Thursday, November 12, 2009
Monday, October 19, 2009
- You have the right to Informed Consent
- You have the right to refuse any treatment
- You have the right to amend or change consent forms and only agree to the parts you want
- Providers who perform procedures against your will are in violation of the law
- Providers who coerce or threaten mothers with forced cesareans are in violation of their own code of ethics, and can be held legally accountable
- What you can do if you need to file a complaint against a provider
We passed out this brochure - "The Rights of Childbearing Women" published by Childbirth Connection.
We also discussed some recent stories about mothers being forced or coerced into treatments they did not want or need, and talked about Jen's birth story (which you can find here, if you have not read it already.)
If you choose to refuse only parts of care or treatment, you can find a "Fill in the Blanks" sample consent form here: http://www.medlaw.
We also touched on quite a few other stories in the news, and what our legal recourse is for them. If you need to file a complaint against a provider, you can start here: https://www.
ON THE TOPIC OF FORCED CESAREAN WITHOUT CONSENT:
According to Prown, The ACOG's own code of ethics is "adamant in protecting [a mother's] right to refuse, declaring that patient autonomy in making medical decisions must be respected at all times; that physicians must obtain informed consent for any medical or surgical treatments; and that a patient’s decision to forego treatment based on cultural or religious beliefs and personal preference or comfort must be honored.
While failing to meet the ethical guidelines required by their profession won’t subject physicians to criminal prosecution, such violations are grounds for losing the right to remain licensed to practice or to become subject to assorted other disciplinary actions. As a whole, the body of state, federal, and case law makes it clear that hospital policies mandating cesarean section violate the legal rights of pregnant women and constitute violations of professional ethical standards as well. In fact, no physician has ever been sued or held liable for neglecting to appeal to the courts to order a cesarean that a patient has refused (see, “Jehovah’s Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of All Pregnant Women” https://www.
ON THE TOPIC OF PATIENT ABANDONMENT:
"Many people are under the mistaken impression that in instances where they disagree with their physician about a course of treatment, their doctor has the right to discontinue care. However, professional ethical guidelines stipulate that a physician may only terminate care after reasonable notice and after providing for necessary interim or emergency care. Physicians who fail to meet these guidelines may be charged with patient abandonment, which is grounds for malpractice and constitutes a violation of ethical conduct that could result in loss of licensure. As a general rule, physicians who wish to discontinue care in a non-emergency situation must notify patients in writing, give 30 days’ notice and offer a general referral to other physicians in the area. However, if ongoing care is required at the time the physician wishes to terminate care (certainly the case with pregnancy), then the physician must ensure that the patient is transferred to a specific provider."*
ON THE TOPIC OF COURT ORDERED CESAREANS:
"In recent years physicians in various parts of the country began appealing to the courts when pregnant women refused to undergo treatment on behalf of their fetus. In the majority of cases, the courts sided with physicians and ordered women to undergo cesareans against their will. However, appellate decisions (which hold the force of law) have since upheld the right of pregnant women to refuse treatment, even in situations where their physician believes the life of the fetus to be threatened.
The most widely cited case, In Re. A.C., involved Angela Carder, a pregnant cancer patient who refused to consent to a cesarean at 25 weeks gestation and stated that she wanted to undergo cancer treatment instead, which her doctors believed would kill her fetus. Officials at George Washington University Hospital intervened and obtained a court order to force her to undergo a cesarean that neither she nor her baby survived. Her estate appealed the decision and won.
The Court of Appeals upheld the right of pregnant women to make all medical decisions on behalf of themselves and their fetuses, arguing that to compel invasive treatment on pregnant women would give fetuses rights superior to those of the mother and diminish the rights of born children whose parents could not, by law, be forced to undergo surgery or donate organs on their behalf. The court further ruled that the viability of the fetus and any potential harm the mother might cause to it by refusing treatment could not override her fundamental right to bodily integrity and informed consent/refusal.
It’s important for VBAC mothers to know that the Carder ruling has had a very chilling effect on the willingness of doctors or hospitals to use the courts to force women to undergo cesareans. Many continue to use the prospect of a court order as a threat to coerce women to consent, but hospitals, doctors, and their attorneys are well aware that, should they proceed and should the mother decide to appeal, they’re looking at a long and expensive legal battle that they will lose in the end.
Any VBAC mother who’s threatened with a court-ordered cesarean should inform staff that she knows that it’s an empty threat, that case law is on her side, and that she plans to appeal the ruling all the way to the Supreme Court if need be."*
*Prown, Katherine. "Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer." International Cesarean Awareness Network.
Friday, October 9, 2009
Mothers facing resistance from her care provider over a VBAC or VBA2C should discuss this information with their provider.
