Monthly Archives: October 2010

2009 Long Island Maternity Statistics by Hospital

New York State has a wonderful law called the Maternity Information Act (Public Health Law section 2803-J, Information for maternity patients). In accordance with this law, each year hospitals must report cesarean rates, intervention rates, midwife attended births and rates of anesthesia, amongst other statistics. The information is compiled by the Department of Health and listed here. Because I am of the mind that likes to see everything in one place and compare side-by-side, I have put the Long Island data into a few different charts comparing pertinent information.

Some of this information is truly horrifying, especially that three of fourteen hospitals on Long Island have over 50% cesarean rates! 50%! (The World Health Organization suggests the necessary cesarean rate is between 10-15%!) I have not yet analyzed the data to see if there is any correlation between monitoring and increased cesareans or inductions and increased cesareans but I’m curious to know if such a relationship exists. As we know the slippery slope of interventions usually leads down one road. 😦

Summary

Cesarean Births

Vaginal Births

All Births

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Another useful tool

I came across this list of Questions for Midwives. I know many of us struggle to come up with a list of the “right” questions to ask a provider in order to assure we’re on the same page for the birth that we want. This list looks to be particularly useful for midwives or especially homebirth but you could definitely pluck some of these questions for discussion with your OB.

http://www.mothersownbirth.com/questions%20for%20midwives.pdf


Overcoming Obstacles

Any natural birth blogger you read on the internet will give you a laundry list of things to do to avoid the dreaded unwanted c-section. These include: stay home as long as possible, avoid constant EFM (electronic fetal monitoring), move during labor, eat and drink during labor, etc. But what if it’s not that simple? What if in order to get to the VBAC you have to put up with rules and regulations? Where is that line drawn? At what point do you suck it up and say you’ll deal with it in order to get the end result you desire?

That is exactly the predicament I’m in now. It’s easy for someone to sit on the other side of the computer screen and judge me for pursuing with a hospital birth but what choice do I have? With the current birth climate in this area I’m trying to remember that I’m fortunate to have a provider that will take me as a VBA2C. For having a provider take me, I have some concessions to make. ‘

For starters, homebirth is not an option. The midwives that I have chosen to work with have to abide by certain rules and regulations in order to practice in conjunction with their backup doctors and in order to practice in their chosen hospital. Although, after one VBAC and a uterus has been “proven” as safe, a mom can choose to have a homebirth next time.

Another concession is that the hospital doesn’t allow VBAC in the birth tub. Honestly, it seems like the hospital requires A LOT for the birth tub but that’s another story for another day. The biggest reason that VBAC isn’t allowed in the birth tub is that a VBAC mom has to be continuously monitored with EFM. What a pain, right? Believe me, the idea of being on those monitors tethered by a four foot cord to a machine is the last thing I want to do. The very thought of it makes me shiver right down to my core. Mainly, I just don’t understand WHY the hospital demands this as EFM has been proven to cause more unnecessary interventions and c-sections than to save babies, especially if you’re with a trained provider who knows when to recognize the signs that something is actually going wrong. EFM is a tool designed for hospitals so that the nurse can sit behind her station and keep an eye on several patients at once. When you have a midwife actually with you, monitoring your baby and your progress it seems sort of redundant and unnecessary. My midwife assures me that their moms take A LOT of bathroom breaks to escape the tethers of the monitors.

Another ridiculous hospital rule that I’m having to abide by is no use of birthing balls during labor. The head nurse feels that they’re a “safety hazard” and won’t allow them in the unit. How silly is that?

I know that I can eat and drink freely during labor and this does offer some reassurance. The idea of living on ice chips while my body is working so hard is not appealing.

I’m also reassured by the fact that I won’t be going to the hospital until I’m at least 5cm. When I go into labor, I’ll call my doula and my midwife. My doula will come to my house and when we think I’m ready to go to the hospital we’ll either go to my midwife’s office or she will stop by my house and check my progress. Then, we’ll make the grueling 45 minute drive to the only hospital that will take me as a VBA2C. That’s right, I don’t have a choice. I HAVE to go to this hospital unless I want to have an unassisted homebirth, which sorry, I don’t. So, that means I don’t have a choice but to put up with the monitoring and the rules and regulations in order to get the desired end result.

