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Friday
Mar192010

What I learned watching the NIH VBAC Conference

I’ve never sat in on anything as political or crucial to the birth community as last week’s National Institute of Health’s Consensus Development Conference on Vaginal Births After Cesarean. I’ve been to Medical Board meetings, participated in the California Association of Midwives’ board meetings and witnessed the surges of energy (meetings) that eventually turned into the (re-)creation of legalizing midwives in Florida. The opportunity to see the two day conference (spread over three days) is still there by clicking on the NIH link above; I highly encourage birthy folks to take the time to listen through at least some of the presentations. There are too many highlights to pick just one speaker; several shared information so profound as to bring me to tears or to clench my fists – they sure evoked emotion! 

I’m pretty informed about VBACs. I know the statistics regarding uterine rupture (less than 1%) and that at least half the uterine ruptures documented were in women that had been induced or had augmentation with prostaglandins or pitocin. I knew that it was riskier to have a cesarean than a vaginal birth. I knew the physical and emotional differences between cesareans, vaginal births and VBACs. I knew that about 30% of hospitals have outright bans against VBACs and that even more don’t have a doctor on staff who will do one. I knew women were traveling or having unassisted births in order to get their VBACs. 

I offer Home Births After Cesareans (HBACs) even though our California law says it is a contraindication for a homebirth (the words they use are “significant pelvic or uterine abnormalities, including tumors, malformations, or invasive uterine surgery that may impact on the current pregnancy”) However, with informed consent, the client has the right to “self-determination”… deciding for themselves if they are willing to accept the risks and continue on the homebirth path. “In recognition of the client’s right to refuse that recommendation as well as other risk-reduction measures and medical procedures, the client may, after having been fully informed about the nature of the risk and specific risk-reduction measures available, make a written informed refusal. If the licensed midwife appropriately documents the informed refusal in the client’s midwifery records, the licensed midwife may continue to provide midwifery care to the client consistent with evidence-based care as identified in this document and the scientific literature.” 

If only it were that easy for VBAC women around the country. 

I listened as speaker after speaker detailed the plight of women, begging for a VBAC, but being rebuffed by doctors and hospitals. Many Certified Nurse Midwives are also limited by rules and insurance. Women have been forbidden to VBAC in certified birth centers for several years. We’ve all heard the stories of women traveling hours, hundreds of miles and crossing state lines to exert their right to have a vaginal birth. Many of us already know that the only “choice” for women who cannot find anyone to attend is to have an unassisted birth, which is, while risky, I’d venture to say, probably less than the risk of a repeat cesarean. In the VBAC community, there is documentation of women who, even though they entered the hospital pushing, were forced… yes, physically… into the operating room and, even though they were screaming their objections (not a strong enough word), stating they were not consenting to the surgery, their abdomens and uteri were cut open and their babies pulled out of them. It sounds unreal, doesn’t it? Like this could never happen? 

In one of my own experiences, with a client hoping to HBAC, we transferred to a highly regarded hospital due to “failure to progress” at 8 centimeters. All mom wanted was an epidural so she could think and figure out what she wanted to do. As we were admitted, we could see the baby’s head coming down, but mom was frantic, begging for an epidural. Matter-of-factly, the obstetrician said, “Sure, once we get you into the OR, then you can have the epidural.” Screaming “No!” he repeated the statement a couple more times. My client grabbed me and begged me to help her get the epidural and the anesthesiologist leaned down to her face and, sickly sweet, said, “It won’t take five minutes to get you out of pain. Let’s go back to the OR, okay?” My client, crazed with pain, asked me what to do. I was horrified that we could see how low the baby was, but they were threatening her, manipulating her, that if she wanted pain relief, she had to consent to surgery. I cried and softly told her, looking in her eyes, that if she wanted the epidural, she would have to go into the OR. I think she screamed, “Take me back!” and they were in the OR within a minute. A nurse came back after the surgery and said the baby had been so low in the vagina, she was told to push the baby back up into the uterus so they could deliver her. This story continues to make me sick to my stomach. And this was at a good hospital, one that has CNMs on staff and doctors who are decently supportive of VBACs. All we could figure was a resident needed to get another cesarean under his belt and was going to get one that night, even if he had to assault a woman to do so. (Oh, and this client was an NICU nurse at another hospital; now an L&D nurse.)

