Adam and Bettie came with me to my first midwife appointment at UNC. Bettie got FREAKED out when they took my blood pressure and weighed me. She didn't want anyone touching me. It was kind of flattering in a sad way that she was so protective. I hated seeing her so upset.
The midwife was nice enough. We talked about my birth trauma with Bettie (and as usual, I broke down into tears) and she told me about the hospital policies--continuous fetal monitoring, heplock, etc. I hated the idea of the required "stuff", but was encouraged by her attitude towards birth. She didn't think twice about natural VBAC. She didn't dwell on the negative aspects or the horrible things that could happen. It was refreshing. I felt good leaving the office.
On the drive back home (and it was a drive...40 minutes) I started getting nervous. I knew that when I went into labor, I wanted to wait as long as I could before going to the hospital. That drive started seeming even longer. I started thinking about Bettie and the fact that she'd be at least 40 minutes away from me. I thought about how long it would take for Adam to drive back to Cary to get her and then come back. It started a big ball of worry in my stomach.
I had to find an alternative. I knew there was a practice in Cary called Triangle OBGYN that had midwives. In fact, one of my doula clients was a patient there and had an amazing midwife for her birth. The downside was, they had terrible reviews on the web and the first time I called, I got put on hold and no one ever came back on the line. The upside was the fact that they delivered at a hospital about 5 minutes from my house. To me, despite crappy reviews and customer service (initially), that was going to be the best option.
I made an appointment for a Friday. That Thursday I started feeling crampy and twingy. I'd had a lot of stress at work and was afraid that I might be having preterm labor. I called Triangle OB and they got me in. I got to see a fabulous midwife named Jessica, and she put my mind at ease. During that visit, my cervix was showing signs of funneling (dilating from the inside), but it was still closed, so that was a positive. She told me that I needed to take it easy, and that she'd see me the next day for my official first appointment.
That first appointment took FOREVER. Their waiting room was crammed full of pregnant women, so I had to wait for over 35 minutes. The appointment itself was pretty good. I saw Jessica again and was told that I'd have to see an OB during the next visit to get cleared to have a VBAC. I was okay with that. It seemed I had finally found a practice I could deal with.
During my next visit, I saw a female OB. Her bedside manner was only okay. She asked me about the exercise I was getting and flipped out when I told her I was running. She told me to stop running immediately and move on to something lower impact. She cleared my VBAC, but I wasn't fond of her.
I still hadn't completely abandoned hope of a home waterbirth, so having had an appointment with that female OB (and not being 100% thrilled with her), I reached back out to the first home birth midwife, Nancy. She told me she was still seeing VBAC patients and she'd love to see me again.
I met with her and her assistant and was back in love with the idea of home birth. Things seemed to finally be working out. She told me that I could continue with Triangle OB because if something happened during the home birth and I needed hospital care, it would be a good idea to have a practice familiar with me on standby. Plus, Triangle could do any labs or ultrasounds that might be necessary. I was okay with that. I was paying Nancy out of pocket and insurance was picking up my Triangle visits.
Nancy knew I was seeing Triangle, but I didn't tell the folks at Triangle I was planning on home birthing. I knew I'd be bombarded with negativity, so it didn't seem worth it. I was also worried that I might go into labor before 37 weeks, and if that happened, home birth wouldn't be an option anyway, so I was happily prepared no matter what the outcome.
Tuesday, July 31, 2012
Thursday, May 31, 2012
OBs and VBAC Lip Service
We decided to start trying for baby number 2 after my successful surgery in April 2011 to bisect a uterine septum--the reason I had preterm labor with Bettie. I got my positive pregnancy test in September. I still get a little giggle that it didn't take long to get pregnant after being told for years I'd have problems getting pregnant. I guess the doc I saw in my early 20's really didn't know what she was talking about.
Early in the pregnancy, at around 5 weeks, I had some bleeding and got scared that I was going to lose the pregnancy. There was no blood in my uterus, so things were fine. What would a pregnancy of mine be, without a little drama?
I had been seeing Dr. Holton, the doctor who delivered Bettie. He's retired from OB work, so by 8 weeks, he recommended that I find an OB to continue my care. Both he and the infertility specialist who did the uterine septum bisection agreed that I was a perfect VBAC candidate. My c-section was done using a low transverse incision and was sutured using double wall sutures.
