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VBAC
I'm shaking my head at this
https://www.bostonglobe.com/magazine/2011/10/28/the-section-boom/Uq6YiseGIEziBXGuq19lFN/story.html
An article on the rising c/s rate. The author, an OB, really dismisses VBAC. No discussion of VBAC safety, how the majority of women are good candidates and will be successful, etc. You can really see the bias coming through in some of the quotes, like this one:
?The biggest downside to doing a caesarean, assuming you don?t have complications, is that it costs the [health care] system more,? says Dr. Michael Grossman, an obstetrician/gynecologist in private practice in North Andover. ?The biggest downside [to not doing a caesarean] is that you lose the kid. It may not affect the statistics, but on an individual basis it?s pretty damn important.?
How is that a fair comparison at all, if you are excluding all medical complications of a c/s, but including all the possible complications of a vaginal birth? Is that the kind of information he gives patients, or uses to weigh his recommendations?
Also, the author ends the article with the story of a mother who wanted a natural birth and ended up with a c/s. He says: Under bright lights, 20 minutes later, we delivered a little girl, who emerged screaming and pink. My patient and her husband were delighted and thanked me for guiding them to a safe delivery. I didn?t spend time second-guessing my decision: Everyone was healthy; the new family was content.
But we know that is not always the case. Which makes me wonder, how many of the women who feel real emotional distress about the way their child's birth went ever tell their OB or MW about how they feel? How many providers are just left in the dark about it and assume everyone is happy? I know I didn't talk to my OB about it after my c/s.
This discussion has been closed.
Re: I'm shaking my head at this
That article was disturbing. I can't believe he fully admitted that the patient didn't need a C-section but he told her it was for the best. I'm sure that after that initial fog lifted and she could think straight she was not at all "content". But by that point she's not the doctor's problem anymore.
Livid. Why is he quoting the great outcome of a cs assuming no complications but then lists the worst possible case of a vaginal delivery? The worst that can happen with a c/s is dead mommy and baby! Not that it happens a lot, but if you are listing the "worst" then that is it.
This doctor scares me and I hope other people see that when they read this article.
Well, I'm sufficiently pissed.
Here's another quote:
At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. ?Less than 15 percent?? the speaker asked. Two hands in the large auditorium went up. ?Fifteen to 30 percent?? Half the hands were up. ?More than 30 percent?? The rest. Then the speaker asked the room, ?How many of you care?? No one raised a hand, and the room broke out in laughter.
Awesome - admittance that overall, the group doesn't care!
The facts are incorrect in this article. 1999 ACOG guidelines? Really? The tone is also very condescending: "But after a pair of nurses got her into a blue hospital gown and she was examined by the resident physicians, it turned out that her cervix was dilated only 1 centimeter."
Guess we know who is in charge there. Let's draw a cartoon of the nurses wrestling this "slowpoke" into her gown. Now, now, dear.
I expect more from this paper. If I was a subscriber I'd definitely be leaving feedback...
Any ideas for countering this load of misinformation?
Yeah, it's completely messed up and really reminds me of everything I hated about my c-section. Especially this:
"The truth is, an obstetrician can persuade almost any patient at any time that a caesarean is the best choice."
I thought I was *so* prepared for L & D -- I had read everything I could get my hands on, I had a perfect vision of what I did and did not want, but what I was COMPLETELY unprepared for was the level of total and incessant bullying on the hospital's (nurses, attendings, residents, everyone) behalf. After a three day induction, I just felt completely beat down and like I couldn't say no anymore. I may have needed a c-section regardless, but what I will always regret doing was consenting to the bully doing my c-section -- I wish, wish, wish, I would have at least waited for a shift change and I'm still mad at myself for not doing that.
Yes! Two things they say more or less throughout: 1) we don't care about what the optimal c-section rate should be and 2) we can convince a patient a c-section is necessary at any point --- "the patient" is vulnerable and we are powerful.
Ick.
I'm sorry you had to go through such a crummy induction. GL with your VBAC!
I 100% agree with this. I actually had a lot of anxiety after my son was born and talked to doctor that specializes in PPD. She offered to make an appointment for me to talk to the on-call doc about what happened and I was like, "right, what good would that do? I doubt he even remembers." So, (and not that I'm terribly proud of this), I felt like my only recourse was to give honest but scathing reviews of him on online "rate this doc" sites. Not that it makes me feel any better.