Even though I have personal experience with the disgusting way our medical system can assault women, physically and emotionally, I could not stop crying as I listened to those other women’s stories. 

Intertwined with the stories was the blunt, copious information/proof that doctors and hospitals were not “allowing” VBACs because of insurance issues. Whether it was the doctor’s malpractice insurance that blocked them from helping women VBAC or the hospital’s insurance that blocked doctors, even those that wanted to help women, insurance companies were the lead puppeteers in this bizarre, topsy-turvy world of the limitation/elimination of a woman’s right to what happened to her body. 

Slowly creeping over me, I realized that it was fear –fear of lawsuits and the fear of losing money- that loomed over the VBAC bans more than any other single reason. (Addendum: An OB stated that the lawsuit issue had more to do with losing their livelihood, spending years in litigation and the terriblt trauma to their families' being sued caused as more important than the thought of losing money through increased malpractice insurance. This is, of course, one person's perspective.) Tucked in there is the American College of Obstetrics & Gynecology’s 2004 statement that VBACs should only “be attempted in institutions equipped to respond to emergencies with physicians immediately to provide emergency care.” Of course, ICANers have known this for ages. I knew it peripherally, but what horrified me was the reality that doctors were willing to risk a woman’s life by doing the more risky cesarean in order to save themselves from litigation or censure. Put another way, it is more important for them to take care of their wallets (and their insurance companies’ wallets) (see what I said above) than it is to keep a woman alive. I let the layers of distress lay one on top of the other, understanding, seemingly for the first time, the selfishness and greed some/most doctors and all hospitals and insurance companies have and to what extent they were willing to go to keep their asses out of hot water. Speaker after speaker exposed/disclosed the financial bottom line and how women were being made to suffer (and die!) so they could be comfortable. 

Because of ACOG’s requirement to have doctors and anesthesiologists at the ready, a great many docs decided to eliminate VBACs from their practice so they didn’t have to sit around waiting for a woman to have her baby. One speaker told the story that at one hospital, the rule wasn’t just the doctor had to be in the hospital at the ready, but in the Labor & Delivery unit itself. No cafeteria. No sleeping in the doctor’s lounge. Sitting and waiting. Could the hospital have been more clear in saying, “The hell if we’re going to have VBACs here.”? 

Wondrously, OBs, CNMs, RNs and the women themselves spoke out about the state of VBACs in our country. Over and over, men and women said they were helping women VBAC, often with intense anger coming from other doctors and hospitals. Some of the providers were so busy, women traveling from hundreds of miles to have assisted births, they begged the board to revise their recommendations so more physicians could give women what they were scrambling to have – their VBACs. 

Layer upon layer of obstacles stretched out a thousand miles. What do we tackle first? The speakers each had their recommendations. The insurance industry; forcing them to stop dictating what doctors and hospitals do. The malpractice insurance companies; stop assuming every labor is a potential lawsuit. Doctors; stop allowing insurance companies to run your lives… oh, and stop doing cesareans for convenience’s sake. Hospitals; allow women the right to their choices and doctors the right to support/attend VBACs. Nurse-Midwives; lobby for the right to attend VBACs again. Women; start suing for wrongful cesareans. 

Looking over the enormous amount of work that needs to be done, it seems insurmountable, but we who support VBACs, we who want VBACs, we who demand the right to our bodies… we cannot quit. 

The NIH’s recommendations, as most of us already know, was that the cesarean rate is too high in this country and that VBACs, with all the research, is proven safer than a repeat cesarean and should be encouraged. They had no comment on how that was supposed to be done. 

While those of us watching hoped for this exact recommendation and were thrilled with the announcement, one parting stab was made that almost deflated the whole conference. Rebecca Spence from RHRealityCheck says, “Panelist Laurence McCullough, the Chair in Medical Ethics and Health Policy at Baylor College of Medicine, spoke for the panel during the public comment session and in a press briefing, taking the position that a physician has an independent obligation to protect a fetus, which, it is claimed, is not dispensed by a laboring woman’s refusal to consent. The panelists’ comments indicated that a conclusion regarding the ethical question was beyond their scope, yet stated to the press and to the audience that the body of law and ethics that protects the right to refuse surgery was not written for, and may not include pregnant patients.” (emphasis mine) It took me asking several women and reading a few blogs before I understood what they were saying: that pregnant women might not/do not have the right to refuse a cesarean… that doctors can still force women, whether through the courts or even strong-arming them, into the operating room.  

