@ican-online.org
(517) 745-7297
Yesterday the Connecticut newspaper New Haven Register published an opinion piece entitled “Media out of focus on midwifery” by Holly Powell Kennedy, CNM, Charles J. Lockwood, MD, and Edmund Funai, MD and I have to say, I am very very pleased to read such a focused, well-reasoned, supportive article on birth choice, the safety of homebirth, and the need for hospitals around this country to step up and better meet the needs of birthing families! And for it to be written by two obstetricians and a certified nurse midwife….its just too good to be true!!
Favorite quotes of mine include:
Yes, Yes, and YES!
Thanks to Christina at the Massachusetts Friends of Midwives Blog posting about this article! What a great start to my day!!
Nursing Birth 
The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On October 21, 2009
Tags: birth, birth plan, c-section, doctor, hospital birth, ICAN, L&D, labor & delivery, midwife, natural birth, OBGYN, pregnancy, transfer of care, Vaginal Birth After Cesarean, VBAC
Submitted on 2009/10/20 at 3:24pm
Comment under: Urgent Message from ICAN! Please Spread the Word!!
Dear Nursing Birth,
I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)
I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!
And how does the doc get away with not telling me something important like this until NOW? Unbelievable!! My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time. I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!
If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.
I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!
I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!
Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).
Sincerely,
Kelly
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Dear Kelly,
WOW! I am so sorry that this is happening to you. You story deeply saddens, frustrates, and angers me because unfortunately YOU ARE NOT ALONE! Women all over this country have to fight everyday for their VBACs. Too many are unsuccessful.
First off I want you to know that your gut is absolutely right; 40 weeks is NOT too late and the research does NOT support your obstetrician’s claims.
Second, if that hospital is actually considering revising their entire VBAC “policy” in response to one mother who, as it sounds to me, shook the boat a little bit by demanding better care as well as exercising her right to informed refusal, they are absolutely outrageous and ridiculous! I would be skeptical of that story if I hadn’t recently read this about the sign placed at the entrance of the Aspen’s Women Center in Provo, Utah.
Third, sounds to me like you did everything right! You found what you thought was a VBAC supportive care provider, you researched your options and decided you wanted to stack as many cards in your favor as you could for a successful VBAC by planning a drug-free/intervention-free childbirth, you wrote up a birth planthat you painstakingly went through “line by line” with your physician early on in your pregnancy, you have sought out and taken childbirth preparation classes that are geared towards not only providing knowledge about how to have a successful natural childbirth but also help in preparing mentally and emotionally for such an important journey (and on top of that you took those classes with your husband!), and you even hired a doula. (Yup! Just as I suspected…you did everything you could!) So what happened?!?!…
Unfortunately you are a victim of the ol’ bait and switch.
It happens to women everyday around this country. And its existence is further proof that our maternity system is broken, in shambles really. There are some obstetricians, family practice physicians, and yes, even midwives that have become really friggin’ good at this awful game. Women write in to me all the time with similar frustrations and complaints as yours, Kelly. And I always find myself helpless and speechless. I don’t know how to help women avoid it and I struggle everyday in my own professional life with how to fight it and stop it!
The worst part of the ol’ bait and switch is the feeling of betrayal that most women report experiencing after they have been victimized they this outrageous action. (I want to note that I used the terms “betrayal” and “victimized” on purpose. I understand that they are very strong words but I feel they are the best to describe this very serious phenomenon). So why does it happen? Both from what I have personally experienced as a labor and delivery nurse as well as what I have read (for example: Born in the U.S.A by Marsden Wagner and Pushed by Jennifer Block) there is not one simple answer for why some healthcare providers use this “technique.” But there is no doubt in my mind that money, greed, fear of litigation, fear of losing patients, competition, superciliousness, willful ignorance, impatience, convenience, blatant disregard for evidenced based medicine, favoritism for the “because we’ve always done it this way” model of practice as well as favoritism for the paternalistic provider-patient model of practice (that is, the care provider only presents information on risks and benefits of a procedure/test etc. that he or she thinks will lead the patient to make the “right” decision (i.e. the provider supported decision) regarding health care) all have something to do with it. Providers who practice the ol’ bait and switch fall somewhere on the, what I like to call “Asshole to Apathy,” spectrum. Some may be bigger assholes than others, but in the end, they all fall somewhere on that spectrum in my experience.
[PHEW! Okay, WOW! Now I’m all worked up! Sorry, sorry! I don’t know where that rant just came from! But this kind of thing really burns by britches!]
So Kelly, you must be thinking, “Where does this leave me?” The good news is that Kristen, a philosophical doula blogger friend of mine over at BirthingBeautifulIdeas is author of an amazing series she calls “VBAC Scare Tactics” which I think is a resource that you, and other moms in your situation, might find very helpful. What you are describing sounds to me like VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date. After that, we’re scheduling a repeat cesarean.”)
In each post she identifies one particular scare tactic, supplies a list of questions that a mother can ask her care provider in response to this scare tactic, and then provides an analysis and/or summary of the research that either challenges or even debunks the scare tactic and its insinuations. In the introduction to the series she writes,
“Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in this country have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.
Sometimes this opposition is blatant. Sometimes this opposition becomes obvious only at the end of the third trimester. (Many VBAC-ing moms refer to this tactic as a “bait-and-switch” since it involves a supposedly VBAC-supportive care provider rescinding this support once the actual VBAC is imminent.) Sometimes even a care provider’s “support” of VBAC is instead a conditional, half-hearted, or perhaps sneakily-disguised opposition to VBAC. These “scare tactics” are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean. (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)
If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way. And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.”
