Denied a VBAC???

More and more we are hearing about women being “denied” a VBAC (Vaginal Birth After Cesarean) by their OBs, Midwives, or local hospitals. Here is some information that can help you get the birth you want and deserve:

#1- VBACS ARE NOT ILLEGAL! Anyone who tells you this is lying (or grossly misinformed.) Period.

#2- Any hospital that accepts Medicaid or Medicare that states they have a “VBAC BAN” is in direct violation of federal code 42CFR482.13 which states that any hospital that is federally funded can lose funding if they deny care and can lose all funding if a complaint is received. 

#3- EMTALA, Federal Emergency Medical Treatment and Labor Act, also known as COBRA or the Patient Anti-Dumping Law. EMTALA requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention.

This means hospitals HAVE to take you if you show up in labor. If you have been denied a VBAC by a hospital or know of a hospital with a ban you can call EMTALA at (404)562-7500 to report them.  You can also contact http://www.medlaw.com if you have been threatened by a hospital for court ordered cesarean, told a hospital has a VBAC ban, or dropped from a providers care within 30 days of your due date or while you were in labor. 

#4-  Check out birthaction.org, specifically your state’s resource page on where you can file other complaints. Also check out  Birth After Cesarean for lots of other specific info on how to get your VBAC.

And last but most importantly!

#5- Contact a local home birth midwife! Even if you think “you could never have a home birth”, or “home birth is too scary!” it can be an eye opening moment when you sit down for a consultation with someone who protects normal, natural birth. It gives you  a chance to ask any and all questions you may have, understand how birth at home works, and provides you with an opportunity to see that not all midwives are long skirted, patchouli smelling, hand-it-to-the-man-ers(although we love those kinds too!!!) and are trained in handling low-risk birth outside of the hospital setting. 

The Birth of Mirielle by Diana

This story comes to us from one of our beautiful clients, Diana. She wanted to share her story with other mamas so that they might be empowered to fight for the birth that they want.

My story is a tad different from many women. I knew what I wanted from my birth experience. I knew from the very beginning that my body was made to do this so I treated my pregnancy as a blessing. In month 4 I went to my OBGYN and handed over the rough draft of my birth plan to see what their thoughts were. I was a member of a practice of 6 doctors, 5 women, and 1 man. The doctor during this visit sat down with me and said “You are going to need some sort of classes to help you get through your first birth naturally. Try either Bradley Method or Lamaze classes. But you’ll need something. We get a lot of women that want to do it naturally…..until they get into the labor suite. Women who prepare have a better chance.” That afternoon I got on my computer, contacted Melissa, the local Bradley instructor, and by 6 pm I was sitting in week 3 of a 12 week session. I got all the materials I needed and my partner, Anthony, and I looked forward to how the class would prepare us for the birth of our child.
Weeks went on and on and Bradley Method graduation day came. After completing the course I started toying with the idea of switching to a birth center birth though I planned on a hospital birth. Unfortunately, due to my pregnancy history of anemia, I was risked out of that being an option. Because of this same reason I did not consider a home birth because our house was too far from a hospital should anything go wrong. I had my final birth plan approved by the obstetricians who were on call around the time of my due date, I had two wonderful doulas, bags were packed, and I was prepared to deal with a hospital staff who may scoff at my desires to do things naturally.

At 7 pm June 18th my contractions began. They were not bad by any standards and I was able to talk and move. I must have baked 6 pounds of brownies for the hospital staff to enjoy. Comfort was an elusive state for me. My labor was not painful, just very uncomfortable. No position was the “right” one. The night passed and early morning came. Megan, one of my fabulous doulas, was called at the un-Godly hour of 4:00 am. She arrived at 5-ish and sat up with us all night/morning as we talked and joked. Labor progressed and contractions started to get more rhythmic. Their interval timing decreased and I started to get shaky. When I began heaving and vomiting regularly with contractions Megan was sure I was entering transition and we should leave to the hospital where my doctors would be waiting for me. We called ahead and arrived at roughly 9:00 am. I went to the office of the OBGYN practice and had a vaginal exam. Charlie, doula number 2, met us here. At this time I was I was 4 cm dilated.