I don’t know if the panel knew exactly what they were implying, but we all heard it nonetheless. Even though the recommendation was to allow more VBACs, it was ultimately in the doctor’s hands to decide when the woman could no longer make her own choices. He (or she, of course) could sail along with the status quo, not pressing ACOG to change their oppressive “recommendations,” not to change his view that VBAC is unsafe, that he has free rein to lord a scalpel over a woman’s abdomen. It was almost as if the panel said, “We recommend VBACs, but it’s absurd to expect it because, you silly girls, you can’t possibly make a sane decision when you’re pregnant and in labor. We’ll make that decision for you.” 

After what seemed like a positive, productive and informative three days, I learned that The System really is rooted in misogyny, it’s values deep in the concrete of control and manipulation and left wondering if anything we ever do makes any difference at all.

Reader Comments (27)

Misogyny indeed - it's about not letting women have autonomy over their own bodies, plain and simple. We will not be free as human beings until we have absolute say over our own bodies just like men do.

BTW, I am very very lucky, I was told a CNM can attend my second VBAC if one is on call when I check in to L&D, but that's in Oregon of course. The policy here is changing, which is good, I think the clinic I go to has a great deal to do with shaping the hospital's policy - bunch of feminist thinking women who believe in women.

March 19, 2010 | Unregistered CommenterEthel

Ok! My thoughts are...I don't even know. Just stunning the illusion of freedom we live under. Proves that it still basically sucks to have a vagina, pretty much anywhere on earth.

March 19, 2010 | Unregistered CommenterStassja

I've had CNM's attend my VBAC. 1999, 2001 and 2003. The 1999 was pretty much completely autonomous (but that was before the VBAC hysteria) and the latter two were completed with an OB sitting at the nurses desk but never laying a hand on me or interfering in the labor and birth at all. I'm currently pregnant and if I don't get PE again I may have a CNM catch this baby too if my very pro-VBAC OB isn't available.

March 20, 2010 | Unregistered Commentermom9

Didn't mean to be a buzzkill : ( What you do matters so much: not just to the individual women and babies that you help. Your lovely, honest writing matters for those of us who work in the birth world but not in direct service. I think it is only together that we'll change the System.

You are one of my inspirations to start writing, and always an inspiration to keep thinking. Thank you.

March 20, 2010 | Unregistered CommenterRebecca Spence

"Sadly, Certified Nurse Midwives have long been unable to attend VBACs."

Where I go to school (in Oregon), CNMs attend VBACs in the hospital. The midwives/women who birth at my teaching hospital have an 80% vaginal birth success rate after cesarean.

March 21, 2010 | Unregistered CommenterOR Student Midwife

You are right. In some areas CNMs are allowed (erg on that word) to attend VBACs. They are not in birth centers. Here in San Diego, they are permitted to in a couple of hospitals, but in others.

Thanks for clarifying.

(And I'm sorry for not getting the comments up when you all write them. I didn't get any notification they were here and just found them now! Sorry!)

March 21, 2010 | Registered CommenterNavelgazing Midwife

Please, let's be fair. Look at this case that went through the DC court of appeals. The decision was handed down three days ago. http://www.leagle.com/unsecure/page.htm?shortname=indcco20100318108

" ' Appellants argue here that Dr. Miodovnik was negligent because he "failed to order a pre-labor cesarean section for Mrs. Abdul-Haqq and instead signed off on a treatment plan calling for a VBAC.' " The plaintiff argued that THE DOCTOR SHOULD HAVE FORCED HER TO UNDERGO A C/S. This doctor was backing up CNMs who went to bat for a patient to try for a VBA2C.