SOURCE: BJOG: An International Journal of Obstetrics & Gynaecology
Vaginal birth after two caesarean sections (VBAC-2)—a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.
Background: Trial of vaginal birth after Caesarean (VBAC) is considered acceptable after one caesarean section (CS), however, women wishing to have trial after two CS are generally not allowed or counselled appropriately of efficacy and complications.
Objective: To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections (VBAC-2) and associated adverse maternal and fetal outcomes; and compare with commonly accepted VBAC-1 and the alternative option of repeat third CS (RCS).
Search strategy We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, Current Controlled Trials, HMIC Database, Grey Literature Databases (SIGLE, Biomed Central), using search terms Caesarean section, caesarian, C*rean, C*rian, and MeSH headings 'Vaginal birth after caesarean section', combined with second search string two, twice, second, multiple.
Selection criteria: No randomised studies were available, case series or cohort studies were assessed for quality (STROBE), 20/23 available studies included.
Data collection and analysis: Two independent reviewers selected studies and abstracted and tabulated data and pooled estimates were obtained on success rate, uterine rupture and other adverse maternal and fetal outcomes. Meta-analyses were performed using RevMan-5 to compare VBAC-1 versus VBAC-2 and VBAC-2 versus RCS.
Main results: VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel–Haenszel).
Conclusions: Women requesting for a trial of vaginal delivery after two caesarean sections should be counselled appropriately considering available data of success rate 71.1%, uterine rupture rate 1.36% and of a comparative maternal morbidity with repeat CS option.
Accepted 19 July 2009. Published Online 14 September 2009.
AU: Samina Tahseen
AU: Malcolm Griffiths
TI: Vaginal birth after two caesarean sections (VBAC-2)—a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections
SO: BJOG: An International Journal of Obstetrics & Gynaecology
CP: © 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
AD: Leeds University Hospitals NHS Trust, Leeds, UK; Luton & Dunstable Hospital NHS Foundation Trust, Luton UK
Saturday, October 3, 2009
Place: Northwestern Memorial Hospital
Length of Active Labor: 6 hours
Gestation: 40w 4 d
Baby's Weight: 7lbs. 11ozs.
Baby's Length: 20 inches
Baby's Apgars: No idea
I can never tell a story in short version, b/c I’m a very detailed person, this is not only my birth story, but the story leading up to the most stressful weeks of my pregnancy that no women should have to deal with. I found out I was pregnant again with number six and I was in total shock. We thought we were done, but someone had others plans for us. I was for the first time scared to be pregnant. Five months prior, I had an emergency c-section at 34 weeks due to a low lying placenta, that from what I was told, turned into a previa and the bleeding wouldn’t stop. I was told in the hospital that I shouldn’t get pregnant for a minimum of a year and if I did, I would have to have a c-section if I didn’t have the baby before my due date, practice rule. So you could just imagine what was going through my head. I started my care with my midwives who delivered my last 3. Everything was going good until my 20 week ultrasound. I had another low lying placenta, and this time the placenta was anterior. What did this mean? She said, let’s pray that this placenta moves up b/c a c-section isn’t the best option for an anterior placenta. Rescan would be scheduled at 33 weeks, and around 30 weeks, found out I had gestational diabetes. Oh great, something else to worry about. It felt like one thing after another. So 33 weeks rolls around and the placenta moved up to 2cm from a 1.5cm. Same exact situation that happened with my last. I was on high alert, freaking out thinking the same situation was going to happen. I went back to the doctor who had performed my c-section, which I thought were great. I was told by the nurse in the ER that “this doc wasn’t c-section happy” at the time. Started care with the practice at 33 weeks and everything was fine and dandy. We scheduled my c-section for August 28, 2009. Since I was going to have a c-section, I was going to make this date a convenience for me. My ultrasound due date was the 6th of September, but the date from my last month’s period was the 12th. So I changed my due date to the 6th without a problem, and we were set to go. Well, at my 33 week ultrasound (I was having level 2 u/s at Hinsdale with the high-risk OBs) the baby’s head was measuring 4 weeks smaller than the body so one of the docs from my new practice wanted me to get an ultrasound quick in the office just to make sure everything was okay. Well the tech found that my fluid levels were at a 5.4, oh great another thing to add on to my list of problems. While she was doing the u/s, since I was now 36 weeks, I asked her if my placenta had moved any, and her response was, “ah it still looks a little low.” What kind of answer is that? So the doc now wants to check me for himself, says the levels are at an 8, but now I need to come in for NSTs twice a week and also fluid checks. Next appt. a new doc, asked her to check my placenta, she didn’t even check and told me while I’m watching her, that nothing has changed. Well, I’m not a u/s tech so maybe she’s right. Another week goes by I’m 37 weeks and they think I need to go back for a level 2 to check my fluids by the high-risk OBs. My levels were over an 11 and my placenta had moved up in two short days from when the doc told me it had not. Were they lying to me, of course they were?! My placenta was at a 3.2 and I asked the doc performing my u/s what he