I was sent down to triage and family started arriving to await the baby’s arrival. I was hooked up to a monitor to assess my progress. In my birth plan I clearly stated I wanted AS LITTLE INTERVENTION and MONITORING as possible. Though, to be fair, they informed me an initial monitoring would be required to see “where in the labor process my body was”. While this monitoring session was taking place I started to notice it was quite lengthy so I asked if everything was okay. The nurse replied “Well, the baby’s heart rate showed a deceleration and we need to monitor it to make sure it doesn’t happen again. If we can go for a full half hour with no decells we’ll be in the clear.” Let me prepare you now…..this is where it all started. Also, keep in mind these monitors are highly uncomfortable belts that strap around the largest part of your belly and squeeze whether you are contracting or not

After further monitoring the OB on call, Dr. R, arrived and read the findings as they were being sketched out by the machine. Dr. R was not thrilled. She suggested we go ahead and move to a room and keep me on the monitors. I told her I would not like to stay strapped down in a bed and asked politely if this was a possibility. She was happy to put me on mobile monitors that were wireless and even waterproof so I could labor in the tub. When I arrived to my room the nurses were told laboring in the tub had been approved by my doctor because my bag of waters had not broken. Apparently a tub labor is very rare at this establishment. But they sanitized everything and when I was all “monitored up” I got in. When in the tub, covered with a towel, family members trickled in and out to say hello and comfort me. I was only allowed 3 people in the room at a time so many people traded off.

While the tub was a wonderful place for me, the nurses were having a hard time letting me enjoy it because every time the baby would move they could not clearly hear the fetal heartbeat and they were under the impression it was decelerating. They claimed this was happening “too often for their comfort”. So out of the tub I went. I was laid down in the bed for another vaginal exam, as it had been about 2 hours since the first one. Still 4 cm. At this point the staff was starting to get slightly annoyed with my wishes to be mobile. When they would leave the room I would get up and move to my heart’s content. I continued laboring in the best way I saw fit.

I decided the tub was where I needed to be so I got in. I also decided the monitors were a little too much for me at this point and they came right off. They were causing too much discomfort and unnecessary panic from the staff. Of course when there was no reading being emitted from the machine a nurse rushed in quite panicked until she saw me. She asked me to return to the bed, even though I was clearly in the middle of a contraction, she tried assisting me up. Anthony told her politely to please wait until I was finished with the contraction before trying to help me into bed. After the contraction ended I told her the tub was where I was going to stay and that if I absolutely had to, I would hold the monitor responsible for the fetal heart rate reading to my belly and move it as the baby moved to be sure they could hear everything properly. Straps were not an option any longer. They baby continued to kick the monitor as if to say “Get that thing out of here.”

Another hour passed and the nurses were getting quite worried about the baby. Charlie, my second doula, informed me “What they failed to inform you of is that heart decelerations are normal during contractions due to constriction and that a few are nothing to worry about.” She was reassuring me that everything was ok and to listen to my instincts about the baby. These instincts also reassured me things were perfect. My last little bit of confidence came from the fact that the baby was moving and that even when she moved you could hear a faint heartbeat coming from the machine at an obviously NOT slower rate than before.

Even so, Dr. R came in and informed me they were going to start IV fluids and oxygen. I told her no. Anthony told asked her “Why?” In my birth plan I specifically outlined IV fluids were not an option. She asked us why and my explanation was evidently not good enough for her. For the next 30 minutes Dr. R and the nurse argued with Anthony, myself, and Charlie about IV fluids stating they were needed to help keep the baby’s heart rate up. They did not relent just because a contraction came. They did not relent when Anthony and Charlie asked them to please stop talking to me during contractions. Eventually I consented to wearing an oxygen mask for a few minutes to get them off my back and they gave up about IV fluids. I then went back to mobile laboring and the machine kept pushing out readings.

After this oxygen treatment failed to work to their liking, they went off to a corner of the room. There was a decent amount of whispering as they reviewed my birth plan. Charlie informed me, after eavesdropping, they were going to start asking me to consent to things I previously told them I would like to avoid. IV fluids were once again brought up. I was asked to return to and stay in the bed. I did neither. I continued to move around. I continued to do what felt natural and right for me.