Yes, the suit against the physician was ultimately unsuccessful. But can you imagine being any of these care providers? I can. I'm a student nurse midwife. I will be in debt for many, many years to pay for my education, but it's worth it to me. It's my calling and I feel the rightness of it in my bones. When someone is sued, it's not the wallet size at risk. It's survival. It's your life's work. Even an unsuccessful suit would have most backup physicians drop you like a hot potato, even if a midwife is not sued herself. Can you really blame those docs? This one was sued in Sept of 2005. It was resolved in his favor 3 days ago. I bet the last 4 years have been just a joy for all concerned.

I desperately want to attend VBACs. I believe it's every woman's right to birth how and where she wants. But I don't know that I'm ready to risk it when if something goes bad, in a way that a client has been fully warned might occur, she could turn around and sue me months later and take away my ability to attend births at all. I don't think that makes me a bad person, a coward, or a bad midwife.

March 21, 2010 | Unregistered CommenterAnonymous

I am a physician and I am totally supportive of what you say and of home birth and VBAC. I am deeply offended by what you wrote:

to take care of their wallets (and their insurance companies’ wallets)

If you think that money (which insurance pays, we don't, so I wouldn't lose any anyway) is the reason we don't want to be sued...you are doing us a great disservice and painting us as demons that we are not. I don't want to be sued because of the personal, emotional, and professional implications of being dragged through the mud and accused of being "evil" in a way in which I cannot defend myself. In a way that is not so different than the words you used to describe us here.

March 23, 2010 | Unregistered Commentersara

Thank you so much for writing this! Man to have had the information I have now, 7 years ago when I allowed an OB to cut my son from me when I wanted a VBAC. Now, having had 5 c-sections, I feel violated similar to feeling raped. I can't believe how much it affects me. I go into labor at 23 weeks now mostly from fear, fear of that knife that I know is coming. Fear of not pushing my baby out. I can't even begin to describe it. I've had 15 miscarriages and can't help but wonder if it's my c-sections....... All I want is to become pregnant again and normally deliver a baby again. It seems to much to ask. I don't even know how to begin. In our area finding a provider is going to be difficult to say the least. Honestly, if we are ever blessed again I'm having an unassisted birth if that is what it takes not to be violated again!

March 24, 2010 | Unregistered Commentermomofmany

first, thank you so much for your post. I was in DC for the conference and am grateful for how well you summed up what happened. Your words (and the comments) take me back to what Eugene Declercq's comment at the conference. If I remember correctly, he suggested that what is needed is an alliance between the unlikely partners of birth activists and ACOG to push for tort reform. The more I think about it, the more that does seem to be an essential piece of moving forward, that we need to change the whole framework in which these decisions are being made.

March 25, 2010 | Unregistered CommenterGeorg'ann

@sara: I think NGM's point in that statement (and correct me if you think I'm misunderstanding, NGM) is to voice her concern over the decision by a majority of the physicians serving women in a medical setting to walk away from the human rights issue inherent in VBAC by imposing bans that are (at least in part) motivated by the 'bottom line.'

Personally, I don't think it's an observation made in error - there *are* care providers out there who opt to deny women their right to informed choice/refusal, and what motivates them is fear of litigation. Also, the statements made at the NIH conference by credible professionals about the financial motivators for or against VBAC alluded that financial security may be a motivating factor for some care providers.

Considering that you chose to be a doctor by profession, I can see why you'd take offense at the way NGM's comment is phrased. Doctors aren't the only ones standing in the way of women having informed choice/refusal in the VBAC issue. Hospitals, midwives and our culture factor into that roadblock, as well. To make a generalization always leaves room for exceptions - as a VBAC supportive physician, you are an exception, and that takes courage as well as skill. I'm grateful that providers like you and NGM exist. You are both a part of the wave of people who will change the world for the better.