thought of me having a VBAC and he said, “I don’t see why you wouldn’t, since you’ve had four previous vaginal births.” My mouth was wide open and I was so happy, maybe there was a light at the end of this tunnel with everything I’ve been through. So excited and nervous for my next appointment, my doc said I could try for a VBAC, but here are the risks (which we all know) and you have to deliver before your due date. But did mention that I was a great candidate b/c I did have 4 previous vaginal births. Now how many people really deliver before their due date? I started calling around to a few practices and all told me I could not switch, so I was stuck. I started researching everything like crazy. I was going to try for a VBAC. I thought there were too many more risks associated with the c-section. So another appointment, and now 38 weeks, I’m dilated to 1cm, 50% effaced. Yes, something is going on. Docs keep talking about c-section and start using “scare tactics”. I say to myself, if by my next visit I have no change then it’s a sign that I just need to suck it up and have the c-section. Maybe these docs are right. I go in on August 31, and I’m 2-3cm, having tons of contractions for the past week and my 2nd c-section is scheduled for September 4th. This is my sign, I can do this. I go online looking for info and I met the most knowledgeable person from ICAN DUPAGE. My angel really! I don’t think she knows how much she helped me through this. I was ready now. I knew I could do this and my intuition told me this is right. I told that doc that I wasn’t having that c-section, it’s ridiculous. I’m going to go into labor any day and I want my “trail of labor.” If I end in a c-section, at least I gave myself the chance to see. I didn’t want it in the back of my mind forever eating at me, thinking “I wonder if.” So the doc let me reschedule for September 9th, but they were booked, so I felt like I got lucky and I was scheduled for the 11th now. My EDD was the 12th. And I thought for sure it was going to happen before then. On that Friday, I still don’t know exactly why, my doc called me 5 times. I’m sure the doc over her probably told her she made a mistake and they needed me to have a c-section, but I never answered. She called me the next day (Saturday) and finally again that Tuesday the 8th after Labor Day. I finally called her back and one of the other docs got on the phone. The whole time they told me no induction, but now she was offering induction if I could get to the hospital in an hour. Are you kidding me? I have 5 kids and not a lot of family or friend help. So I said no. My sister-in-law took time off from work for Friday to help, my 3rd “elective” c-section date (September 11th). She couldn’t understand how come I had no one to watch my kids in an hours notice. The docs response,”what if you went into labor right now who would you get?” I was seeing red. I stayed calm and said and I have friends, but that they have kids in school, and I couldn’t have someone drop everything they’re doing to watch my kids when they all have stuff going on. It would be different if it’s an emergency, but this is not. She proceeded into telling me my baby was going to die if I wait any longer. I snapped!!! I raised my voice very loudly and said “Don’t you dare use your scare tactics on me!” And I did know I had an appointment that night to see this particular doc so I apologized, and wanted to cancel my appointment b/c I knew they really wanted to slice me open and I looked at my husband who heard our conversation and said, “Watch, they will try and get me into the hospital tonight.” I went in anyway, and she was all smiles. I do my NST, everything is great, and I’m great. I was having my usual contractions. Nothing different from my previous NST. They were all over the place nothing regular. I’m 3cm, 80% -1 station. She declares me in labor and I need to report to the hospital immediately. I look at her and said, are you kidding me! I’ve gone into spontaneous labor 3 times and I can assure you that I’m not in labor. She said what if when I’m driving the baby’s head starts crowning? I said, “I wish it was that easy.” She is getting really ticked off. She is trying her hardest for me to agree to go in and said my doc will come in just for me if I go now. How did she know I was going to be in labor when I came into the office?” After 15 minutes going back and forth, I refuse and I left. She caught me coming out of the bathroom and told me she wanted to check my fluid levels. Red flag. I’m thinking oh great, now they got me. She checks and she measured a 9. The baby is great. When she walks me out she looks right at me and almost begs me to go to the hospital. Seemed really weird at the time. Well, that night, I did not have the baby, since she did tell me I was in labor. On the 10th, I called and canceled my c-section. I’m still having contractions, getting stronger now and I know it’s going to happen. On September 11, I call the doctors office first thing in the morning to set up a NST and I was told a doc would call me back. She said they wanted to talk to me about setting up another c-section. So I thought someone would call me back. I got home around 2:30 and saw an envelope at my front door. Opened it and I was shocked. They were “withdrawing from my professional care due to failure to comply with medical advice” b/c I canceled my c-section multiple times. Why didn’t they tell me that on the phone that Friday morning since I’m due the next day and now I have no doc? No warning, no referral, nothing. At the end of the letter they wrote: “I trust that you understand that my purpose in writing this letter is out of concern for the health and well-being of you and your unborn child.” Okay, they told me 3 times that my baby could be born “stillborn” “dead”. If you were that concerned and I need all these NSTs, why would you drop me? I call my husband; I send e-mails and start calling everyone and everybody that could give me some advice. I start calling doctors offices out of Hinsdale and all tell me that won’t take me. At this point, I’m crying, hysterically. What am I going to do? Can I go to CDH now? Do I want to? I’m hyperventilating. What kind of people do this to a very pregnant person? I call my midwives and see what they recommend. They tell me I can do my NSTs there. I do feel a little better. Saturday: My midwife calls me back and tells me to try UIC or Northwestern. She also says that I should have this baby in the next few days. I decide to call up UIC, Northwestern and Hinsdale L&D departments for some answers. I talked to all three (I will not write what they said to my questions), but Northwestern answers were the best. I found out that if I come down in labor that the residents would take me. So the next day, my husband and I decide to head down b/c I was 3cm and still having tons of contractions. If my baby was “going to die” and I needed to have this baby ASAP, that a hospital that delivers 12,000 babies a year, will deliver this baby today if necessary. I go down and I’m not in labor and I’m sent home. Yeah, I have docs now!! The clinic with residents. I’ll take it. The resident and the nurses were shocked that I was dropped b/c I needed to have a c-section. They didn’t think I needed a c-section. Yes!! We left there in such a great mood. On Monday someone was going to call me to set up an appointment. Monday I get the call that they can’t take me. WHAT????!!!! Since it’s a clinic, they just can’t squeeze me in, and it’s already a 3 hour wait. Then the doc tells me that by law I’m bound to the other practice for 30 days that she advises that I call them to receive care, but if I go into labor to come to Northwestern for a “VTOL” (vaginal trail of labor}. I can’t go back to those docs. She then said that I should try and call the physicians referrals and maybe one of the practices will take me. I try 2 and both say no. I’m crying again, freaking out crying. My husband goes online looking for VBAC friendly docs and finds a message board with a name. He calls, talks to the right person, and 15 minutes later a doc calls us back Dr. Brian Foley. I tell him everything and he didn’t even hesitate and accepts me as a patient. My superman. I’m crying so hard on the phone thanking him so much for taking me. We set up an appointment for that Friday and he said I shouldn’t go past this weekend that we’ll set up an induction for Saturday if I don’t go into labor. He said if I go into labor before than just call them like I’m a patient and he’ll let all the docs know what’s going on. I’m happy but still worried.
Finally the birth story!! So that all happened on Monday! Wednesday at 3 a.m. on the dot. I wake up to contractions. I’ve been waking up the past few days, so I try and go back to sleep. I wake up at again at 3:30 and decide to go downstairs and time them. By 4:00, I decide I’m in labor; they’re about 8-9 minutes apart. I call my sister-in-law to come over and I call my doula Sarah (who is such a wonderful person and I recommend a doula for their great support). I call the doc who tells me to come on down. We leave around 5:00 a.m. We get downtown around 6, go into Triage and get checked in and hooked up. Around 7 I get checked and I’m at 4 cm 100% effaced. This is really it. Everything looks good and I’m sent up to L&D. My nurse Nicki, is super nice. After a thousand questions, a heplock and blood work, it’s probably around 8:30 and we decide to walk the halls. I’m hooked up to an electric fetal monitor, which keeps falling. There’s not much room to walk the floor and I get bored, the contractions are coming stronger and a little closer. Oprah is going to be on and I want to watch it. We get to the room and all of a sudden, the contractions are even stronger. The doc comes in and I ask her to check me. I think I’m a 7. Guess what, only a 5. I ask about an epidural and I have a few questions. My husband and doula say I can do it. My response, I know I can do it I’ve done it 3 times before without drugs, but I don’t want to. I’m tired, and I don’t have the fight in me. I put up a fight of my life these past few weeks with these docs and I’m tired. The Anesthesiologist comes to answer my questions, hey Oprah is on. I say hold on I have a contraction coming, OMG, I’m screaming and crying (which I didn’t do for my other ones) I look up and said in an “Exorcist” voice, “GET ME AN EPIDURAL!” All of a sudden another contraction and the urge to push, “I HAVE TO PUSH.” The bed gets broken down, the doc has me move down and the baby’s head is crowning. The whole time, I’m thinking, I just want the epidural. I actually always thought that I would feel like I can’t push b/c of all the fear of uterine rupture, but that thought didn’t even cross my mind. So one more contraction, here’s the head, and I had a little trouble with her shoulders and out she came at 9:18 a.m. I went from 5cm to her completely out in 10 minutes from what I was told. It was so fast and furious and amazing. I was so happy. Dr. Chen was awesome. My placenta came right out without pitocin (which is normal for nurses to give you a shot of it to get the placenta out) and I was up to the bathroom by myself in an hour. Only two stitches. I felt great! I did it. I knew I could. It was the best delivery of all my girls and the fastest recovery time (I’m two weeks postpartum right now). We were made to have children and we should have the option on how we birth them. I hope my story can help just one woman out there. We can’t sit here and let these docs control our given right to birth!!