I looked at the website of the practice he recommended and it became obvious that they were not pro-VBAC, so I didn't even call them. I decided to reach out to Nancy Harman, a certified nurse midwife who came highly recommended from the home birth community. I exchanged a few emails with Nancy and decided I really liked what I was hearing. I made an appointment with her and saw her at 10 weeks.
Nancy is very earthy and her assistant, Andrea was awesome. I instantly liked both of them. About 10 minutes into my appointment, they got a call from a mother in early labor, so they had to cut my appointment very short. Nancy told me she'd contact me over the weekend to reschedule and chat.
The weekend came and went and I heard nothing. At the time, Adam wasn't totally on board with home birth, so when two weeks came and went without hearing anything from Nancy, I just figured she thought I wasn't a great candidate for home birth, so I started looking for OBs.
While trying to find a practice, I had my genetic screen, and the baby looked good. The woman who did the ultrasound also did my ultrasound with Bettie. I love her. She told me that early markers looked like this baby would be a girl, but not to buy anything pink at that point. Having been burned by an early ultrasound with Bettie (I was told boy at 18 weeks, then girl at 20), I knew better. :)
I finally found a practice in Raleigh that had a lot of pro-VBAC verbiage on their website. During my initial nurse visit there, the nurse danced around c-section and induction rates, saying they didn't keep track of that kind of thing. That was a big red flag. During my first real visit with one of the OBs, they wanted to do a pap. It was less than 3 months since my last one, so I declined. That set off a mild confrontation with one of the nurses. It became really apparent that they wouldn't be very supportive of a woman who stood up for herself, which was another red flag.
When I finally got to see one of the OBs, I asked her about c-section rates. She mentioned that the hospital they use for delivery, Rex, had about a 36% c-section rate. When I said that hospitals don't do c-sections, OBs do, she got flustered. She talked the good talk about being pro-VBAC, but I had a gut feeling that something was off.
When I got home, I researched VBACs at all the local hospitals. It turned out that Rex has a de facto ban on VBACs. No wonder their c-section rates are so high. I knew that my chances of a successful VBAC at Rex were slim, so I decided to look for other practices who delivered at more VBAC friendly hospitals. I requested my records from the Raleigh OB, and found it very telling that in those records, the OB I saw wrote in big, bold letters: discussed the probability of CATASTROPHIC UTERINE RUPTURE in VBAC patients.
Hmmm....first, she didn't say anything to me about rupture, and second, the fact that she indicated "probability" instead of "possibility" and put CATASTROPHIC UTERINE RUPTURE in all caps and bold tells me that if I'd have stayed with them, they probably would have scheduled me for surgery instead of supporting me in a VBAC.
One upside is, the Raleigh practice already scheduled my 20 week anatomy ultrasound, so while I was finding another provider, that was at least on the calendar for December 22, 2011--the day after Bettie's birthday and the day before mine. I had the same ultrasound tech, and we had a great time! She discovered that the baby was a boy and looked absolutely perfect. He was measuring exactly right according to my due date, and my cervix looked nice and long. It was such a great day!
I decided to try to get into the UNC Midwife practice because their VBAC rates are really high. There was so much red tape involved in getting an appointment, it was incredible. It took me 6 weeks to get in, and before I could meet with a midwife, I had to see one of their maternal-fetal medicine specialists to get cleared to VBAC. I saw Dr. Strauss on December 27. It was a little ironic that I had to meet with him because he stopped my preterm labor a week before I ended up having Bettie. He actually remembered me. We chatted and he looked over my records. He ran some numbers and determined that I had a 78% likelihood of having a successful VBAC, so I had his blessing to meet with the midwives.
Early in the pregnancy, at around 5 weeks, I had some bleeding and got scared that I was going to lose the pregnancy. There was no blood in my uterus, so things were fine. What would a pregnancy of mine be, without a little drama?
I had been seeing Dr. Holton, the doctor who delivered Bettie. He's retired from OB work, so by 8 weeks, he recommended that I find an OB to continue my care. Both he and the infertility specialist who did the uterine septum bisection agreed that I was a perfect VBAC candidate. My c-section was done using a low transverse incision and was sutured using double wall sutures.
