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VBAC
Need thoughts on this (long)
in VBAC
Today I spoke with the OB who delivered my first about my desire to try VBAC, and she warned me about the worst case scenario. The hospital where she delivers does not have anesthesia available 24 hours a day so if I were to attempt a VBAC I would have to sign a waiver stating that if my uterus ruptured, she would have permission to essentially do a c-section without anesthesia because she wouldn't be able to wait the 30 minutes or however long to get an anesthesiologist.
There is another hospital close to us that I believe does have anesthesia 24/7, but she doesn't deliver there. Would you look into changing doctors this late in the pregnancy? I know I don't have a lot of time to shop around for OBs at 29 weeks. Take the risk and sign the waiver? I am so confused and disturbed. What she described--being held down while being cut open--sounded like torture, and I'm terrified, but I really had my heart set on attempting a VBAC.
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Re: Need thoughts on this (long)
Um, your doctor sounds like she's trying to scare you into a RCS. What does her hospital do if they have a non-VBAC mom who needs an emergency section??? I would find a new provider, and check your local ICAN chapter for help.
ETA: sorry, I was on my phone before. It isn't too late to switch providers, ICAN usually has local message boards of women who can direct you to someone who is more supportive. Good luck - it really sounds like she's definitely painting a worst-case scenario for emotional effect.
DS2 - Oct 2010 (my VBAC baby!)
This is exactly what I don't understand about the VBAC bans for this reason. What about emergencies? Why should VBAC really be considered different from a first time vaginal birth (for those who it will be)? If you are a first timer and have an emergency they wheel you back. I mean somehow we all got them the first time. Talk with her about all of this. Find out what happens when there is an emergency for someone who is not VBAC. See what she says.
I agree with pp. Your doctor is trying to scare you, and I can see why it would work! It does sound like torture! But, like others said, what exactly do they do with emergency c-sections for non-VBAC patients? Does she terrify all of those moms with this "worst case scenario" as well? I'm guessing probably not.
I would definitely look into getting a new provider. Not only would I have a strong preference to deliver in a hospital with 24 hour anesthesiologists, but I would have doubts that your current OB is going to be truly supportive when the time comes.
All of this. A non-VBAC woman could still have a uterine rupture (or many other emergencies). No hospital should deliver any babies without a 24 hour anesthesiologst.
Oh FFS, talk about scare mongering. Does your doctor tell every woman who comes in that if they have a cord prolapse or a large abruption or a shoulder dystocia they may have to be cut open with no anesthesia? Because the chance of having a uterine rupture in a VBAC is about the same as any woman having a sudden emergency in labor. Your doctor is applying a double standard to VBAC and I agree with pps that she's trying to scare you into choosing a RCS. I would be interested to know what she would say if you asked her what happens if a first timer has a cord prolapse or a huge placental abruption during labor and whether she makes everyone else sign a waiver. I bet she doesn't.
I'd look for another doctor. You don't know if it's too late to switch if you don't call around ask. I hear lots of stories on TB about people switching at 30+ weeks.
Really, isn't this the whole point of giving birth in a hospital--that they can do a crash c/s? Otherwise, why not give birth at a birth center, which has equally good outcomes and lower morbidity rates? Or at home for that matter?
I think it's fine if hospitals without 24 anesthesia do deliveries, but they should be upfront about their limitations and not act like they're all that much safer than out of hospital birth. To me these hospitals have all the downsides of hospital birth (increased risk of intervention, infection, etc.) without the major benefit--the ability to respond fast to a sudden emergency.
Ditto all three of you. You guys have said everything I was going to say.
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
I thought that the standard of care required all hospitals to be able to get a baby out in an emergent situation? Does anyone here know? Geek, do you?
This sounds ridiculous. I would be more worried about giving birth at a hospital that couldn't get me anesthesia 24/7 than anything. My vote is to switch hospitals even if it means switching doctors. But I might press the OB a bit more to find out how that is even allowable. Maybe even mention something about the standard of care and being able to get a baby out in an emergent situation. You could have any number of things happen not related to the vbac where the doctor has to do the surgery now. What do they do then?
ETA: I definitely know that 30 minutes is well outside the standard of care for an emergency c/s. I think any hospital would be setting itself up for lawsuits if they took any patient who ended up needing a fast c/s but they had to wait around for the anesthesiologist to show up. I say run fast and far away from that ob and hospital.
I'm not sure, but you'd think that would be standard, right? Like some of the other ladies have said, that is the big argument about hospitals that put a VBAC ban in place. They say they're not equipped to handle a VBAC emergency, when really there doesn't seem to be any reason why that would be different from another labor emergency that necessitated an immediate C-section. The risk of cord prolapse and placental abruption is comparable to that of uterine rupture in a VBAC (somewhere around 0.5%, different studies I just searched for had different numbers) and they can happen in any labor, regardless of previous C-section or not. If you're not properly staffed or equipped to handle a VBAC emergency, then it stands to reason you're not properly staffed or equipped to handle a prolapse or abruption, and IMO, you have no business keeping your maternity ward open if that's the case. As Iris said, that defeats much of the purpose of delivering in the hospital, doesn't it?
Sarah - 12/23/2008
Alex - 9/30/2011
"I say embrace the total geek in yourself and just enjoy it. Life is too short to be cool." - Shirley Manson, Garbage
I had an OB at the practice that deliverd DD#1 pull this crap on me, and I ran. Now, I didn't know I was pregnant yet, but the garbage she was telling me to scare me would have made me never want to have sex again and try childbirth of any kind if i hadn't done some research on VBAC. A it nd made me lose respect for any doctor that would pull such scare tactics.
If you really want to attempt a VBAC, it does not sound like this provider will support you, and going with the other hospital would be in your and the baby's best interest.