Tuesday, September 29, 2009
Sunday, September 20, 2009
Also, please include the basic birth stats at the start so we can get the gist of the story. For example:
Time/Date of Birth:
Length of Active Labor:
Gestation: (example: 39 w 4 d)
Baby's Apgars: (example: 8/9)
Include any other information you think is important. Your story can be as long or short as you'd like. I will not edit anything.
Thanks in advance!
Place: St. Francis Hospital, Evanston IL
Length of Active Labor: 38 hours
Baby's Weight: 9 Lbs, 10 Oz
Baby's Length: 21 Inches Long
Baby's Apgars: 8/9
***Disclaimer - This is incredibly long and detailed, but I hope that the following story could serve as a bit of inspiration to any woman who ever finds herself in my situation. Reprinted with permission.
Thursday, May 15 was my last day of work before maternity leave. I went in that morning in great spirits, though on the train ride in I was feeling a few contractions, pretty typical of what I had been feeling for weeks. At 8 am, I sat at my desk joking with my boss about how many times I’ve felt contractions that turned out to be nothing.
At 8:30 am, I felt a pretty painful contraction that was definitely unlike any others I had felt. Then, I felt a little ooze, but I assumed I was imagining it. I went to the bathroom, and there was my mucous plug! I have never been so excited to see something so gross! Since my first birth was an induction at 41 weeks with absolutely zero signs of labor, I was so thrilled to see my body showing the “signs.”
I had another hard contraction on the way back from the bathroom, so I stopped by my boss’s desk and said “um… I may need to leave soon… I’ll let you know.”
I sat back down and painful contractions started immediately. I figured I’d try timing them and sure enough, they were 3 minutes apart, 60 seconds long. I was still able to talk through them, so I called my aunt to have her keep me company on the phone and distract me while I counted them. I decided to count them at least until John got to work at 9 so I could tell him if anything was happening.
By the time he got in at 9, I told him I thought we really needed to leave. Shortly after, He came over to my desk and we took a look at the train schedule to figure out which train would get us home. I had wanted to labor at home as long as possible before going to the dreaded hospital. As we sat there it became very clear that the contractions were so hard and close together that there was no way we were going to make it home. Since we were already downtown, the hospital was only a half hour cab ride away.
We went downstairs and flagged down a cabbie (who was NOT thrilled about letting a laboring woman into his cab.) We arrived at the hospital somewhere right around 10 am, and at that point I could not talk at all through the contractions, and there was almost no break between them.
Holly, our doula, met us there. The resident checked me and said I was completely effaced, 0 station, but only about 2 cm dilated. Right away we got me into the shower to try to ease some of the pain, but the hospital shower was more like a cold water closet – absolutely no relief at all – so I only stayed in for about a half hour. The nurses were supposed to be getting the tub ready for me, but they never got around to it. Once I got back to the bed, the contractions were so hard and fast that I was yelling through them and the urge to push was unbearable. Holly couldn’t believe that I was only at 2 cm when I was having transition-type contractions along with the urge to push, so she ran out to get someone to check me again while I was screaming in pain. We all thought I had to be in transition, but when they said I wasn’t even close, I started begging for the epidural. I wanted to go without it because I knew it would complicate my delivery, and my previous epidural experience was awful, but I just couldn’t bear that much pain for another minute. I was starting to lose it. Of course, I felt so guilty because I wanted to do this naturally, and I was so scared that it meant the beginning of the end of my “attempt” at VBAC. I felt like a failure in front of Holly, but she was great about it and said that she didn’t blame me one bit with the type of contractions I was having and it being so early. I couldn’t have lasted like that for another 8 cm, and I’m so glad that she made sure I didn’t feel weak for giving into the pain management.
At 1 pm, I got the epidural, and within a half hour I started to feel like a human being again. After that, labor actually got pretty fun! John, Holly and I all sat around joking and talking while I painlessly had contractions every 3 minutes, and by 6 pm I was at 7 cm dilated and +1-2 station. I was so excited that I was so close. I kept joking that if labor would be like this, I’d have ten more kids! Then, a bunch of my family showed up and the roomful of people started to get really overwhelming. I started to forget why I was even in the hospital at all.
Let me say that until this point, baby’s heart tones were completely perfect, and my body temp was a steady 99 degrees.