When Dr. R returned for the 5th time and completed the third vaginal exam I was still 4 cm. It had now been 5 hours. At this point the serious conversation which led to much insult towards myself began. I explained to the nurse who was “caring” for me that I disagreed with the reading coming from the monitor. I knew that movement was a good sign and told her “the heartbeat only decelerates when the baby moves into a new position and the monitor can’t get a good reading. I think it’s slightly misgiving.” She seemed to not hear a word and pressed on with the issue of heart decells. Anthony interjected with a similar statement to mine but she cut him of to say “We go to school for YEARS to learn to read these machines. I think I know when I see a decell in a fetal heart rate.” At this point we knew in what direction things were headed.

Dr. R started telling me that if there was no progression within the next few hours we would have to start considering breaking my bag of waters. In a previous office visit I asked how many hours they would wait during labor until deciding it was necessary to break the bag and this same doctor told me to my face “18 to 24 hours depending on the condition.” Again, it had been 5 hours. I didn’t object, just listened to what she had to say, knowing what I was willing to do to get my ideal birth. Contractions came and went, Dr. R and her nurse came down hard about starting interventions I was not comfortable with. Finally the exchange of words which can be called no less than a one-sided argument as I refused to let myself become flustered by their persistence came to a zenith when my own doctor, whom I hired, voiced to me verbatim “I can get an order of non-compliance to properly treat this child,” It was this statement which lead to my decision to go home.

I stopped talking. Dr. R said her peace. The nurse continued to monitor me and the baby. After a few minutes the nursing coordinator for the hospital was sent in to try and convince me to stay. She was very nice, but then again someone had to be in order to get me to stay. I knew I had to maintain with her my viewpoint that I needed to be in a caring and nurturing environment in order to properly deliver my child. I told her the hospital had been nothing but stress since the moment of my arrival and that it was my belief that this was the cause of my failure to progress. I told her there was no other option for me but to return home. I looked my doctor in the eye and told her I was sorry if she felt I was insulting her expertise, as that was not my intent, but for the health of myself and my child it was in my best interest to leave.

I can honestly say I don’t remember the ride home. According to Anthony I slept through most of it, awaking only when I had a contraction. At home our tub was sanitized and Charlie prepared me a wonderful lavender oil filled bath to labor in. I got in and slept a bit. After no more than 30 minutes my labor started getting much harder. My moaning got much deeper and new instincts came over me. I wanted to get out of the tub. I wanted to stand, I wanted to be on all fours, I wanted to sit on the toilet and try that. I could not get into a position I was okay staying in. My restlessness eventually landed me on all fours, with my head against a wall for support. Anthony helped me then sit and sat behind me to help me. After another 30 minutes of position “musical chairs” I settled on all fours again. While all this was happening my father was having a panic attack after listening to what the nurses and doctors told him while we were at the hospital. So he decided he needed to come into the bathroom where I was laboring with Anthony, Charlie, Megan, my mother, and my best friend to tell me I was being irresponsible and should get my ass back to the hospital. He neglected to recognize my calm efforts to tell him this was not the time and continued to upset me to the point of sending me into a contraction. It came on hard and, this time, with the sensation I needed to use the bathroom.

I looked at Anthony and told him to get Charlie and Megan. I told them I thought we should go. Since I had not yet experienced a feeling of “I can’t do this” and they didn’t want to leave too soon to the hospital and risk a repeat of that morning, they told me they thought we should wait a little longer. A minute later another contraction came on and I looked Anthony in the eye saying in all the seriousness I could muster, “We need to go now”. As I was contracting I reached back and felt the baby crowning along with a strong urge to push. I calmly tried to control my breathing and the head went back up into the canal. We packed into the car. Anthony drove his SUV as my mom rode shot-gun. I was in the back bent over the car seat on all fours once again. We sped off t the hospital hoping no cops would try and stop us while Anthony did 80 mph in a 40 mph zone. We ran one red light (after stopping and checking for oncoming traffic).