March 25, 2010 | Unregistered CommenterDonna

it seems to me that until most women, not pockets and handfuls here and there stand up for themselves, we will never be able to be treated with the basic understanding that we are indeed capable to think and make choices for ourselves. many women i have found like drugs, like the three day stay in the hospital and having the nursery take care of their new baby. it's sad, but it has to be said. even when most mom's to be find out that they can have a vbac at home with a midwife, or at best can consider it, they don't want to. they line up for c-secitons, scheduled so they can pic the birthday of their soon to be child for many different reasons. i personally had four hbac's with a wonderful midwife then have moved on to sitting with moms to be whenever asked, but i have seen many women who just really love all the techno birth, love the idea of it, love the whole movie that comes along with walking into a hospital being put into a wheelchair and told when to push etc. etc. i hope not to offend any here, as most here don't feel that way, but it's pretty obvious that most do. it's spreading all over the world too, and that's what get's me. i recently moved to northern africa, and the section rate here is rocketing. not because it's needed, because it's wanted, it's looked at as being privilaged/educated. the older generation of people here were born at home, nobody is allowed homebirths here anymore. nobody will attend them or even wants to.

March 28, 2010 | Unregistered Commenterjennifer

a mix of emotions flooded me while reading this post. i felt, hope and pride, anger and frustration, empathy and joy. and in the end i felt sadness. sad that so many of us have been wrongfully cut and so many of us are forced into a corner through fear and politics. pregnancy and birth are not an illness, and though there is a time and a place for emergency medicine, it has been abused, misused and become a nightmare for many birthing women.

thank you for sharing and i hope that we all; moms, dads, midwives, obs, hospitals, doulas, and the birth community can work together for mother and baby friendly care.

March 28, 2010 | Unregistered Commenterkrazymamak

I bristle at the implication that ob' s are motivated to perform c-sections based on remuneration. While one can never know the various motivations that regulate out behaviors and I suppose that some might act largely for their pocketbook, that does not negate the evidence that VBAC carries particular serious risks--- and comparing permanent neurological deficits to a post-op wound infection is profoundly glib.

As long as we are pursuing motivations, why not consider midwives' motivations to do more deliveries as part of the economic equation? Are midwives immune to the pull of the pocketbook? Is it possible that they are advocating VBAC because that is the situation that benefits them financially more than c-section? I'm not making this accusation, only pointing out that the argument rubs both ways... and it hurts.

Nobody has the absolute answer to what is best for particular situations, but assigning blanket motivations such as misogyny and profiteering hinders your overall thesis.

April 1, 2010 | Unregistered CommenterTony61

I am listening to what you are saying... and while I do think the money thing is lower on the motivation scale than I used to think, it is still there. Docs have a WHOLE lot more bills/loans/insurance to pay than a midwife. Midwives make a pittance for the hours put in, but no, our education and skills simply cannot be compared. All midwives are not altruistic, but it is rare that an OB is concerned with the emotional impact of their actions and reactions. An emotional connection cannot be discounted in the name of technology.

Re: misogyny... either you are a part of the status quo and cannot see it or you haven't seen the evil things docs do to women in the name of their "best interest." One of my clients was sutured, without lidocaine -and without a tear- because the doctor was pissed she was trying for a homebirth. I've witnessed vile vaginal exams, words that "put a woman in her place" and out and out manipulation to make a woman see her female body as defective. Men and women who respect women do not treat a human woman in such a way.

Yeah, no one should be treated that way, but men simply are not. You cannot demonstrate one place in medicine where men are manipulated, treated roughly, lied to and man-handled the same way women are in birth. Because it doesn't exist.

April 1, 2010 | Registered CommenterNavelgazing Midwife

I certainly have never seen the level of misogyny that you describe-- I agree, that is disgusting and should never be tolerated. I have seen racism, weight-based discrimination, misogyny, reverse racism, bias against the poor or non-English speakers... among all manner of humans acting inhumanely.

Even in your apparent backtrack you persist in qualifying your argument with the non sequitor that "doctors have more expenses"; implying, if it is even true, that he/she will therefore do an unnecessary c-section. I know plenty of midwives with kids in college and husbands who are laid off, and most certainly are less-well-off than I am... I don't immediately assume they're unethical.

I get the emotional component.... I've practiced for 16 years, but I would like to think that when I'm in jeopardy or infirm, that my clinician will act, well, clinically. This is even more reason for the patient (or client) and midwife to seek out an ob who supports their plan--- before they are 8 cm. Find someone, or better, a group, who is supportive. And if it's that's difficult to do, please don't insult the entire profession of physicians who for the most part are on *your* side.

I would urge you to be careful when attributing cynical causation in the VBAC discussion. Both sides of the debate have valid arguments, but the discussion rapidly deteriorates when these unnecessary jibes are broached.

