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from:msnbc.comPanel: Many hospital policies deny patients choice
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Want to give women this choice? Pass tort reform to get rid of frivolous law suits so hospitals and doctors won't be so afraid of lawsuits. Present the mom with the risks and benefits and have her sign off on the risks so she can't sue if a uterine rupture occurs when she knew it was a real risk. Of course exluding situtations when true malpractice occurs.
The problem with VBACs at our small hospital is that they require the OR team to be in house after hours. Our staff is stretched as it is, being on call every third night and working the next day. We just don't have the resources. Most patients choose a repeat c-section close to home over a VBAC an hour away from home.
Exposing women to needless surgery so you don't have to stay "in house after hours" is the most morally repulsive, reckless and selfish thing I have ever heard of . If you don't want to be in the Hospital, and give people the best care regardless of how long you have to stay, you should get another job. You do not deserve to be in health care. Giving birth does NOT follow a schedule for your convenience.
My sister in law, had a C-section with her first because of a transverse breech. She was told all through her second pregnancy that she would be allowed a "trial of labor" however two days before her due date, she was told that she would be having another C-section, and she did not have a choice. She had no complications, and no reason to have another C-section. The doctors lied to her, and refused then to sign off on a home birth. Well, my sister in law had her home birth. There was no mid-wife in attendance (1000 times better that any doctor could ever be a birthing) because of the doctors short sighted selfishness. There was no reason to deny her a VBAC other than being able to charge more money for a C-section.
My first birth was c-section due to a breach baby. I attempted VBAC but they kept losing my daughter's heart rate and my blood pressure so they kept rolling me and turned off the epidural. Then my first scar ruptured. I ended up having my daughter (who started out w/out a heart beat but was revived quickly) through the rupture WITHOUT any anesthesia. I was a healthy candidate -- not obese or with high blood pressure or anything like that. Needless to say. I do not recommend VBAC to anybody! But I would never even consider a law suit. I have a healthy child, that is compensation enough.
YEAH! I'm so happy to see this addressed. My oldest was a c-section due to a medical problem he has. But there is no healthcare providers in the area who can allow a vbac. So I had a successful vbac with a midwife at home. No problem. I'm due here in two months for my second vbac. It'll be a another home delivery with a midwife. The only other option is a repeat c-section.
After having a C-section with my first child, my doctor matter-of-factly said that if I wanted to have my second VBAC that I could. I am so glad that he encouraged me to do that - as my delivery went smoothly and so both my subsequent children were VBAC. The biggest advantage to me? The unbelievably short recovery time and my enjoyment with my newborns as I had not just had "surgery." Being able to get up and walk around and feel great hours after their birth convinced me that C-sections were so much harder on women's bodies and I applaud physicians (and hospitals) who give women the chance to experience the joys of natural childbirth after a previous C-section.
I had a C-Section with my second child in 1983 due to urgent medical issues. In 1990 I became pregnant again and was told by the OBGYN that I would have to have another C-Section. He was an older Dr. but thank goodness had a younger Dr. with him in the practice. The younger Dr. agreed with me that I should be allowed my choice to try a vaginal delivery. My now nearly 20 year old son is my VBAC baby as noted on his birth certificate and I am so pleased that I was given a choice!!
The panelists and proponents of Trial of Labor after Cesarean are missing a few important logistical points that play heavily into OB.
1) VBAC lawsuits are one of the leading causes of litigation for obstetricians, and without some meaningful reform of our current medicolegal system, VBAC will go the way of the dinosaur.
2) All of the hospitals I have worked at have the REQUIREMENT that the delivering physician be "immediately available" and have extended that to mean "In the Hospital" or "On Campus" for the ENTIRE duration of labor for a woman with a prior cesarean. This means CLOSING the office, cancelling the family day, and spending the night there until the baby is out, placenta is delivered, and everyone but me is happy. Of note here, the surgical First Assist and the obstetrical anesthesia provider are required to be present as well as the OB-- for the entire duration. NOT cost-effective for the Hospital, which already runs in the red since so much OB is Medicaid and is a $-losing practice...
3) The reimbursement for VBAC is LESS than that of a 50 minute cesarean delivery. Figure this in with the time requirement listed in #2, there is Zero motivation for me to offer Trial of Labor.
Etc. etc. etc. It all boils down to having no reason, as an OB, to offer this "service." {I had posted this yesterday but I didn't feed over to the MSN site from NewsVine. Sorry for the duplication}.
|From the NewsVine side, this conversation isn't feeding over. Here's my reply to a reply I got there slamming me for basically being self-centered, and stating the Midwives will stay with their patients all day for even low-risk labor, etc...|
Just not worth the risk (medicolegal), not worth angering the other 20 women who just got their appointments cancelled for the whole day while I have to stay at the hospital (professional), and not worth missing my kids' bedtime stories (personal).
