I’m 21 weeks pregnant today and having a consult with a new OB. When I first got pregnant and went to a well-regarded midwifery group that was comfortable with taking me as a VBAC (Vaginal Birth After Cesarean) I thought I was all set. At my first appointment, they mentioned I would need to have a consult with an OB from the hospital where I’d deliver, but did not seem concerned that I would not be an acceptable patient.
Fast forward a few months and last week I finally met with that OB. True to form for the narrow-minded, lawsuit-fearing, fat-hating, knife-happy bad guy OB stereotype, the OB was not on board with my having a VBAC at his hospital. His reasons- my weight (I am obese) and the size of my first child (9lb 6oz, deemed by him to be “humungous”).
Now, both of those reasons are medically accepted risk factors (although from what I gather, the “obesity means increased C-section rate” isn’t well-studied to correct for doctor-perceived risk, meaning OBs are more likely to insist on a C-section because they think there is a danger, versus a C-section is actually necessary).
If the doctor had said, “We are a small community hospital and don’t have surgical teams at the ready 24/7 or a NICU, thus your risk factors exclude you as a VBAC candidate under our hospital’s VBAC protocol,” I wouldn’t have been mad, disappointed, but not mad. However, he didn’t leave it at that. He had to tell me how poor my chances for a successful VBAC were and advise me of the futility of trying.
Um, he’s a medical doctor not a fortune teller. My single previous pregnancy and birth are not a sufficient sample-size on which to extrapolate. Also, even if my chances of a successful VBAC are low, it doesn’t mean it isn’t worth a shot to try and avoid major abdominal surgery.
So frustrating. And thus, I am 21 weeks and searching out another practice/hospital that will take me so that I may attempt a VBAC. After my c-section with Mabel, the midwife and OB who attended the birth assured me that there was no reason I couldn’t try for a VBAC in the future. They chalked my failure to progress with her poor positioning (neither face-up, nor face-down, but cock-eyed) and felt it was a fluke and not an indicator that I was incapable of a vaginal delivery.
I’m a scientist. I know there are risks. I also know that you can plan all you want and you aren’t guaranteed the birth you planned on.
However, I also know that the American College of Obstetricians and Gynecologists (ACOG) issued the following guidelines:
Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists. Source.
Based on the science and recommendations, the doctor should have said, “You don’t fit in this hospital’s protocol, I encourage you, based on ACOG guidelines to find another provider at another hospital that is better equipped to help you attempt a VBAC.”
Thusly, I am searching for a new provider.
With impeccable timing, today, my cousin posted a link to this article in The Sun about Ina May Gaskin- the most well-known and well-respected midwife in US and probably the world: Oh Baby: Ina May Gaskin on the medicalization of birth. I love that Gaskin speaks in citations- she mentions her facts and data and their source. When there is insufficient evidence for her to draw a conclusion, she doesn’t offer an opinion, she states that there hasn’t been enough research. What a breath of science-minded fresh air.
The two particular quotes (out of many) from Gaskin that stood out to me are below:
The U.S. maternal death rate steadily decreased between 1936 and 1982. At that point it leveled off for a few years and then began rising. Women today actually face twice the chance that their mothers did of dying from pregnancy-related causes.
A vaginal birth has always been safer for the mother. The risk of death of the mother is three times greater for c-section than for vaginal birth. If we’re talking about emergency c-section only, this figure rises to four times greater. (Source)
I will continue to advocate for myself, I will push to receive care informed by science and medicine, not unsupported opinion and baseless predictions. That I have to go to such great lengths to find a practitioner to provide such care is a terrible shame.