April 1, 2010 | Unregistered CommenterTony61

I love intelligent discourse. Thank you for pushing me harder to make sense. I appreciate that.

I re-read the post, reminding myself what I was writing was a report of the NIH Conference. It wasn't just my personal opinion, my suppositions or my making things up, but case after case of truth as reported to the NIH.

Even if we agreed to remove the monetary incentive as a reason for cesareans (and I am not agreeing to do that), the fact that doctors ARE doing cesareans for reasons other than the life and health of the mother and baby... namely, for fear of litigation. It isn't a valid reason, to me or many, many other women.

April 1, 2010 | Registered CommenterNavelgazing Midwife

Yup. Those are all valid concerns. Are we requiring too many resources-- available anesthesia, obstetrics, OR team-- to the point that no VBAC's are even possible. Allocation of scarce resources is becoming the coda for all health care discussions, not just obstetrics. This is a type of rationing, no different than disallowing dialysis in 90 year-olds or chemotherapy for persistent stage 4 cancers. That is certainly part of the argument. Is it appropriate for a hospital that does 25 deliveries per month make it's only anesthesiologist and obstetrician stay up all night for a VBAC or keep a entier OR available for an 8-hour labor? This can have ramifications on the OR schedule and staff.

But the other question is whether VBAC is safe even under the best circumstances. Our group of four doctors determined that we would each statistically have one avoidable brain-damaged neonate from VBAC delivery over our 25 year careers. Is that appropriate? Studies from the 1980's at LA County showed that VBAC was safe, but subsequent cohorts have had more sobering results. The science is evolving and the standards are changing.

Surgical complications can be devastating, but the vast majority are treatable with no sequelae. Obstetrics is perhaps the most intimate medical specialty and the practitioner and client must have similar philosophies. I can remember in the early years of my career, patients would be in tears because they felt *compelled* to VBAC by their insurance companies or the standards of the day. My board certification case list in 1996 was required to contain a certain number of VBAC labors. Times have changed.

In our community I know of no malpractice carrier who mandates repeat c-section, but I fully respect physicians who advise against VBAC. There is data to support both practices.

April 1, 2010 | Unregistered CommenterTony61

I'm not as eloquent or have as much information as my VBAC-supportive friends are/have, so I've asked them to come and read... and to help add to this conversation. It is rarer than rare an OB would give us (natural birth advocates) the time of day. Thank you.

April 1, 2010 | Registered CommenterNavelgazing Midwife

What about patient/client autonomy? Isn't that important as well? How about her being able to have choice? I will highlight two cases where this was clearly not part of the picture & limited these particular woman in their reproductive rights.
Year 1998 A young healthy 20ish PRIMP. C-section for breech presentation. Year 2000, she catches the end of the VBAC wave & sucessfully has a VBAC after a short labor & all is great. Textbook normal vaginal birth. 2005 she is pregnant again & is REQUIRED to have a C-Sec at the same hospital, with the same provider as both prior births due to that primary c-section 7 years prior. This was strictly due to hospital policy, NOT because it was the client's choice nor the providers. This woman's surgery was dictated by fear, not by evidence based research.
Case 2. Again a young healthy late teen PRIMP mother. After a "long" labor of 12 hours she is labeled as failure to progress & consents to a c-sec. This was in 2002. In 2003 she is pregnant again & seeks VBAC but can not find a provider in her HMO that can attend one in any hospital in the area. She consents to a 2nd C-sec. 2005 pregnant again & again looks for a VBAC. At this point no one in her medical system would even consider a VBAC after 2 c-sec. She does interview a few MW, but having that scar x2 she would only consider to do one in a hospital & in this anti VBAC climate, she could not get one. During her 3rd c-section & she ruptures. All because of those invasive procedures that her uterus endured. Her dream of a large biological family is crushed. She is advised to never get pregnant again.
Now, I know that c-sec are medically necessary for some women. It can be a life saving procedure for some moms & babies. However in both these cases at least one of their c-sections was not medically indicated and both woman's reproductive rights were violated.
As a future health care provider (I am a nursing & midwifery student) I am frustrated. This anti vaginal birth climate is scary. 40% c-sec rate in New Jersey is appalling. I really believe that this is what the outrage is about. Most birth advocates know that birth is not all butterflies & fairies. We know about the true risks, however I believe that there are OB's that practice in fear of litigation & under the handcuffs of hospital policies. When we help woman become Mothers under those boundaries many suffer.