At 7 pm, the staff shift changed, and that ended up being the beginning of the bad news. The new resident came in to check me and said I was at 5 cm. I said “but the last doctor just said I was 7 cm – did I go backward?” He said “No, that can’t happen. She was wrong, you were never at 7 cm.”
I instantly became very sad and discouraged. 5 cm was all I got to with my first labor, and I suddenly felt so terrified that my body couldn’t dilate past 5 cm at all. When he left the room, Holly reminded me that yes, a woman can go temporarily backward, which I knew from all my reading to be true. Then, my actual OB came in to see me for the first time and started telling me that we needed to consider augmenting my labor or giving me another c-section. Then I started getting panicky. I could see where this was going.
I told him that I wasn’t interested in that – he knew that because he had my birth plan – and maybe all the commotion from the visitors made me lose focus, and that I just needed to refocus my energy back on my labor and get things rolling again. He told me that my “focus” had nothing to do with it and I probably just wasn’t able to get past 5 cm. I said that one of the doctors told me I was 7 cm, and he also said “she was wrong.” Even though I was scared of that being true, I told him that I hadn’t had enough time and I was not going to even consider giving up so soon. He said something about him having been there “all day” and wanting to go home, so I told him he better go on home and come back to check on me in the morning because I wasn’t going to end my labor just because his day was over. Things started to get heated and I couldn’t believe I was even having that conversation. It was obvious that he was annoyed with me, but I didn’t care. So then he started with the scare tactics – “but the baby is becoming tachycardic” and “your water has been ruptured for more than 8 hours, you both might get an infection.”
I told him that Jules heart rate had been perfect all day (which he should have known) and it was only getting a little higher because I was getting stressed out. I needed to be left alone so I could get back to laboring. He rolled his eyes and said he’d be back in the morning.
So, because the official pressure was on, John, Holly and I all put our heads together and got back to work. Holly left John and I to be alone so we could reconnect and do some nipple stimulation. John and I sat in the dark for an hour or so just being together, and things definitely picked back up again. At midnight we decided to call it a night and start fresh in the morning. John slept, but I couldn’t. I laid awake all night long staring at the fetal monitor, talking out loud to Jules and asking him to please keep his heart rate baseline below 160. It was amazing the way he responded to me. His heart rate baseline went back to normal and stayed that way all night long. I was so proud of him for hanging in there with me. I felt like my baby and I already had a real connection. We were a team.
The next morning at 6 am, I had my second wind and was ready to get the show on the road. I woke John up and told him to get himself fed and cleaned up so we could seriously get our game faces on. Holly was back and ready to go, so our spirits were lifting. The resident from the night before (the same one who told me I was 5 cm) checked me and said I was 6-7 cm. So, that at least meant that I had progressed 1-2 cm overnight while doing nothing but laying flat on my back. I felt like this was great news, but just then a nurse came in who completely ruined our mood. She asked me if I had considered Pitocin to get things moving. I told her I wasn’t getting Pitocin, and she started arguing with me. This is the nurse, by the way, a person who has absolutely no right to advise me medically one way or another. She said I should think about getting the baby out healthy, and I told her he was healthy. I watched his heart tones all night long and he was perfect. Then she said “Well, I’ve seen fetuses with good heart tones be born with APGARs of zero” – meaning dead. I got pissed. I couldn’t believe this woman just tried to throw a “dead baby” scenario in my face, especially when nobody is in any danger. John could tell I was getting really upset again (who wouldn’t?) and he jumped in and told her she needed to stop. She tried to apologize, but it kept coming out like “well, I don’t mean to upset you - BUT…..” Thankfully, once we got her out of the room I didn’t see her again for the rest of the day.
Around 10-ish, my doc came back and said I’d had enough time and he wanted to do an internal pressure catheter. I told him I was making progress and he said I hadn’t because I had been 7 cm since 5 pm the day before. Now, that didn’t even make sense because he was the one who agreed with the resident the night before that I had never gotten to 7 cm. Now he was saying that I had “stalled” at 7 all night. He was getting very heated with me and kept trying to say that I needed to listen to him. He said that my uterus – I kid you not – “just might not work” so I needed to have a c-section. He said I’d had enough time and my “trial of labor” had failed. He said it was a case of “failure to progress” at which point I shot back “No! It’s a failure to WAIT.” He wanted to do an internal pressure catheter to measure the strength of my contractions, and if they were adequate it would mean that they obviously weren’t effective so I needed to be sectioned. The other side of the coin was that my contractions were inadequate, which meant that he would give me 6 hours for them to become adequate or I needed to be sectioned. Well, I didn’t like either of his scenarios. I told him I just needed for people to stop stressing me out and let me labor. He thought I was being “reckless.”