I looked at the website of the practice he recommended and it became obvious that they were not pro-VBAC, so I didn't even call them. I decided to reach out to Nancy Harman, a certified nurse midwife who came highly recommended from the home birth community. I exchanged a few emails with Nancy and decided I really liked what I was hearing. I made an appointment with her and saw her at 10 weeks.
Nancy is very earthy and her assistant, Andrea was awesome. I instantly liked both of them. About 10 minutes into my appointment, they got a call from a mother in early labor, so they had to cut my appointment very short. Nancy told me she'd contact me over the weekend to reschedule and chat.
The weekend came and went and I heard nothing. At the time, Adam wasn't totally on board with home birth, so when two weeks came and went without hearing anything from Nancy, I just figured she thought I wasn't a great candidate for home birth, so I started looking for OBs.
While trying to find a practice, I had my genetic screen, and the baby looked good. The woman who did the ultrasound also did my ultrasound with Bettie. I love her. She told me that early markers looked like this baby would be a girl, but not to buy anything pink at that point. Having been burned by an early ultrasound with Bettie (I was told boy at 18 weeks, then girl at 20), I knew better. :)
I finally found a practice in Raleigh that had a lot of pro-VBAC verbiage on their website. During my initial nurse visit there, the nurse danced around c-section and induction rates, saying they didn't keep track of that kind of thing. That was a big red flag. During my first real visit with one of the OBs, they wanted to do a pap. It was less than 3 months since my last one, so I declined. That set off a mild confrontation with one of the nurses. It became really apparent that they wouldn't be very supportive of a woman who stood up for herself, which was another red flag.
When I finally got to see one of the OBs, I asked her about c-section rates. She mentioned that the hospital they use for delivery, Rex, had about a 36% c-section rate. When I said that hospitals don't do c-sections, OBs do, she got flustered. She talked the good talk about being pro-VBAC, but I had a gut feeling that something was off.
When I got home, I researched VBACs at all the local hospitals. It turned out that Rex has a de facto ban on VBACs. No wonder their c-section rates are so high. I knew that my chances of a successful VBAC at Rex were slim, so I decided to look for other practices who delivered at more VBAC friendly hospitals. I requested my records from the Raleigh OB, and found it very telling that in those records, the OB I saw wrote in big, bold letters: discussed the probability of CATASTROPHIC UTERINE RUPTURE in VBAC patients.
Hmmm....first, she didn't say anything to me about rupture, and second, the fact that she indicated "probability" instead of "possibility" and put CATASTROPHIC UTERINE RUPTURE in all caps and bold tells me that if I'd have stayed with them, they probably would have scheduled me for surgery instead of supporting me in a VBAC.
One upside is, the Raleigh practice already scheduled my 20 week anatomy ultrasound, so while I was finding another provider, that was at least on the calendar for December 22, 2011--the day after Bettie's birthday and the day before mine. I had the same ultrasound tech, and we had a great time! She discovered that the baby was a boy and looked absolutely perfect. He was measuring exactly right according to my due date, and my cervix looked nice and long. It was such a great day!
I decided to try to get into the UNC Midwife practice because their VBAC rates are really high. There was so much red tape involved in getting an appointment, it was incredible. It took me 6 weeks to get in, and before I could meet with a midwife, I had to see one of their maternal-fetal medicine specialists to get cleared to VBAC. I saw Dr. Strauss on December 27. It was a little ironic that I had to meet with him because he stopped my preterm labor a week before I ended up having Bettie. He actually remembered me. We chatted and he looked over my records. He ran some numbers and determined that I had a 78% likelihood of having a successful VBAC, so I had his blessing to meet with the midwives.
Tuesday, May 22, 2012
The Journey Begins
My VBAC journey started right after the premature birth of my daughter Bettie via emergency c-section at 33 weeks for breech presentation. Many people say breech presentation is a variant of normal and warrants trying for a vaginal delivery, but, as many women have found, locating a medical professional who is trained and competent with vaginal breech delivery can be an ordeal. It's a dying art.