Halfway there the baby crowned again. I told my mom “Look.” She turned over her seat and said “Oh my God, that’s the head.” I was able to again, keep calm and let my baby go back in. As we had the hospital in view I finally felt the contraction that wasn’t going to be controlled. I told my mom to tell me how far out the baby was and she said “Ok the nose is out, you need to push.” I pushed and out came the head. One more push and I heard my baby crying. We were in the hospital parking lot. My mom proclaimed “He’s here! He’s here!” I said “It’s a boy?!?!” She replied “No! It’s a girl!!!” My daughter was finally here. Anthony flew out of the car to get nurses and doctors and after we got all situated on the stretcher with a crowd of onlookers amazed at the rare event of a “car-baby” we were wheeled inside. I kept my daughter held close with the umbilical cord still in tact as her APGAR scores were taken. Anthony cut the cord. I was given a small private room just outside of the ER to deliver the placenta. As soon as that was done Anthony carried in our daughter with the most awe-struck expression on his face. We looked down at her in pure amazement with full knowledge our lives had just been changed forever. Mirielle Airi Diez De AShe’s the love of my life.
ndino was born at 6:54 pm on June 19th 2009 weighing 5lbs 10 oz and measuring 19 ¾ inches long. The smallest angel I’ve ever seen.

“It’s not your birth.” by Charlie Rae Young

    

      “It’s not your birth.” This is a phrase I hear quite frequently from other birth professionals. Whether they are childbirth educators, doulas, or midwives. That statement seems to be an automatic reply in the birth community when a women chooses something that we know, on a professional level, is an unhealthy choice. Whether it be birthing in a hospital, allowing interventions, or choosing not to breastfeed. Are we, as a birth community, standing idly by while mother’s make uneducated choices because it is politically correct?
     As a doula, I feel it is my duty to educate women on the options they have regarding their birth. With my daughter I desperately needed someone to educate me. I needed someone to say that the hospital is not the place for a healthy woman to give birth. Someone to explain that out of hospital births are just as safe, if not safer, as hospital births. I wish someone would have told me my choices were not the best. I wish someone would have been brutally honest with me. Sure, it was MY BIRTH…but doesn’t every mom want what is best for themselves and their babies? Don’t we all as mothers want to give our children the best start possible?
      I understand a natural, intervention free homebirth is not the right choice for every woman. However, shouldn’t we encourage all women to do their research on what is the best birth? Shouldn’t we be providing them with good information and not leaving them at the hands of a Google search? Midwives, you should be shouting about your good outcomes from the rooftops! Doulas, tell every pregnant woman you meet about what you have to offer! Give them the numbers, the facts, book recommendations. Childbirth Educators, give women the truth. They have come to you because they WANT to learn. They need to know what really lies ahead for them at the hospital if they choose to birth there. They need to know that interventions during pregnancy are not always necessary. They need to know what to expect out of a homebirth. Lets teach women that it is their body and their choice to birth however they choose.
     I will say, that if after we all do our jobs to adequately inform parents, that it is ultimately their choice to choose what is their best birth. Like many other things, we take all of the information we have acquired and apply it how we feel is appropriate in our lives. At the end of a woman’s journey into motherhood she should be able to say, “I made the best educated choice for myself and my family, and I do not regret anything about it.”
      We, as a community, need to stop making the excuse of “its not your birth” and start reaching out and sharing valuable information with childbearing women. No, It is not my birth…but it is my job as a fellow human being to stand up for what I believe in, what my quest for information has taught me. It is my job to make sure there is never another woman who crosses my path who will end up with a traumatic birth experience because she simply did not know any better.

The Perineum, Privacy and Normal Birth by Evelyn Ojeda-Fox

 

Birth is an internal process that is easily disturbed by unnecessary interventions. According to midwife Ina May Gaskin, “sphincters are shy”.

A woman’s dilated cervix can easily close in the presence of disruptive people or actions (cervical reversal). In a normal birth, vaginal exams and other handlings of the perineum during labor are interventions that can interfere with the natural birthing process.

At any other time in our lives, our vagina is considered “private”. During birth a woman is told to lay back, open her legs and allow her body to be explored by strangers. A laboring woman loses her dignity, privacy and trust in herself in the hands of the people that she has hired to assist her in this sacred moment.

