Help me not have another c-section, please?

In My Humble Opinion
1

With my last child I feel like I was rushed into a c-section I didn’t want/need. Basically, it was my first delivery, and I’d had an epidrual and it was keeping me from pushing. The doctor who was taking care of me wanted to wait until the meds wore off, but then my doctor showed up and got impatient. I don’t even know if I ever gave permission. (I know for a fact that I never signed a consent form. The hospital told me that not signing the forms just meant I had to give verbal permission for things. So if I wasn’t sure if I wanted drugs, for example, I just didn’t sign the form and they had to ask me while I was in labour. That’s what they told me, anyway.)

Anyway, that’s in the past. The problem now is this. I have been trying to find a midwife in Houston who can take a patient who has had a c-section and doesn’t want another. I have only found one who can, and they won’t accept my insurance. At this point, I can’t even find a doctor who will do it. They tell me that the attitude in Houston right now is “once a c-section, always a c-section.”

I am shocked. All of the books I read during my last pregnancy (including “What to Expect…”) made this out to be a thing of the past, totally out of vogue. And yet, in a city with one of the finest medical communities in the world, I appear to be stuck.

Don’t I have a choice in this? I don’t know where to turn now… help?

2

I don’t know how exactly, having no medical knowledge but I believe it is actually very dangerous for a former c-section mother to give birth vaginally, both to the baby and the mother.

Personally, if I ever have a child, I would want a c-section. I have no desire whatsoever to go through vaginal childbirth, and I don’t understand why anyone would. I mean, hours of pain, indignity, the risk of tearing in the anus, perenium and the clitoris, the risk of having your defecatory/urinary system messed up or your sex drive destroyed by aforementioned tearing, plus a stretched out vagina? Why is that considered desirable?

Why do you want to put yourself through that? If I were in your position I would be very, very happy! As it is, I am seriously consdidering never having children, because I never want to put myself through that.

3

No offense, but that is not the question I asked. A c-section is not fun. It took me a week just to be able to walk again. Plus, my doctor did a “bikini cut,” which he claimed meant that I wouldn’t have to worry about this.

4

BTW, I went through 25 hours of labor before my c-section. All of the problems that I had after the birth were a result of the c-section, not the labor. Those 25 hours were NOTHING compared to not being able to sit up, walk, or move myself in bed because of the healing wound in my abdomen.

5

From what I hear (FTR, IANAD, IANAWoman) is that it’s a liability thing in a lot of ways. I guess each subsequent doctor feels that the first C-section was necessary for some reason and don’t want to find out what that reason was the hard way ('specially when it’s their asses on the line).

Congrats on the impending new one, my condolences about the whole C-section thing.

6

(Note: I wouldn’t actually do the following. Probably.)

Suppose I just showed up at a hospital in labor. Could they force me to have a c-section? Could they kick me out if I didn’t want one?

7

Unfortunately, I don’t have much advice about VBAC (vaginal birth after Caesarian). I’m sorry to hear about your bad experience with your first birth. My wife and I are due with our first child any day now and we have read and re-read all the books (especially the book about the Bradley method) that are strongly against Caesarians.

We are both worried that, as KKBattousai said, the medical malpractice liability is just too great and the hospital will always try to rush a mother into a Caesarian. We are very anxious to avoid this.

You said that the midwife you found will not take your insurance. I offer the following: If you can get a referral from another doctor in your medical group, perhaps your GP, you can probably be covered at nearly any facility. Check out the entire Houston area for natural birthing centers and try to get a doctor’s referral to one. And do it NOW, as early as possible in the pregnancy. You don’t want to be dealing with the uncertainty in your final weeks.

I sincerely hope it works for you. My wife and I have really been struggling with modern medicine’s desire to just take all the control away from the mother. It’s a terrible state of affairs for otherwise complication-free pregnancies.

I don’t know the details exactly, but you can always decline a medical procedure. I may have to use that move during our upcoming birth.

8

Jpeg Jones, my husband’s company just put us on a very restrictive HMO. It SUCKS. I even considered dropping my insurance and paying a midwife with the money that would be going to insurance, but they wanted $3 grand up front.

Don’t be afraid to stick up for the decisions you and your wife made! We chose our hospital and doctor very carefully last time (using the same doc/hospital that delivered my step-son), and they still stepped on our toes. I wasn’t sure if I wanted drugs, and I ended up asking for demoral. Then they tried to give me an epidural while I was completely out of my senses on the demoral. (It had a profound effect on me.) My husband had to stop them. I ended up getting it anyway, but at least I CHOSE it.

