Successful VBAC at VCMC! This hospital does not allow VBACs
Mon, 04/20/2009 - 19:39 — Anonymous
Nicole has given permission to post this here. A great story about the power of being informed and of the Right to Refusal of Treatment.
Here is my story. I have proven that informed consent/informed refusal works.
I have also included a short background.
I had a c-section in 1990 after pushing for almost 3 hours. The babys head was showing but I was exhausted and he wasnt coming out. I was 15 and probably not even finished growing. He was a healthy 8 lb 9 oz boy, now my 19-year-old college student. In 1994, I was pregnant with my second and the standard of practice then was VBAC. The doctor had no concerns but did caution against an epidural as he believed it may prevent me from pushing hard enough and progressing as I should so I did not have one. I’m thankful for this. I agreed to induction when at almost 40 weeks I had horrible sciatica. The induction worked and I also had an injection of Stadol (which was useless) and easily delivered by VBAC another healthy boy, 7 lbs 8 oz, who is now 14.
In the summer of 2008, at age 33, I became pregnant with my third baby. I was shocked and horrified at my first prenatal visit when I was told I would be required to have a c-section. It was described as a repeat c-section but that terminology never made sense to me since I had already had a VBAC. I went home and cried because the whole thing made no sense and I also felt it wouldn’t be best for the baby, not just me. I started searching online and found ICAN. I found there was a local chapter, here in Ventura, and sent an email to the leader, Tawnya, begging for guidance. I received a wonderfully welcoming response and was also invited to monthly meetings which I began attending. The education and encouragement I received from the group is greatly responsible for my VBAC success. I am also thankful for the friends I have made in the process.
I received my OB care through the Womens Health Center with VCMC. I saw three different doctors, whoever they would schedule me with. I began care at 8 weeks pregnant and that is when I was told I would be having a c-section. Each doctor continued to tell me the same throughout my pregnancy but I did not respond to them as I was in the continuing process of educating myself and trying to figure out how I was going to make my second VBAC happen. They did advise me that UCLA is the only facility that allows VBACs and just for the heck of it, I went to my Primary Care Physician and got a referral. My PCP also agreed with me about the c-section being unnecessary. He did state that he wonders what would happen if I just go to VCMC in labor and refuse a c-section. He said he believed I should not have a problem if I chose to do this.
I went for my consult at UCLA anyway. My visit was with the Vice Chair of Obstetrics. He concluded that I was an excellent candidate for a VBAC but also stated that I do not need to go all the way to UCLA for this, I could go to my local hospital and refuse a c-section. I continued OB care at the Womens Clinic and told the doctors I will be having a VBAC which I will be traveling to UCLA for if I feel I could make it. The doctors asked me at every visit, “You’re going to UCLA right? They also took several opportunities to remind me that I will not be allowed to labor at VCMC. They didn’t go into detail. I would just respond by stating that I know.
One thing that was interesting to me was that each time I would see one of the doctors and he would measure and palpate the baby he would say, “This is not a small baby”. I was never really sure whether he was being honest or trying to scare me into c-section. It did turn out he was correct. But trust was always an issue and for much of my pregnancy I was only being followed for a c-section so I finally had to tell the doctors one month before my due date that I was not having a c-section so that they would start checking for things they need to check for a vaginal birth. That’s when the “You’re going to UCLA, right?” started.
I was also connected with a student doula who I met with a few days before my due date. She was so supportive and knowledgeable and was there with me at the birth.
I was due March 25th and continued for 2 OB visits after my due date. On March 31st, I went for a visit for a fetal non-stress test and an ultrasound to determine amount of fluid. Everything was fine.
At about midnight, early morning April 1st, I started having contractions about every 10-15 minutes but didn’t think much of them since the previous 2 nights I had experienced the same thing but when I got up in the morning, they went away. This time they didn’t go away. I called my doula and waited all morning while the contractions continued about every 7 minutes then to about 4-7 minutes. We went to VCMC at about 1pm. Not knowing how I would be treated at the hospital did cause me a lot of extra stress that I could have lived without. Knowing my rights and being certain that I was not putting my baby or myself in danger was a key to not letting the stress take over.
