Last week I did something I’ve been needing to do for months –
I broke up with my OB.
I’m sad about it for a few reasons. One – I love love love my OB. I came across him by chance (I was going to another gynecologist, she retired, and I was transferred to him). From my first check up I liked him. He’s easy to talk to, listens to my concerns, never cuts my appointments short AND somehow is still always on time. And… let me be honest – he’s a fellow African America. Basically we feel like family. He was excited for us when we had the second ultrasound to confirm we were expecting (the first there was just a sack – we weren’t sure if this one was gonna make it). And I look forward to updating him on every appointment about my workouts/runs/baby movement/etc. His staff is also excellent.
The problem? Something I’ve known from that first appointment I had with him – a year before I got pregnant with this blessing.
His VBAC policy.
I had LB via emergency C-section in West Virginia. I went to a midwife practice there that I LOVE. Anywho, one day I’ll write up this story – but basically his heart didn’t tolerate labor well after the epidural so after a few pushes and some attempts with the vacuum – we went to the ER. I have struggled with accepting that I made the best choice for my son. I did in that final moment – but during labor mistakes were made. Anywho – all is well and he is healthy and in the 95th percentile for height and weight and other than a slight heart murmur that seems to have corrected itself – he’s perfect.
So VBAC. Vaginal Birth after Cesarean. It’s recommended by the AHS/WHO in most cases. The biggest risk is the >1% chance of uterine rupture (which is less than the risks associated with repeat CS – but it’s a very dangerous risk). This risk is a little lower to me because I dilated fully prior to my last csection which means statistically this labor will be faster. Also, my last labor was quick, started spontaneously (not induced), and happened a few days prior to 40 weeks. My incision is a low transverse with double layer stitching. I have a healthy BMI, a low risk pregnancy, and the reason for my past csection wasn’t something that is expected to recur. If there was an ideal candidate for VBAC, I’d be it, haha.
It is recommended during a VBAC to have continuous monitoring of the baby. A drop in heart rate is the first sign of uterine rupture. Most doctors do this by having you wear a monitor on your belly during labor. I’m fine with this.
My beloved OB’s policy is more conservative. I would have to have an early epidural “just in case” (as soon as I go into labor), I would have to come into the hospital as soon as labor starts and I would have to have my water broken and monitors placed into my babies scalp.
I’ve never been ok with it. I asked him if we could do it another way and he told me no, and explained his logic. And I still stayed with him. Until I really started thinking about labor, what I want, and what gives me the best chance of a successful vbac.
I had complications with LB’s reaction (and my own) to the epidural last time. I do not want to get one in early labor. I do not want to labor laying down on my back and not be able to move (can’t get up after epidural – can’t move with internal monitors). And i don’t want to be at the hospital prior to 4-5 cm.
At first I thought these requests were unreasonable – until I found out literally every other practice that had a good VBAC success rate would allow my birth plan. Then I started researching hospital statistics – and found out that the hopsital I’d deliver at with him has a … GET THIS… 15% episiotomy rate. Other hospitals around here are less than 5%. They also don’t have a high VBAC success rate. And they don’t have the highest level NICU around so God forbid something went wrong – I’d be at a different hospital than my baby (who would be transferred to another one – down the street).
Naturally I found out which hospital had the highest level NICU and looked into their vbac options. I found a midwife practice that delivers there that has the HIGHEST VBAC success rate in the area. They have delivered several natural VBACs this year. Oh, and their csection rate is only 11% (they have planned csections included in that). The average around here? 35%!.
I went over earlier this week for a consultation. They said everything in my birth plan was more than doable – and even gave me some options I didn’t know about. They suggested birth classes, were familiar with the methods I plan to use for pain management (hypnobirthing), and were just all around perfect. So, I switched.
My anatomy scan is still on Monday, but will be with the midwife practice. I’ll find out the sex of the baby then.
I feel a lot more comfortable and connected to the baby now. I think before I was trying to avoid thinking about the birth process and how my birth plan wouldn’t work – and in turn I found myself thinking about the whole pregnancy less and less. I wanted to correct that, so I made a change.
My advice is don’t be afraid to make a change. Do your own research, and interview providers. Don’t just show up for an appointment – schedule a consult where you can be fully clothed and talk to them face to face. Bring specific questions. Here is what I asked my beloved ex-OB and the midwife practice I decided on:
- What are the options for mom’s who had a previous csection?
- How many TOLAC have you had this year? (trial of labor after cesarean)
- What is your VBAC success rate?
- What is your standard VBAC procedure?
- At what point during labor do I need to come to the hopsital?
- How would you monitor the baby?
- What positions for birth would I be allowed?
- As a VBAC what is different for me vs other birthing moms?
- How many weeks pregnant would I be allowed to go? (some practices will make you schedule a CS if you don’t go into labor by 40 weeks)
- What are my options if I do not go into labor by ____ weeks? (inducing with pitocin increases the change of uterine rupture).
- What things can I do now to increase my change for success in this VBAC?
Though I do prefer midwife practices in general (less invasive, more natural and in line with my beliefs) – it was the answers to these questions that made me switch. Not their titles.
Anywho – I’m writing this mainly for me but also for anyone else who is struggling with an OB or midwife who they aren’t sure about. IDC if you’re 38 weeks – GO FIND SOMEONE ELSE. Being under stress and not feeling supported during labor can stall your progress and rob you of a beautiful birth. It can be dangerous for both you and your baby. Switching is scary – but worth it. You won’t regret it.