April 2, 2010 | Unregistered CommenterCristina S.

With all due respect, Navelgazing Midwife, it's just now dawning on you that it's related to the med mal situation? Obstetricians have been saying this for years now. The homebirth community just has been refusing to listen.

It's interesting watching you come to grips with many of the realities of birth that happen when you attend more and more births (esp when you decided to get more education and training, despite others thinking you sold out). It's as though you've just discovered these things that others in the birth community have known for ages.

And there is a certain prissy entitlement about a woman / patient who thinks that an OB and/ or anesthesiologist should just sit around waiting rooms for hours on end for her "experience." It's usually accompanied by the same prissiness of "I'm so AP that if the baby gets taken away from me for five minutes to be weighed, it'll impact my bonding oh-so-much and it's a crisis of unparalleled proportions ... but you, you don't need to have a life, your family can just wait at home while you sit around a waiting room for 12 hours for me."

April 2, 2010 | Unregistered CommenterMe

Wow. Prissy? I've never heard the woman's and baby's needs expressed quite that way before.

If the care provider/OB/midwife doesn't want to "wait around," they shouldn't be in obstetrics. Perhaps dermatology is a better choice. Or, as too many OBs do, work in shifts.

I have zero pity for an obstetric worker who whines about the length of time it takes for a woman to have a baby or that she has needs that are inconvenient for them. Go work somewhere else.

April 2, 2010 | Registered CommenterNavelgazing Midwife

This is just a pet peeve of mine. You're an excellent writer and deserve any and all polish. It's "free rein," not "free reign." It's a reference to horses, not ruling over people.

With the content itself, I agree completely.

April 2, 2010 | Unregistered CommenterBBT

Oh. My. God. I *never* knew that!! I am horrified that I've written it wrong all these years! Egads. *hanging head in shame*

Thanks for teaching me. Really, really. Thanks for taking the time to do so.

April 2, 2010 | Registered CommenterNavelgazing Midwife

Glad it was helpful. :) You're not alone though. I'm one of relatively few in the modern world who has literally given free rein, so it's an easy one for me, but not so obvious to most people. I really do enjoy your blog.

An equestrian mama

April 3, 2010 | Unregistered CommenterBBT

Heh, I think I have written "free reign" myself, many times. I never knew that, either, so thank you to your poster!!!

Why is it so hard to have a baby these days? I live in OC, am pregnant with my second, and just want the *option* of a VBAC. And I feel like it's going to HAVE to be a fight, that I just don't have options.

Your blog has helped me, so I thank you. If a hospital birth is in my future, then I'm going to go with it. I know what I want, I know how to say "no, thank you" and I know how to just listen to my inner voice and do what I need to do.

I do worry about being forced into a c/s, but need to not worry about that, and focus on a happy, healthy pregnancy.

I would love a water birth. Water calms and soothes me. I can see a home birth filling my home with so much love and peace. Just trying to get my husband completely on board...and maybe figure out the financials :)

Kinda wish you were in OC...there aren't many VBAC friendly midwives up here :)

May 22, 2010 | Unregistered CommenterJamie

Reading this makes me want to send thanks backwards to the OB who helped me VBAC in 1974 and 1977. He got a midwife to sit with me and listen to the baby's heartbeat (with a fetoscope; doptones were just coming in the MD offices then) every 15 minutes until he could come, and he did just that, sit with me, and do the monitoring.
I had my two VBACs without electronic monitoring and without an IV. They were not at all perfect births, and I wound up quite angry with him over something which happen in the second one, but they made it possible for me to go on and have the uncomplicated home births I had later. I guess I didn't realize at the time how unusual this all was. So, thanks to Dr. James Brew. I wonder if he is still alive? Probably not. Hope his spirit is somewhere where he can receive my thanks.
Susan Peterson

August 15, 2010 | Unregistered CommenterSusan Peterson

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