Gloria Lemay, Canadian birth attendant and birth activist, writes: “Why avoid that eight-centimeter dilation check? First, because it is excruciating for the mother. Second, because it disturbs a delicate point in the birth where the body is doing many fine adjustments to prepare to expel the baby and the woman is accessing the very primitive part of her ancient brain. Third, because it eliminates the performance anxiety/disappointment atmosphere that can muddy the primip (woman having her first baby) birth waters. Birth attendants must extend their patience beyond their known limits in order to be with this delicate time between dilating and pushing.” http://www.glorialemay.com/blog/?p=72

Why Should We Be Concerned?

• Vaginal exams are the traditional clinical method to evaluate progress in labor. According to Freedman’s Curve (a 1955 study of 500 women), a woman should dilate 1 cm per hour after she has reached 4 centimeters of dilation. When women don’t perform to this standard, some birth attendants become frustrated and push for drugs such as Pitocin and other augmentation methods to speed labor to progress “normally” initiating the cascade of interventions.

• A woman may become discouraged by multiple exams and mindless comments such as, “you are only __cm”. Labor then can stall giving way to interventions that often end in cesarean.

• Vaginal exams increase the risk of infection by bringing bacteria towards the cervix, even when done carefully and especially after the release of the membranes.

• Vaginal exams are not a reliable way to predict when labor will begin. Labor normally begins when the baby is ready and a wonderful cocktail of hormones begin to release.

• Vaginal exams are particularly painful during contractions and disrupt a woman’s concentration.

• Perineal massage during labor, besides being intrusive and invasive, according to research does not protect the perineum. http://www.bmj.com/cgi/content/full/322/7297/1277

• There is a higher incidence of perineal tears with the hands-on approach to perineal care during the pushing stage of labor than with the hands-off approach. http://www.ncbi.nlm.nih.gov/pubmed/12092017

• Some practitioners routinely do a stripping of the membranes, with or WITHOUT the woman’s permission. Using their fingers they separate the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This is a painful procedure, can leave you spotting or bleeding and has not proven to be effective for everyone. It could start the cascade of interventions.

• Informed consent means that you need to have all the information to accept or refuse treatment. Do not open your legs unless you understand why and agree with the reason. If you don’t agree, ask for the research.

How To Have A Gentle Birth And Protect The Perineum:

• Hire a midwife who trusts the birth process and will support and encourage you to listen to your body.

• Review your birth plan with your midwife at every prenatal visit during your last trimester. (You are not being “difficult”. It’s your body, your baby.)

• Reprogram your mind by immersing yourself in images of normal gentle birth.

• Prepare your perineal muscles and tissues during your pregnancy by having a healthy diet and regular exercise. Read more.

• Walking, squatting, pelvic rocks, tailor sitting, kegels and swimming are useful exercises to strengthen the pelvic floor.

• Gentle perineal massage during the last weeks of pregnancy could help a first time mom get acquainted with different sensations in the perineum.

• Try different positions to birth your baby. Stay vertical. Listen to your body!

• Labor down/Breathe the Baby Down, this is the opposite of directed pushing or purple pushing which can harm your baby by depriving him/her of oxygen.

• While laboring down, you can support your own perineum to help you stay in control of your body.

• Instead of vaginal exams, the most accurate way to judge progress of normal labor is by noticing the changes in the mother’s behavior. For that you need a birth attendant willing to be present and compassionate.

• Visualize: “I am stretching beautifully,” “There’s lots of room for the baby to come through,” “I’m doing this nice and easy”, “I’m getting huge.”

• Vocalize deep sounds by chanting, moaning, grunting. A loose jaw = a loose perineum.

• Apply warm compresses everywhere on the woman’s body so there is less focus on that one spot (the perineum). The woman relaxes, the midwife relaxes. -Naoli Vinaver, CPM, Mexico

• Refuse an episiotomy.

• Avoid an epidural.

• Hire a doula to be your advocate in the implementation of your birth wishes.

In conclusion: Stay. Away. From. My. Vagina!

Other Resources:
http://www.mothering.com/easing-tension-and-fear-natural-childbirth-understanding-sphincter-law-conversation-ina-may-gaskin