Can I say NO to a repeat c/s against ob advice?

Jessimurph · October 2011

I signed an intent to vbac form for my ob. It spelled out the risks, that they will not induce and that i have to go into labor by 41 weeks. Am i within my rights to refuse a scheduled cs at 41 weeks? Ideally i'd like to give it till 42 since the average first timer goes into labor at something like 41wks 3days. I'm not sure how much power i actually have before he refuses to treat me or something.

Geekchick921 · October 2011

They can't hold you down at C-section you at 41 weeks. I do think they might have the right to "fire" you as a patient for non-compliance, though. I don't know.

It sucks that they will not even attempt to induce you. Is this the hospital policy's or the OB's? If it's the hospital, maybe the OB will let you slide a few more days before an RCS. You can also always try to self-induce with nipple stimulation and whatnot. Good luck, Jess!

Jessimurph · October 2011

I'm not sure if it's hospital policy or his groups policy. I should find out. I assumed it was standard policy.

disbride061103 · October 2011

Jessimurph:
I signed an intent to vbac form for my ob. It spelled out the risks, that they will not induce and that i have to go into labor by 41 weeks. Am i within my rights to refuse a scheduled cs at 41 weeks? Ideally i'd like to give it till 42 since the average first timer goes into labor at something like 41wks 3days. I'm not sure how much power i actually have before he refuses to treat me or something.

You can absolutely refuse the section at 41 weeks. They can not perform surgery without your consent. If you are ok with being induced, I would look for a provider who is willing to do so. I was induced with my VBAC attempt. Without an induction, I never would have had the chance to experience labor. GL!

iris427 · October 2011

You absolutely have the right to refuse. I don't know if they would be obligated to continue treating you at that point, since it would be pretty hard to find a new doctor at 41 weeks pregnant. Of course even if they did drop you as a patient, once you were in labor, a hospital would be legally obligated to provide you with care or transfer you somewhere that could. Obviously going into labor with no doctor and showing up at L&D for the on-call doctor or residents to treat would not be ideal, especially as a VBAC, but you do have that legal protection as well.

You might be able to negotiate past 41 weeks if you offer to come in for NSTs. Are there any other VBAC providers in your area who might be more flexible if this one won't be?

MrsJordanalmond · October 2011

this is my ob policy to a T. 41 weeks and no induction. not only that, they don't routinely offer sweeping the membranes to potentially get things gogin.

none of these policies are based on acog or ama recommendations but liability, convenience and $.

i tried looking for another provider, but it seems that almost everyone on my insurance has very similar policies.

my plan is to start acupuncuture at around 36 weeks to try and make things happen. also i've hired a doula who has given me a bunch of things to try if we get close to the wire. and, if all else fails, i may 'forget' to show up for my rcs if i get to 41 weeks without progress. you know, pregnancy brain.

Jessimurph · October 2011

I don't know if my OB will negotiate. I'm hoping he's reasonable at the end of I go into labor before and it's moot. My other option is a midwife, but it will be $2000 cash extra that my husband is not willing to spend. I'm looking into doulas now and am hoping I will be able to get some advice from her towards the end.

MrsJordan-Do you know if there will be any financial consequences to forgetting your rcs? It seems a little risky to forget major surgery. Hopefully neither of us will have to deal with this. I'd love info on acupuncture inducing labor....I've never heard this before.

bensbabe · October 2011

Jessimurph:
I don't know if my OB will negotiate. I'm hoping he's reasonable at the end of I go into labor before and it's moot. My other option is a midwife, but it will be $2000 cash extra that my husband is not willing to spend. I'm looking into doulas now and am hoping I will be able to get some advice from her towards the end.

MrsJordan-Do you know if there will be any financial consequences to forgetting your rcs? It seems a little risky to forget major surgery. Hopefully neither of us will have to deal with this. I'd love info on acupuncture inducing labor....I've never heard this before.

I was going to try acupuncture, but I needed an induction--baby had her own idea & I went into labor the night before my induction. You can google acupuncture for your area & specifically search for ones who deal w/OB patients.

You don't necessarily have a financial consequence. Also, at that point, if you're dropped from care for non-compliance, (in most states) you are still covered by that practice for 30 days, so most OBs won't even bother that late. We've had people cancel or not show-up for c/s all the time. As you near that 40 week mark, start to put the bug in about NSTs & going past 41 week to 41.5 or something at or right before 42 weeks. Delay scheduling your c/s as long as possible. Call & cancel or don't show-up. They can't force you to have surgery.

MrsJordanalmond · October 2011

https://www.yinovacenter.com/blog/archives/4538/

the link above is for the woman i go to for acupuncture, and her plan for getting labor started on it's own. it is based on a study from new zealand ...

https://www.medicalacupuncture.org/aama_marf/journal/vol17_3/article_2.html

as far as the consequences to 'forgetting' my c/s ... i really don't know. and while i'm very serious about a vbac, i'm really not sure how serious i would be about 'forgetting' ... we'll have to see when things get closer.

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