I went to the OB department and was introduced to my nurse. I provided her with a copy of my birth plan. I also quickly explained my refusal of a c-section. She said it was no problem, women have done it there before and I won’t have a problem with the staff. Her positive response was such a relief!
A resident, came in a short time later. She acknowledged my refusal of a c-section and that the attending doctor would need to come in and talk to me but that they should be able to accommodate that and the rest of my birth plan which she had reviewed. A big part of the plan was for no interventions since it is known that interventions can often lead to need for c-section. I also wanted to be fully aware of everything going on throughout the birth process.
The resident checked me for dilation but was unable to tell where I was at. My contractions were about 2-3 minutes apart and very strong already. The attending doctor came in and gave me the Scare Tactic Risks Lecture. My kids were in the room the whole time and I don’t have very much respect for this doctor anymore as I felt this demonstrated horrible bedside manner. It included the usual percentages (not including my actual risk percentage since I already have had a VBAC) and death or damage to the baby (just for extra scare factor). My doula and I both explained the truth to my kids after the doctor left. We all know this is a legal issue, not a medical one. After he left there was not a single mention about it. I was allowed to proceed without issue. The contractions were incredibly strong.
The resident checked me again and advised me I was 4 or 5 centimeters, I think. The contractions continued and I rarely saw my husband as he was trying to give the family members who were gathered in the waiting room the opportunity to come see me. The labor room had a 2 visitor limit. About an hour flew by and as the contractions got worse, the nurse offered pain medication but I stuck to my plan and refused.
A short time later they got so intense I felt I had to push. I remember lying on my side on the bed, holding my legs together while pushing and barely being able to breathe. I told my doula that I felt the urge to push and she went and told the nurse and asked her to check me. At first the nurse said “no, it was too soon, there’s no way I could be close to complete yet”. My doula insisted and the nurse came in and checked me. I wont forget the look on her face, an obvious 10 centimeters. She called for help but the nurses station didn’t answer. My husband and doula helped her get the bed moved and finally to the door where she had to yell to the staff that she needed help and they were moving me to the delivery room. The resident doctor must have been on break or lunch and they introduced me to another resident. Also, the staff physician who was present and assisting.
I had a horrible cramp in my right groin as I was trying to hold my legs back to push. I was yelled at by a nurse, when I had horrible pain and stretched my leg out for a minute. I didn’t kick anyone. She left the room, thank goodness. I don’t remember how many total times but I remember pushing about 3 times per contraction. It was not long because I remember thinking I needed to get the baby out now because I wasn’t going to live through another contraction. During a push I felt the baby’s head come out as they were telling me it was. They then had me stop for a moment, then the next push brought out the body.
I was able to feel the entire length of the baby’s body come out. I didn’t recall this with my younger son as the Stadol had made my brain kind of foggy. Everything was clear this time, though, without any medication. The baby, my first girl, weighed 8 lbs 10.5 oz and was 20 in.long, beautiful and healthy. The placenta was delivered with a very small push. It turns out my waters broke while I was pushing. I had been wondering how that was going to work since they were ruptured with the plastic hook by the doctor during my labors with my first two kids.
I ran into the resident doctor who first checked me about a week later and she told me of someone who came in for a VBAC a few days later. She said the patient stopped progressing and ended up with a c-section. I didn’t ask but would guess there may have been some type of intervention that slowed progression.
The Key Factors in VBAC Success on vbacfacts.com provided me with some very important points that I followed during my labor, with the exception of #3. They are the following:
1. Supportive husband
2. Educated herself
3. Supportive care provider
4. No drugs whatsoever
5. Refused induction
6. Refused rupture of membranes
7. Stayed ACTIVE and changed positions the entire labor
8. Ate and drank as she wanted to
9. Remained completely relaxed and therefore had plenty of energy
10. TRUSTED HER BODY!
I think following the list was one important key to my success combined with knowing my rights to informed consent and informed refusal. All of this I learned through the ICAN group and the wonderful individuals that are a part of it.