After 10 minutes or so of arguing back and forth, I told him I just wanted more time. He left in a huff, and came back about an hour later with another doctor, telling me he had spoken to every doctor at that hospital, along with a doctor from another nearby hospital, and the hospital administration and I only had one of two “options.” I either had to sign the c-section consent form, or sign a “Waiver of Liability” meaning that the hospital was no longer liable for whatever happened to me and the baby. I couldn’t believe he was standing there threatening me. I know my rights, and I told him so. Nobody could force me to sign anything.
John asked them to leave the room so we could discuss our options, and total panic took over the room. I started bawling and pleading to Holly and John that I just could not have a c-section. They both knew that, but I just needed to cry. I was having a complete breakdown. Here I am in labor, and more sad and scared than I have ever been in my life. I know all my legal rights, and I knew the hospital could not force me to sign either one of those forms. We started thinking about ripping all the IVs out of my arm and just leaving the hospital. We started trying to call local chapters of ICAN to see if anybody could offer any advice (nobody ever called us back.) I alternated from sobbing to shouting angrily. I tried to think of any lawyers I knew who I could call for instant representation, or at least advice. I couldn’t believe that there I was, having to deal with that while I’m trying to birth a baby.
An hour later, the doctor came back and told me time was up and I had to sign something. I told him we were making phone calls and until I knew what the best thing to do was, we weren’t signing anything. Insert more crying and panicking for another solid half hour until I just made up my mind that I wasn’t letting them bully me for one more second. I was too upset to even try to keep talking to them so I told John he had to handle the situation, so went into the hall and talked to the doctor. John basically told him that I wasn’t signing anything, and that’s all there was to it. The doctor then said that I was pretty much asking for my baby to be born with “cerebral palsy,” and started scaring John into submission. He spouted off “statistics” to John about everything that may go wrong to cause us to have an unhealthy baby. Well, I am not a statistic. I am a human being who deserves to be looked at as an individual, and not some number. John came back in to report what was said, and it was clear that he was starting to buy into what the doctor was saying. I reminded him of all we knew about these scare tactics, and that we could see the fetal heart monitor for ourselves. There was absolutely no reason to be concerned about the baby at that point. The only problem with the baby was that his mother was being forced to fight a legal battle during her labor. Through my tears and anger, I convinced John that he had to get out in that hall and go to battle for his wife. He wanted a VBAC just as badly as I did, but he was cracking under the pressure, and I just couldn’t have that. I needed him to be strong at that moment more than I ever needed him before.
John left again – and Holly just sat with me while I sobbed. She was a rock throughout the entire debacle, and she reminded me that I wasn’t being reckless at all. She reminded me of how much I loved my baby and that I wasn’t going to do anything to put our lives in danger. Then she asked me what my ideal outcome would be. Holly is great at breaking up the clutter, forcing you to think, and getting back to the big picture. I told her that my “ideal outcome” would be for the doctor to magically decide to leave me alone and let me labor on my own until I had the baby vaginally, no matter how long it took. Of course I knew that was highly improbable, but it was good to refocus on my goal whether or not it looked like it might happen.
edited to add *** In the middle of all the fighting, my in-laws came to the hospital with Jonas, my older son. My whole face was swollen from crying so much, and I was an emotional mess. Well, when I saw him, I broke down even more because I thought "Here sits this perfect, beautiful, healthy boy who came into the world by c-section. He's FINE! Why am I fighting so hard to have a vaginal birth?!?! I'm so selfish! Who cares how my baby comes out!! I'm going to end up hurting us both because I'm so stubborn!!" After that I made them take Jonas away because I didn't want him to see me in the shape I was in. Right at that moment I almost called the doctor in and told him to go ahead with the section. But, when I thought about those words coming out of my mouth, I got angry again and kept on fighting. I knew I'd regret that c-section, and the pain would only be doubled. I also knew that I owed it to Jonas and Jules both to get my VBAC so their mom could get her head straight again. ***
But then, John came back with surprising news. The doctor had finally cracked, admitting to John that Baby’s heart tones weren’t worrisome, and said that he’d leave me alone to keep laboring as long as I promised to let them intervene if anything did become worrisome. I couldn’t believe it. I was so relieved, but so still so scared at the same time. John had found a way to make the doctor understand how important the VBAC was to me, but at the same time I wasn’t trying to be a martyr. He managed to convince the doctor that it wasn’t some personal attack on him, and that what I needed more than anything was for everyone to stop putting such an excruciating amount of stress on me so I could just do my thing. Somehow, John’s words worked, and the doctor softened.