As I said before, we still aren’t sure if we ever gave consent for the c-section. I might have, but I was pretty out of it, certainly not informed consent. I sort of wish now that my husband had insisted that they wait a bit longer. We’ll never know if I could have given birth vaginally once the epidural wore off.

9

Cessandra, that sounds like a horrible experience.

one C-section does not preclude you from having a vaginal delivery, two would.

the process is termed “trial by scar”. if you don’t have many adhesions, and your baby is in a good position, you should be fine.

your doctor should only be advising you to have a C-section if they REALLY feel that your uterus will not withstand the strain, or if your baby is presenting badly.
(i was an emergency c-section 20 years ago, and my mum was all set for a vaginal birth for my sister, 14 months later, when they found out that
a) baby hadn’t engaged and was free-floating
and
b) OB dr was going on holiday over her due date.
she opted for an elective C-section)
AFAIK some of the laws concerning patient consent do not apply to pregnant women.
however, they can only obtain a court order to overturn your refusal if the life of either you or your child is materially in danger by your refusal.

your refusal should stand if this is NOT the case.

it might be a good idea to remind them that consent is not valid if obtained under co-ercion, and refusing to treat you unless you have the section could very well be construed as co-ercion.
it could be grounds for a suit.

10

My sister-in-law just gave birth in the regular fashion, after having her first kid via c-section, so it certainly is possible. And I didn’t hear anything about doctors preferring another c-section (not that I necessarily would have heard if they had), except for a couple weeks near the end when the fetus was lined up to come out breach (which had been the motivation for the first c-section). Nor was it a quick and easy birth (speaking relatively, of course), as the kid was finally born some 21 hours after they started inducing labour. Why they started inducing I’m not entirely sure, but she was a fair bit overdue already.

Reading the comments regarding insurance and hmo’s makes me furious at the extent to which medical decisions are made on non-medical grounds, and simultaneously glad I live in a civilized country with socialized medicine where the bean counters have so much less say.

11

First off, DON’T drop your insurance just to pay a midwife. Then you might get your V-BAC, but you’d be without insurance. With other kids and being pregnant, you cannot afford to be without insurance.

Since you were dopey on Demerol, was there perhaps some other mitigating factor that made the doctor do the c-section, that you weren’t aware of? You should ask for copies of the doctor’s notes from the birth. You might have to pay $15 or so, but it will give you some more insight into exactly why he did the c-section.

You certainly have my sympathy. I had one with my son, due to placenta previa, six years ago. I knew I was going to have one when I was 4 months pregnant.

The best thing I can suggest is to go through your HMO book and find a doctor who is willing to give a V-BAC a try.

C-sections are not fun. A vaginal birth is soooo much easier.
Infectious Lass, you need to educate yourself about birth a little more. The horrors you describe are not all that common.
A c-section is major abdominal surgery.
A vaginal birth is so much easier to recover from. After my daughter was born, I WALKED to my recovery room. I had two stitches from the episiotomy. I felt great the next day, and went home the day after that.
When my son was born by c-section, I felt like shit for days. I had a catheter for 24 hours. I had an incision from hip to hip. I had a headache for two weeks. I didn’t feel completely like myself for about two months. I actually still have a little spot on my right side about the size of a fifty-cent piece that’s still numb, six years later.

Trust me, given a choice, a vaginal birth is the way to go.

12

I had my first child in 1976. It was Lamaze with no medications and a vaginal birth, 7.5 lbs.

Then I had twins in1980. Both were breech and 7 pounders so we elected for a C-section. (The OB doctor was willing for me to try delivering vaginally but the pediatrician felt the babies would be safer to be delivered C-section.) I had the bikini cut.

Then I had my 4th child in 1986, vaginal birth, no medication, 8 lbs.

And my 5th child in 1988, vaginal birth, induced labor because he was overdue, and had an epidural, 8.5 lbs. Induced labors are usually not recommended for VBAC as the contractions are much stronger with induction but they monitored me closely and weren’t too worried as I had had a vaginal delivery since the c-section. (Labor and delivery was only 2 hours.)

13

There was a major study on VBAC released within the last year. The waters are very murky as to what is actually safest. FWIW I think a trial of labour and vaginal birth is worth investigating when it’s a bikini cut and it was a c/sec due to failure to wait for progress. Even with true failure to progress, it doesn’t mean that would happen again with a differently positioned baby.

Houston’s a bad place to try for VBAC. There was a totally avoidable baby death at home which was a VBAC and it led to most midwives avoiding VBAC. The baby died of infection after waters were broken for 3+ weeks and the pregnancy went postdates. It was a very sad case of someone valuing VBAC over safety. I know after that baby died there was a period of time where no midwife would do a VBAC let alone a VBAC at home.