There are definite benefits to a successful VBAC, but understand that until "society" is willing to fix a few of the problems I've listed, then as a physician in practice, the risk-v-benefit profile doesn't always make sense to offer this service. (That being said, I'm the only one in our office that will still do them... Just so you know where I'm coming from...)
And ask yourself this: How much would you pay (give up) to be able to spend an evening with your children reading their bedtime stories? That's all I'm saying-- I'm willing to give up offering VBAC's as a service so that I can be home with my own family. Personal choice for me driven by the risks and lack of financial incentive to do otherwise.
Sounds to me like you are better suited to dermatology or podiatry if you intend to practice 9-5 medicine.
Don't the teach you guys in med school that placentas don't have dayplanners on the fetal side?
Jeez.
You should quit your job, then you can spend all the time with your kids you want. You actually think it's ok to force surgery on a woman so you can have more free time?? You sound like you must be the worst doctor in history. What moron told you that birthing is a 9-5 job? You do not deserve to be in the medical profession. I pity anyone who is your patient.
You need to get a new job. Women have the right to decide how they birth their own children. While I understand you wanting to spend time with your children, you wanted to be in this profession, no one made you. You were also given the right to choose how to have your kids, so please give the women in your practice that same right. The only motivation you should need for giving women in your practice the right to a vbac is the knowledge that you are helping a women on what will probably be the happiest moment of her life.
While the legal and professional concerns about VBAC have validity, the issue boils down to women having choices about how they birth. The system is set up to fast track women into major surgery (the c-section rate is over 31%!) that defaults them into having no choice about how they deliver their future children. Maternity care is in shambles in this country, almost every way of measuring quality of maternity care sheds a terrible light on the US, the c-section rate and VBAC debate are highlights of this.
Larry and Grace,
You obviously missed the part in my note where I said "That being said, I'm the only one in our office that will still do them..." You all seem to be making this pretty personal, and missing what I'm saying-- as in "Here's part of the problem with American Maternity system, and here's some ideas to fix it..."
No kidding it's not 9-5. But 24/7/365? You try it (at a discounted rate). And BTW, I'm not "forcing" anyone to have surgery. Patients know by or about the second visit if VBAC will be offered, leaving them about 30 weeks for them to decide if they want to go try to find another doc... They can decide for themselves whether or not I'm the "worse doctor in history."
Seems like a lot of me, me, me from both sides. While the woman giving birth thinks that she's the most important thing in the hospital. Doctors on the other hand have personal lives as well. Granted if a doctor is on call then they're on call and should be at the hospital for child birth. But say that it's a smaller hospital that has limited OB doctors, you can't expect them to be oncall 24/7/365, that's what causes burnout, which what we're seeing a lot of in the medical field. Smaller hospitals just don't hve funding to keep their specialized doctors on staff for extended periods of time. But to attack doctors on this forum and claiming they shouldn't have gone into the field because they don't want to be at work all the time is ridiculious. Doctor's are people too, held at a much higher standard then a lot of other professions.
Though, if there are doctors that are forcing patients to have c-sections, it should be done just because they want to go home. But then again, if this is your OB doctor you had 9 months to question him about what his standing are on several issues, and if you don't like it then you can change to another doctor.
My wife had two c-sections , then had a natural childbirth with our third child.
What doesn't seem to be addressed is the way the mother feels. When I nursed my baby for the first time I couldn't feel my legs. I was so distracted by that and the pain and the pain medications, it was sad. I then had thrush, maybe due to the antibiotic they gave me and didn't tell me about. I knew this wasn't the way it was supposed to be. I felt left out of something wonderful. Next baby was a medication free VBAC. After I gave birth I felt like I could take on the world. It was beautiful and both my baby and I were strong. We nursed right away and bonded properly.
I know that as doctors you have lives and families that you want to be a part of too and I don't want to begrudge you that. Considering how few women want to try VBAC though, I would like you to remember that most women only have 2-3 birth experiences in their lives. You can make it amazing for them.
Twenty years ago this summer I had a VBAC delivery at a small hospital in rural NE Iowa. The surgeon who had performed my cesarean two years earlier was on stand-by, but thanks to my physician and nurses my daughter was delivered without any problems. I was impressed at the time with their commitment to allowing me the VBAC option and am amazed that it is an issue still being discussed/debated today.
I had a scheduled c-section for the birth of my 3rd child (1st was vaginal, 2nd was c-section due to the fact that I wouldn't dilate and there was fetal distress). I opted for the scheduled surgery since the reasoning behind my emergency C was due to MY body not working properly.
I went into labor a week before my scheduled surgery date. THANK GOD we did a c-section - my uterus was seconds away from rupturing along the previous c-section scar. Could have killed me and my son!