John brought the doctor in, and he tried to make up with me. I cried my eyes out when I tried to explain to him how important it was that I didn’t leave that hospital with another uterine scar wondering what could have been if only I’d had a little more time. I promised him that I would be open to the cesarean if it became obvious that was the only choice. I made him understand that I had no intention of hurting myself or my baby, but there was no way I could submit to a surgery that wasn’t medically necessary at that point. Then, he left me alone to get back to business. He was obviously still annoyed with me, but I think John helped him perhaps feel a slight bit of empathy for me too.
By that point, it was 2 pm on Friday and contractions were down to 10 minutes apart. I sat and concentrated on breathing to bring my heart rate and the baby’s heart rate back down. John and Holly agreed that I needed to take a nap and start fresh when I woke up. Holly ran home to take care of a few things, and we all just tried to settle in to change the tone in the room. I didn’t feel like I could nap, but I knew that somehow we had to put a break in the day and change the energy in the room. At that point all I could do was sob and I knew if I didn’t change my mind frame soon, things were going to get very bad.
Just then my friend Kelly called and said she was stopping by. It was so nice to see her, and she really helped distract us from the hell we had just been through. She stayed for a couple hours before she had to go to work, and by the time she left we were feeling a lot better. I thought maybe I could take a nap then, but as Kelly was leaving, my friend Kathryn (who was in town visiting) called to say she was stopping by. I did get concerned for a second that I was getting distracted, but luckily those two friends are the most low-maintenance people I know, and they were both really helping to relax me. Right before Kathryn got there, Holly came back with some fresh things she’d learned about stalled labor. She said that my cervix may have swollen from sitting up, so I should try alternating laying on my sides to bring down the swelling. She had also suggested a few times that I turn down the epidural so I could feel things, and I finally listened to her then. I was really afraid of feeling those horrible contractions again, but I knew she was probably right. I laid down on my side and then Kathryn came in. We all just sat and talked and slowly the mood of the room shifted.
At around 5:30 pm, contractions started getting pretty intense. I went from being able to carry on a conversation with Kathryn, to needing to stop and breathe through each rush. Then it steadily became more and more intense. Within an hour I was feeling full labor again, and contractions were long and strong. They checked me and I was at 8 cm. Progress! Then the pain got worse, and worse, and then 9 cm! Pretty soon I was screaming again and having the unbearable urge to push. I asked for another little shot of the epidural because I was so scared of the pain. I begged them to check me because I didn’t want to push if it wasn’t 10 cm yet. After what seemed like an eternity, the resident checked me and said I was “complete” so I could start pushing! Kathryn asked me if I wanted her to leave, and I told her no. I was so glad she was with there with me.
At 8 pm, I start pushing. At first the pushing wasn’t very fruitful because I had made the mistake of getting more epidural. I couldn’t feel the rushes as strongly, and the urge just wasn’t there like it had been right before I got the epidural dose. For about an hour, I pushed without a whole lot of progress. I was still so terrified that my pushing was going to fail and they’d call for a c-section – after all that work. Then I changed positions, and right about that time the epidural started to wear off. The more I could feel, the more I realized that I felt like Jules head was stuck on something. As the pain became unbearable, I started screaming for them to send in the doctor to see what could be done to help get the baby down. When my doctor finally came in, he realized that Jules was almost out, but I was pushing against an anterior lip (a little part of my cervix was swollen.) Pretty soon, the room was filled with equipment and people; the stirrups were out, and the doctor was in position to catch the baby. I had always hated the idea of pushing on my back, but there I was – feet in stirrups and nurses holding my legs back – pushing as hard as I could while the doctor yelled “PushPushPushPushPush!!” All I could think of was what I knew about that being the least effective position to push in, but I was literally in no position to do much about it. And as I laid there pushing as hard as I could, I was still terrified that the doctor was going to find some reason why I wasn’t pushing good enough, and call for a c-section. I couldn’t concentrate on anything except how scared I was of something going wrong, and I knew that I had to get the baby out before the doctor invented another reason to section me. I was watching Jules head come down in the mirror, and begging myself to get him out.
After 5-6 more contractions, with about 4 pushes each, Jules was born at 10:01 pm. As I sit here writing this, I still cannot believe it’s real. The nurses put him on my chest, and John cut the cord. I laid there in total wonderment while the doctor stitched up my 2nd degree tear. I finally passed the placenta 45 minutes later, and the whole 38-hour ordeal was finally, finally over.
Within a couple hours I was up showering. The difference in recovery between a vaginal and cesarean birth is like night and day. We left the hospital 36 hours after Jules was born (the earliest possible moment that they’d let us go) and at only 3 days postpartum, I feel almost completely back to normal. No, I feel much better than normal. I feel like Superwoman.
The sheer thought that I got my VBAC, after 2 years of c-section depression and a 38-hour hard fought labor, is completely overwhelming to me still. I wish every woman in the world could experience this feeling, and I hope all other women in my situation are able to have their VBACs too.