I never talked to my OB again. I scheduled my follow-ups with the CNMs that were a part of the practice. When I was due for another well check, I was thinking ahead to my VBAC and already shopping for a new provider. I had PPD and it set in very quickly after my first was born - I was still in the hospital. I let it linger too long before talking about it because everyone thought I should be happy. This time --- non-traumatic birth and so far (knock on wood), no PPD.
At one time I thought about writing my OB a letter (this was when I was working through my anger about how things went) - with the intention of ripping it up when I was done. Never did it but I wonder how OBs/MWs would respond if more patients were vocal about their discontent?
Thank you!
Yes, yes, yes!! I always felt like what really bothered me wasn't the c-section itself, but the way that I was treated up to and during it. They were so incredibly patronizing and treated me like I was less than a person. My MW (truly a "med-wife", I learned after) had been great during my prenatal care, but changed gears completely once we were in L&D. There was no talking to me about things, just ordering that this and that. And this was not an emergency situation.
At the end of it, I just gave up and consented to so many things because I was scared and exhausted, not to mention starving, thirsty, and shivering.
I haven't read the article yet, but I think a real problem I have surrounding hospital L&D in general is the infantilization of women during the process. Believe me, I know that I'm not a health care professional, and I like to think I'm smart enough to know what I don't know, but I don't think it's asking too much to be treated like the well-educated, well-read woman that I am, instead of condescending to me like a child.
oooh, I still haven't finished that article, I started it last night. Too much other stuff to read, ha ha!
Anyhoo, related to your question, I talked to the MW who attended DS1's birth about how no one checked his position until after I had pushed for ages, and how I was really upset with having the c-section, etc etc. She was really dismissive of me questioning why no one knew he was posterior earlier, and not understanding why I'd be upset about it. I finally got a grudging "yeah, I guess I can understand that it'd make me pretty sad if I ended up with a c-section, too..." Sigh.
I think the vast majority of women probably never talk to their providers about their unhappiness, so the providers just assume everything is hunky-dory afterwards, because hey, mom and baby are both physically healthy, so what's the problem?
DS2 - Oct 2010 (my VBAC baby!)
Yes. During my 4 day ordeal my OBs would come in and give me choices, and then try to bully me into making the choice they wanted. In the end I just wanted it all to be over and have my baby and I gave in to things I never wanted. Next time, I refuse to be so vulnerable.
We had the same story...and we're both due the same week in June. Let's do it right this time!
My MW was very laid back about the entire process, bordering on indifferent. She knew how much I wanted a natural birth so I figure that she understood how upset I was. Afterwards she kept telling me that DS was too big, and that I could have pushed for 6 hours and he wouldn't have come out. The real problem was that he was posterior, and I wish that she would acknowledge that as being the real issue. It would make me feel a lot better. I know it, she knows it, why won't she say it?
Yes x 100. And I even used to work in the same L&D ward before I got pregnant, and I was still unprepared for what it would be like.
I completely agree. It's infuriating. I loved my VBAC OB because, among other things, he treated me like an adult.
Honestly? I did. I've talked to her a number of times about it, and I'm 10 month pp and already starting a list of questions for her for my next appt next year. I blame myself 100% for my C/S, she reassures me it was not my fault I had a big OP baby. She even followed up with the people on call when I arrived and the nurses in charge of my NST (I 'failed' a NST before being sent to be induced) to figure out all the pieces. She sent me straight to a therapist who has sent me back to my OB with more questions, etc. I know I'm lucky to have such an amazing doc and I wish more people would speak to their docs about how they feel.
~~ married 8.11.07
~~ DD1 1.16.11 ~~ DD2 1.3.14 ~~
~~ BFP3 12.22.15 MMC 2.29.16 @ 13 weeks ~~
~~ 2 D&Cs (3.1.16 and 3.10.16) for MMC
~~ BFP4 10.27.16 MMC 1.23.17 @ 16 weeks ~~ D&E 1.26.17 ~~
depressing and scarey the statistics you can access. CS rate in america is around 50% right now. most of them not for medical reasons but for the patients and doctors "convenience."
check out a video, "Pregnant in America" its kinda depressing but can shed some good light on the current mindsets.
The national c/s rate in the US is about 33%. I don't doubt it will keep rising though.