Am I scared? You bet. I’m terrified of the hospital. We went for my 20 week ultrasound and I had a panic attack. In my head going to the hospital to have a baby means getting cut open to have a baby and I’m having serious issues coping with this. Who knows, I might end up having my baby in the midwife’s office. At this point, I just cannot see myself willingly saying during labor, “OK, let’s go to the hospital now!” All I can see is me in labor, freaking out about going to the hospital, then getting there and my labor completely shutting down because of the FEAR and then guess what happens from failure to progress – another c-section. I told my midwife and her partners during the hospital tour that the ONLY way they’re getting me in for another c-section is in the case of a true emergency and they’ll have to put me under general anesthesia. I get the shakes just thinking about voluntarily letting someone put a needle in my back and laying there so vulnerable, unable to breathe while someone cuts me open and flops my internal organs around like a game of operation.

So if you see a girl doing laps around the hospital in mounds of snow, that’s me. If you see a pregnant lady in the 7-11 parking lot across the street from the hospital moaning in labor, that’s probably me and if you hear about a lady giving birth in her car in the hospital parking lot that will most definitely be me. Or maybe I just won’t make it that far at all.

I’m completely at peace with the idea of giving birth at home and I wish that I could do it. Prior to this pregnancy I never wanted a homebirth. I understood why some people wanted to do it but I never wanted it for myself. Now that I’m with a midwife who is providing such excellent personalized care I completely understand wanting to have her in my home catching my baby and I see how I could trust her to know if something was going wrong with me or my baby. I wish that a homebirth was an option for me right now and I hate that politics and insurance regulations are the only thing keeping it from my reach.

I’ve started studying the hypnobirthing program with hopes that it will be what I need to get me through the fear of the hospital. I ordered a book today called, “DON’T CUT ME AGAIN! True Stories About Vaginal Birth After Cesarean” by Angela Hoy. I’m hoping to get some sense of calm and clarity from reading other women’s stories. Right now, the only calm I get are from reading HBAC stories online.

Baby steps towards the goal. That’s where I’m at right now. I’ve overcome so many obstacles to get where I am. Now, I need to come my own mental obstacles, my own emotional scars, to get where I need to be to make this VBA2C a reality.


The Road to VBA2C

After my second c-section, I was so traumatized and ruined by the process that I was convinced i didn’t want any more children.

When we firmly decided to add baby #3 to out family we had just moved from New Orleans to Long Island. I was wrongly convinced that the climate would be better here.

Almost a year before we were ready to TTC I began doing my homework. I called doctors and midwives and I kept getting roadblocks. None of the hospitals were allowing doctors to do VBA2C and the midwives couldn’t do VBAC at home. I reached out to the local ICAN chapter for reccomendations and support. Through ICAN I found the name of an OB/GYN who was reported to do VBA2C. I met with him in January and it was a great meeting. He sat with me for nearly an hour discussing VBAC. I left with a sense of relief but still a gnawing sensation. Something wasn’t sitting right. I knew that it was because he was still a doctor, a trained surgeon who was taught in medical school that birth is a medical procedure, not a natural act. His question of WHY I wanted a VBA2C wasn’t sitting right with me. Still, at the time he was my only option without going into Manhattan, a feat I was actually weighing in my mind.

In some sort of swoop of divine intervention, we ended up having to wait nearly a year in between when we wanted to start TTC and when we were able. Looking back now it was the BEST thing that could have happened.

In March I got an email from the local ICAN leader stating that one hospital was now allowing VBA2C. She only knew of one midwife currently doing them there but would follow up on others.

Soon enough I found myself pregnant. Of course, I called that midwife and made an appointment. I met with her, happy to have the opportunity to have a midwife. After our first meeting I really liked her but I wasn’t sure if we were the right fit. I picked up the phone to call another midwifery practice. The next day I got a phone call back and made an appointment for my interview with J.

I immediately clicked with her. I felt a sense of calm and belonging. After our meeting I went home and made a list of pros and cons regarding each midwife. I talked it out with a friend and halfway through our conversation I realized I knew my choice was J without even thinking about it.

Here I am now at 19 weeks and even though things are falling into place I’m still nervous that suddenly the plug will be pulled and I’ll be forced back under the knife. What if the placenta is near my scar? What if I develop GD? What if I start dialating early and need a cerclage? What if I get high blood pressure? What if, what if, what if….

I’ve hired a doula for labor support. J will be there at the hospital with me the whole time. I’m studying hypnobirthing. My only hang up mentally is the hospital. That really deserves it’s own post.