Things I love about BirthingBeautifulIdeas’ VBAC scare tactic posts include:
#1 Her writing is organized and clear. (You know how much I love organization and lists!)
#2 She respects research and understands the importance of evidenced based medicine. (In fact, the reason BirthingBeautifulIdeas is aware of much of the research she cites is because she actually used said research studies in weighing her own decision about whether to have an elective repeat cesarean section or instead prepare and plan for a VBAC.)
#3 She has personal experience with this subject. (In fact she not only experienced a VBAC scare tactic and the “bait-and-switch” with her former OB, but also made the difficult decision to and successfully did transfer her care to a VBAC supportive care provider late in her pregnancy (at 37 weeks to be exact!) as well as experienced a subsequent and successful VBAC hospital water birth. Check out her story “My very own VBAC waterbirth”.)
#4 She does not provide advice. As she said herself, she is NOT anti-OB nor is she telling women to do anything. Instead she provides tools that allow women to make their own decisions and stick up for their own decisions about the birth of their babies hoping that in doing so women come out of their birth experiences feeling positive and empowered, regardless of the outcome.
Kelly, please check out the post VBAC scare tactics (#3): An early eviction date. I was going to write to you about the research and such on the topic but BirthingBeautifulIdeas has already done such a fantastic job herself that it wouldn’t even be worth it to summarize her article.
While I’m at it, here’s the entire VBAC scare tactics series:
VBAC scare tactics (#1): VBAC = uterine rupture = dead baby (aka “Why would you want to risk a VBAC only to have a ruptured uterus and a dead baby?”)
VBAC scare tactics (#2): When bad outcomes in the past affect patient options in the future (aka “I’ve seen a bad VBAC outcome, and it was terrible. You really don’t want to choose a VBAC over a repeat cesarean.”)
VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date. After that, we’re scheduling a repeat cesarean.”)
VBAC scare tactics (#4): No pre-labor dilatation = no VBAC (aka “Since you are 39 weeks pregnant and your cervix isn’t dilated or effaced, it looks like you probably won’t go into labor on your own ‘in time.’ We need to schedule a repeat cesarean and forgo a VBAC attempt.”)
VBAC scare tactics (#5): VBACs aren’t as safe as we thought they were (aka “You know, VBACs aren’t as safe as we thought they were. They are much more dangerous to you and your baby. A repeat cesarean is the safer route.”)
A VBAC scare tactic interlude (Thoughts and resources on transferring your care to a VBAC supportive care provider, inducing labor when you have a history of a cesarean and weighing the pros and cons of pain medications and interventions if you are planning a VBAC.)
VBAC scare tactics (#6): CPD or FTP = no VBAC (aka“Here in your chart, it says that your cesarean was for failure to progress (FTP). Oh, and there’s also a note here about cephalopelvic disproportion (CPD). You’re not really an ideal VBAC candidate since your cesarean wasn’t for fetal distress or breech presentation, so we need to schedule a repeat cesarean.”)
VBAC scare tactics (#7): Playing the epidural card (aka “An epidural can mask the signs of uterine rupture, so I do not permit my VBAC patients to have an epidural during their labors.” OR “In case of an emergency cesarean, I require all of my VBAC patients to have an epidural in place in early labor. That way, we will not have to wait for the anesthesiologist to get the epidural in place if a uterine rupture occurs.”)
VBAC Scare Tactics (#8): The MD trump card (aka “Look, I’m the one who has earned the medical degree and I am telling you that you cannot attempt a VBAC. Your only choice is a repeat cesarean. Period.”)
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Kelly you wrote, “Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.” You are right. You don’t have to do anything they say. You have the right as a patient to both informed consent as well as informed refusal. However I want to say a few things. (Here comes my cyber pep-talk, meant of course to be 100% supportive of whatever you chose and not at all meant to give you advice. But I don’t think many women get a chance to hear from anyone what I am about to tell you. To get the full intent of this pep talk just picture me standing behind you vigorously rubbing your shoulders as I squirt water into your mouth from a sports bottle and wipe the sweat off your face. So here it goes…)
You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for. Your desires for said unmedicated, intervention-free VBAC are well supported by the research. You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC. You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE. You deserve it for THIS birth.
I know that it is scary to even think about transferring care to a new care provider so late in the game. But I encourage you to at least think about it. Even if you think that there are many limitations in your options regarding availability, insurance, distance, etc. etc, it is worth it to you to at least check it out. I also encourage you to get in touch with your local ICAN chapter (unless, of course, you have already done that.) Some of the members might be able to give you some suggestions on VBAC friendly care providers that they know actually attend VBACs! Sometimes even if a VBAC friendly midwife or doctor is booked they will make an exception for a late transfer of care if a doula friend or former patient calls and asks for a favor. (I’ve seen it happen before with my local ICAN chapter). Also ICAN’s website has a variety of helpful articlesfor moms planning a VBAC against hospital or provider resistance.
I can tell by your story that you are a very strong woman and my gut tells me that you will indeed fight for your rights even if you stay with your current obstetrician. You just shouldn’t have to do that and it saddens me that any your energy is going to be dedicated to defending yourself during your birth. Even one tiny little bit of energy devoted to that is too much! You deserve more! You deserve better! I think you said it perfectly when you wrote, “It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!”
I couldn’t agree more!
So Kelly, I wish you the best of luck! And like many of my readers, I really wish I was going to be your labor and delivery nurse! CONGRATULATIONS on your pregnancy and on your upcoming birth! I will keep you in my thoughts and I hope that you will one day come back and tell us how your birth went! I hope that this post has helped you in some way. Oh and please apologize to your friends and family for me since you probably will be wasting a lot more time in front of the computer now that I have provided so much reading material! Haha!
Sincerely,
NursingBirth