Nicole
Here is my story. I have proven that informed consent/informed refusal works.
I have also included a short background.
I had a c-section in 1990 after pushing for almost 3 hours. The babys head was showing but I was exhausted and he wasnt coming out. I was 15 and probably not even finished growing. He was a healthy 8 lb 9 oz boy, now my 19-year-old college student. In 1994, I was pregnant with my second and the standard of practice then was VBAC. The doctor had no concerns but did caution against an epidural as he believed it may prevent me from pushing hard enough and progressing as I should so I did not have one. I’m thankful for this. I agreed to induction when at almost 40 weeks I had horrible sciatica. The induction worked and I also had an injection of Stadol (which was useless) and easily delivered by VBAC another healthy boy, 7 lbs 8 oz, who is now 14.
In the summer of 2008, at age 33, I became pregnant with my third baby. I was shocked and horrified at my first prenatal visit when I was told I would be required to have a c-section. It was described as a repeat c-section but that terminology never made sense to me since I had already had a VBAC. I went home and cried because the whole thing made no sense and I also felt it wouldn’t be best for the baby, not just me. I started searching online and found ICAN. I found there was a local chapter, here in Ventura, and sent an email to the leader, Tawnya, begging for guidance. I received a wonderfully welcoming response and was also invited to monthly meetings which I began attending. The education and encouragement I received from the group is greatly responsible for my VBAC success. I am also thankful for the friends I have made in the process.
I received my OB care through the Womens Health Center with VCMC. I saw three different doctors, whoever they would schedule me with. I began care at 8 weeks pregnant and that is when I was told I would be having a c-section. Each doctor continued to tell me the same throughout my pregnancy but I did not respond to them as I was in the continuing process of educating myself and trying to figure out how I was going to make my second VBAC happen. They did advise me that UCLA is the only facility that allows VBACs and just for the heck of it, I went to my Primary Care Physician and got a referral. My PCP also agreed with me about the c-section being unnecessary. He did state that he wonders what would happen if I just go to VCMC in labor and refuse a c-section. He said he believed I should not have a problem if I chose to do this.
I went for my consult at UCLA anyway. My visit was with the Vice Chair of Obstetrics. He concluded that I was an excellent candidate for a VBAC but also stated that I do not need to go all the way to UCLA for this, I could go to my local hospital and refuse a c-section. I continued OB care at the Womens Clinic and told the doctors I will be having a VBAC which I will be traveling to UCLA for if I feel I could make it. The doctors asked me at every visit, “You’re going to UCLA right? They also took several opportunities to remind me that I will not be allowed to labor at VCMC. They didn’t go into detail. I would just respond by stating that I know.
One thing that was interesting to me was that each time I would see one of the doctors and he would measure and palpate the baby he would say, “This is not a small baby”. I was never really sure whether he was being honest or trying to scare me into c-section. It did turn out he was correct. But trust was always an issue and for much of my pregnancy I was only being followed for a c-section so I finally had to tell the doctors one month before my due date that I was not having a c-section so that they would start checking for things they need to check for a vaginal birth. That’s when the “You’re going to UCLA, right?” started.
I was also connected with a student doula who I met with a few days before my due date. She was so supportive and knowledgeable and was there with me at the birth.
I was due March 25th and continued for 2 OB visits after my due date. On March 31st, I went for a visit for a fetal non-stress test and an ultrasound to determine amount of fluid. Everything was fine.
At about midnight, early morning April 1st, I started having contractions about every 10-15 minutes but didn’t think much of them since the previous 2 nights I had experienced the same thing but when I got up in the morning, they went away. This time they didn’t go away. I called my doula and waited all morning while the contractions continued about every 7 minutes then to about 4-7 minutes. We went to VCMC at about 1pm. Not knowing how I would be treated at the hospital did cause me a lot of extra stress that I could have lived without. Knowing my rights and being certain that I was not putting my baby or myself in danger was a key to not letting the stress take over.
