Pissed! but Accepting?

Wednesday was a banner shite day.  My midwife had been encouraging me to maintain a relationship with an OB, and I knew this necessitated a change.  Friends and L&D nurses urged me to try this one doc, Dr. A (we shall call him), stating that if anyone was going to give me a chance at VBA2C, it would be him.

So, I naively went to my 9:50am interview/appointment with Dr. A.  I was nervous – didn’t really sleep the night before – but hopeful.  The staff was very nice; the nurse was nice.  (I had previously talked with her.)  I had previously met this doc, so at least I wasn’t worried about that.

He was interested to know why I was there since obviously I had been seeing another OB for the 1st three-quarters of my pregnancy.  I told him I had 4 reasons:

  1. I am very motivated for a VBA2C

He interrupts . . . “Don’t do it.”  Shaking head.  Patronizing tone.

I cry.

The rest of the appointment was him trying to scare me out of it, and by the time I told him I’d been diagnosed with a thin lower uterine segment (LUS) during the RCS, he was certain that I am a nut.  Actually, he recognized that I had done a lot of thinking and researching, but he didn’t think I had given enough thought to permanent damage to the baby and permanent damage to me.  (Like, DUH!  What else have I been thinking about the past 7 months.  FFS!!!!!!!)

What was scary is that he’s familiar with the same research I’ve studied.  He mentioned the Cochrane library.  He refuted the opinion of the NIH VBAC Consensus Panel (because most of them don’t deliver babies).  The research doesn’t point to maternal death from uterine rupture but he’s seen it.  Fetal demise begins within 8 minutes of the onset of bradycardia associated with rupture which is too short a time to get a cesarean performed.  Yada yada.

Terrifying.  And I’ve done my research.  I’ve been researching this since 2007.  I have a PhD.  I have fantastic research and analytical skills.  And I was still terrified.  And I still doubted myself, my support system, everything.  And I resented my baby.

And I freaked the hell out.  Couldn’t go to work. 

So, you probably see the “pissed” part.

Here’s the “accepting” part.

Of course he’s going to do “his job” and dissuade me from VBA2C.  In his experience, it’s too  risky to justify.  He’s not going to understand why I disagree.  I’ll never be able to “educate” him here either.  When I don’t rupture and have this baby at home without incident, he’ll assume I got lucky.  I accept that he views birth with a completely different lense.

However, he’s agreed to take me and said he won’t drop me either even if I go forward with the VBAC.  He’d rather babysit me through this poor choice than turn me away.  I’ll have to sign an AMA (against medical advice) waiver just to cover his butt.  Fine; whatever.  So, for now . . . I’m planning to continue my concurrent care with him.  If it becomes a regular thing for him to try and terrorize me, then I’ll drop him.

Although he really shook me to the core on Wednesday, thanks to the amazing support of ICAN and Birth After Cesarean, I’m back on track and actually feeling more solid about my birth plans.  I just don’t “see” the hospital figuring into this experience.  Perhaps God or my baby or some 6th sense will change things, but for now, I’m back to planning a peaceful birth at home.

A Note to My Friend

This morning I received an encouraging e-mail from a friend.  She has been through infertility and recurrent losses, but it looks like she finally has a keeper!  Luckily she has found medical providers who were able to come up with a good treatment protocol for her situation.  She has weaned off of the progesterone shots (daily shots of progesterone in oil – owie!) but is still on heparin, I believe, for the duration of her pregnancy.  She is finally in the second trimester!

She mentioned that her fear of childbirth is abating.  Some of that is because she has experienced natural miscarriage, and she has been told that it is like mini labor.  I wanted to share (most) of my response to her.  Of course I could have said much much more, but I really don’t want to be “that crazy friend” who can’t shut up about natural childbirth.

Just remember that the OB is just a person, not a god.  And what YOU want DOES matter.  Ask about birth plans and how the hospital honors them.  I would hire a doula, someone who will be able to advocate for your needs and your desires.  Seriously, that’s the biggest mistake I made – I thought that having a CNM would “save” me from unnecessary intervention, but it didn’t.  The rest is history.


I thought the childbirth education classes at [name removed] were just fabulous.  My only criticism is that I somehow didn’t understand how life altering the cesarean was going to be.  I’m not trying to scare you – the cesarean was a piece of cake for me, and it didn’t mess with breast feeding at all (in my case).  It’s just that I was so shocked when I went in for my 6-week post-partum appointment with the OB who did my surgery and was told about uterine rupture.^  And then last July-August when I was preparing for baby #2 I learned so much about the failings of our maternal health care system, and that’s when I really “cracked.”  I was just so pissed and became somewhat disappointed in [name removed] for not having been more forceful.*

Regarding labor – I didn’t even know I was in labor.  Granted I had a violent stomach flu . . . but I was surprised that I showed up at the hospital 9cm dilated!  Probably one of the most painful things I have gone through was my second miscarriage.  Supposedly subchorionic hematoma miscarriages are pretty bad, and this one was no exception.  And during my last miscarriage I kept nearly fainting from the blood loss.  Labor?  Piece of cake.  You’ll be brilliant!  Remember that the pain is good – it’s there for a reason.  It helps get your baby out and into your arms.

I am just so excited for you.  I am so glad that you’re out of the first trimester!!  And hopefully you’ll really start feeling great, and pretty soon you’ll start feeling your “lemon” move.  That will bring you much comfort and joy.

^ For the record, every laboring women has a small risk of uterine rupture.  Most uterine ruptures in VBACs were historically caused by labor augmentation and induction tactics.  A “window” or a dehiscence (separate terms in my mind) is not the same as a true uterine rupture.

* One thing I forgot to mention to her is that my husband seems to remember our childbirth educators talking about uterine rupture.  Maybe they mentioned it, but again, it didn’t leave the impression that it should have.  I only pushed for 2 hours and then gave in to the cesarean.  I thought it made sense.  Had I known – really known – what a cloud the cesarean would cast over the rest of my childbearing years, I’d have resisted that cesarean.  My baby would have tolerated it – when she was delivered, her APGAR scores were 9 & 9.  Nearly perfect.  Not a baby in distress as I had been told.

Perhaps what childbirth educators could add into their series is a session on how doctors perceive cesarean scars.  Why the medico-legal culture dominates obstetric practices.  Why certain risks (cesarean surgery, amniocentesis, etc.) are acceptable and others (natural birth, especially after a cesarean) seem foolish.