Contact me privately Cessandra and I’ll see if I can find some contacts for you in Houston. Have you tried LLL? The LLL leaders should know who’s worth talking to. Not that your insurance is necessarily gonna cover them. ::sigh::

14

Oh, gosh, that’s horrible, Primaflora! I mean, I want a natural birth, but not at my child’s expense!

I’ll email you.

15

Not to gang up on Infectious Lass, but vaginal birth is preferable, for the reasons that BiblioCat mentioned. I’ve been through two of these, and the second time, I was able to go through five hours of a six-hour induced labor with no meds at all. I won’t lie; it did hurt and it hurt a LOT, but I learned techniques to help manage the pain. I only asked for pain meds when I started to feel myself wearing down.

Cessandra, VBAC isn’t nearly as rare as you’re being led to believe; in fact, some doctors are embracing it as the method of choice for delivery. I don’t know the particulars of your insurance coverage, but have you asked your PCP for a referral for an OB who practices out of Women’s Hospital? Everyone I knew in Houston who was pregnant delivered there, and had nothing but good things to say about it. I would at least make an appointment and go over the previous records with an OB to see what they have to say about it. Depending on the reason for the initial c-section (IME, there’s usually a lot more documented in the medical record than the patient remembers, and if you were on Demerol, there’s a pretty good chance you’re misremembering something), you may not have the option of VBAC, but that’s for your practitioner and you to decide.

My suggestions are these. Make an appointment to talk with an OB, at least to discuss the possibility of VBAC. Bring the records from your previous delivery. Also, when you’re closer to delivery (say the fifth or sixth month), pre-register at the hospital you’re planning to deliver at. Make sure all consent forms are filled out, signed and witnessed appropriately. The time for significant decisions is not when you’re in active labor.

From a legal standpoint, if you’re in active labor and you present to the ER, they have to take you, regardless of insurance coverage. There are major downsides to this. You probably won’t get “your” doctor. Depending on the hospital (and if you deliver at the Medical Center, it’s a probability), you’ll have a resident who won’t know you, your history, or your desires.

From an insurance standpoint, however, if you do this, you’re responsible for the bill. Even authorization after the fact won’t guarantee coverage. Aaron’s delivery ran to about 3K for the OB, 5K for my hospital care, and another 3K for Aaron’s care, for a total of about 11K. Can you honestly afford to take that risk?

Robin

16

Eeek, it bothers me that so many people are scared of VBAC.

In CA, we tend to be very supportive of VBAC as long as there is no danger to mama or baby. The details of the previous c-section determine it mostly, but not always.

It is one hell of a lot easier to recover from a vaginal delivery than a c-section. I have had 2 vag births with episiotomies and epidurals, and my best friend has had 3 c-sections. No contest. I was out of the hospital by day 2 having iced my stitches for one day, while she was messed up for weeks after the hospital stay.

I wish you didn’t live in TX!

17

Having recently finished my maternity/postpartum rotation, VBACs don’t seem to be that uncommon at all!

Most of it seems to depend on the reason you had the section to begin with, and what kind of incision you received.

For ineffective pushing due to drugs, breech presentation, placenta previa, fetal distress or any other one time thing, I’d definitely push the issue - this kind of stuff isn’t necessarily going to happen the next time around.

On the other hand, you might have a harder time arguing if the baby was very large (any kind of cephalopelvic disproportion is anautomatic c-section, i think), or the incision wasn’t a low transverse one - or if your last c-section was very recent.

Speaking personally, though, I’m going to go for an elective c-section next time around. My c-section recovery was alot easier than my friends with vaginal deliveries. I have a theory that it has something to do with how long you pushed for, but I have no proof on that one. Good luck Cessandra!

18

I think Texas doctors are also very supportive of VBACs. My two VBACs were here in Texas. I think the OP was having trouble finding a midwife who would accept one. Most midwives won’t accept anyone who might be considered “high risk.” My two VBACs were considered “high risk.” (And my last pregnancy was high risk not only for the VBAC but because I was an older woman of 38 years old.)

I think that the poster will be able to find a doctor in Houston who specializes in “high risk” that will be willing to do a VBAC. (I live 90 miles south of Houston.)

19

Hey! That’s tantamount to a curse! :wink:

20

Cessandra, IANAMommy, nor so I wish to be, but there was an article in the Washington Post the other day that might shed some light on why you’re having such a problem finding a midwife/doctor that agrees with your sentiments. Apparently, pushing for C-sections is not just a Houston thing.

http://www.washingtonpost.com/wp-dyn/articles/A12788-2003Feb1.html