My c-section experience wasn't positive--the surgery, the fact that 10 or more people touched my child before I did, the 18 hour wait to first touch her.... I've written about it here.
When Bettie finally got to come home and we got settled, I got curious about options for possible future deliveries. I knew there was an out-of-hospital birth center in Chapel Hill. I wasn't a candidate for their services with Bettie because of the high risk nature of my pregnancy and the breech presentation. I reached out to them to ask about VBAC and was immediately told that they don't support VBAC unless the primary c-section had to be done under their care.
To me, that meant that future deliveries would need to be managed through a hospital.
I started to research everything I could about VBAC. I learned about the risk of uterine rupture and the fact that, while it does happen, it happens very rarely (less than 1%). There are so many other obstetric complications that have much higher and equally, if not more deadly consequences than uterine rupture in a scarred uterus. I also learned that most uterine ruptures aren't the catastrophic variety. They involve the scar opening up, but neither the mother nor the baby suffer any ill effects.
After looking at my c-section report, I verified that my surgery was done using a low transverse incision, making me an ideal candidate for a VBAC. My records also mentioned that my doctor discussed vaginal breech delivery, which is a lie, but at this point, that's water under the bridge.
I read message boards and talked to people about VBACs. I explored options and watched videos of a variety of births. I decided that should I get pregnant again, I really wanted to give birth in the water.
I taught HypnoBirthing classes and attended births as a doula. I was impressed by the women and families I was supporting and knew that if and when I got pregnant again, I definitely wanted an unmedicated VBAC in water.
My research continued as I tried to figure out how I could have a water VBAC in a hospital. None of the hospitals in my area were supportive of water birth. Many of the hospitals prohibit even laboring in the water once the mother's water breaks. That was a little disheartening.
In talking to folks and reading, I learned about home birth midwifery. I talked to a few women who had had beautiful home water births attended by certified nurse midwives and was intrigued. I wasn't afraid of the idea of labor or delivery. I knew I wanted as few interventions as medically necessary to ensure that I'd get to VBAC and not be coerced into a second c-section. I decided at that point to start talking to home birth midwives.
My c-section experience wasn't positive--the surgery, the fact that 10 or more people touched my child before I did, the 18 hour wait to first touch her.... I've written about it here.
When Bettie finally got to come home and we got settled, I got curious about options for possible future deliveries. I knew there was an out-of-hospital birth center in Chapel Hill. I wasn't a candidate for their services with Bettie because of the high risk nature of my pregnancy and the breech presentation. I reached out to them to ask about VBAC and was immediately told that they don't support VBAC unless the primary c-section had to be done under their care.
To me, that meant that future deliveries would need to be managed through a hospital.
I started to research everything I could about VBAC. I learned about the risk of uterine rupture and the fact that, while it does happen, it happens very rarely (less than 1%). There are so many other obstetric complications that have much higher and equally, if not more deadly consequences than uterine rupture in a scarred uterus. I also learned that most uterine ruptures aren't the catastrophic variety. They involve the scar opening up, but neither the mother nor the baby suffer any ill effects.
After looking at my c-section report, I verified that my surgery was done using a low transverse incision, making me an ideal candidate for a VBAC. My records also mentioned that my doctor discussed vaginal breech delivery, which is a lie, but at this point, that's water under the bridge.
I read message boards and talked to people about VBACs. I explored options and watched videos of a variety of births. I decided that should I get pregnant again, I really wanted to give birth in the water.
I taught HypnoBirthing classes and attended births as a doula. I was impressed by the women and families I was supporting and knew that if and when I got pregnant again, I definitely wanted an unmedicated VBAC in water.
My research continued as I tried to figure out how I could have a water VBAC in a hospital. None of the hospitals in my area were supportive of water birth. Many of the hospitals prohibit even laboring in the water once the mother's water breaks. That was a little disheartening.
In talking to folks and reading, I learned about home birth midwifery. I talked to a few women who had had beautiful home water births attended by certified nurse midwives and was intrigued. I wasn't afraid of the idea of labor or delivery. I knew I wanted as few interventions as medically necessary to ensure that I'd get to VBAC and not be coerced into a second c-section. I decided at that point to start talking to home birth midwives.
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