I went to the OB department and was introduced to my nurse. I provided her with a copy of my birth plan. I also quickly explained my refusal of a c-section. She said it was no problem, women have done it there before and I won’t have a problem with the staff. Her positive response was such a relief!
A resident, came in a short time later. She acknowledged my refusal of a c-section and that the attending doctor would need to come in and talk to me but that they should be able to accommodate that and the rest of my birth plan which she had reviewed. A big part of the plan was for no interventions since it is known that interventions can often lead to need for c-section. I also wanted to be fully aware of everything going on throughout the birth process.
The resident checked me for dilation but was unable to tell where I was at. My contractions were about 2-3 minutes apart and very strong already. The attending doctor came in and gave me the Scare Tactic Risks Lecture. My kids were in the room the whole time and I don’t have very much respect for this doctor anymore as I felt this demonstrated horrible bedside manner. It included the usual percentages (not including my actual risk percentage since I already have had a VBAC) and death or damage to the baby (just for extra scare factor). My doula and I both explained the truth to my kids after the doctor left. We all know this is a legal issue, not a medical one. After he left there was not a single mention about it. I was allowed to proceed without issue. The contractions were incredibly strong.
The resident checked me again and advised me I was 4 or 5 centimeters, I think. The contractions continued and I rarely saw my husband as he was trying to give the family members who were gathered in the waiting room the opportunity to come see me. The labor room had a 2 visitor limit. About an hour flew by and as the contractions got worse, the nurse offered pain medication but I stuck to my plan and refused.
A short time later they got so intense I felt I had to push. I remember lying on my side on the bed, holding my legs together while pushing and barely being able to breathe. I told my doula that I felt the urge to push and she went and told the nurse and asked her to check me. At first the nurse said “no, it was too soon, there’s no way I could be close to complete yet”. My doula insisted and the nurse came in and checked me. I wont forget the look on her face, an obvious 10 centimeters. She called for help but the nurses station didn’t answer. My husband and doula helped her get the bed moved and finally to the door where she had to yell to the staff that she needed help and they were moving me to the delivery room. The resident doctor must have been on break or lunch and they introduced me to another resident. Also, the staff physician who was present and assisting.
I had a horrible cramp in my right groin as I was trying to hold my legs back to push. I was yelled at by a nurse, when I had horrible pain and stretched my leg out for a minute. I didn’t kick anyone. She left the room, thank goodness. I don’t remember how many total times but I remember pushing about 3 times per contraction. It was not long because I remember thinking I needed to get the baby out now because I wasn’t going to live through another contraction. During a push I felt the baby’s head come out as they were telling me it was. They then had me stop for a moment, then the next push brought out the body.
I was able to feel the entire length of the baby’s body come out. I didn’t recall this with my younger son as the Stadol had made my brain kind of foggy. Everything was clear this time, though, without any medication. The baby, my first girl, weighed 8 lbs 10.5 oz and was 20 in.long, beautiful and healthy. The placenta was delivered with a very small push. It turns out my waters broke while I was pushing. I had been wondering how that was going to work since they were ruptured with the plastic hook by the doctor during my labors with my first two kids.
I ran into the resident doctor who first checked me about a week later and she told me of someone who came in for a VBAC a few days later. She said the patient stopped progressing and ended up with a c-section. I didn’t ask but would guess there may have been some type of intervention that slowed progression.
The Key Factors in VBAC Success on vbacfacts.com provided me with some very important points that I followed during my labor, with the exception of #3. They are the following:
1. Supportive husband
2. Educated herself
3. Supportive care provider
4. No drugs whatsoever
5. Refused induction
6. Refused rupture of membranes
7. Stayed ACTIVE and changed positions the entire labor
8. Ate and drank as she wanted to
9. Remained completely relaxed and therefore had plenty of energy
10. TRUSTED HER BODY!
I think following the list was one important key to my success combined with knowing my rights to informed consent and informed refusal. All of this I learned through the ICAN group and the wonderful individuals that are a part of it.
Nicole
Comments
Thanks Nicole