Saturday, January 16, 2010

Waking the Thought Police

Subtitle: How to have an All-American VBAC.

Firstly, I need to make it clear that for some reason, I'm famous among family and friends for having to do things the hard way. And in this case, the "hard way" is actually utilizing a hospital. The "easy way" would be a home birth.

So, why in the name of all things good and crunchy and wild-strength-of-a-woman-unleashed are we purposely going with a hospital VBAC?

For starters, cash flow. Miscarriages when done at home are cheap. Ones that quickly turn into a frightening emergency are quite expensive. As we aspire to live as debt-free as possible, our home birth midwife fund fast turned into a hospital bill fund. And was instantly obliterated.

Secondarily, it seems that the previous miscarriages might have been hinting at some thyroid trouble. I would like this to be noted, from start to finish, what various levels of thyroid hormones are doing. I had a baseline reading at the onset of this pregnancy, and it remains to be seen what will happen later.

So after nixing four other obstetrics groups (and boy, do obstetrics groups hate to be nixed. Word to the wise- it's hard to keep a straight face while nixing someone who obviously has already started sharpening their scalpel at the sight of your positive pregnancy test), we landed on a small group that works out of the small Catholic hospital that we used for our miscarriage-turned-emergency last July. Even though this group seems slightly more VBAC-friendly than the other groups, there are still multiple brick walls.

Let's start by looking at some statistics. Click right HERE for a good table of statistics gathered in a hospital setting alone in 1995. I emphasize "hospital setting alone," because statistics gathered by many American midwife groups suggest that the VBAC success rate at home is statistically significantly higher than the success rate in the hospital. This is due to a lot of factors that we can explore at another time, namely the use of various chemicals that are given in hospitals that interrupt the bio-pathway of the cascades of hormones involved in a normal, healthy birth. The statistics at this website seem to correlate The American College of Obstetrics and Gynecology, as cited HERE. So now, we have the prior, research-based understanding that it seems that, "Dozens of studies report that for women who have had one prior cesarean birth with a low-horizontal incision, the risk of uterine rupture is 0.5% to 1.0%." This, readers, is fairly close (in other words, there seems to be no statistical difference) to the rate of a spontaneous uterine rupture in a woman who is having her first baby (in other words, has never had uterine surgery).

My surgical scar is the very best type to have- a low, horizontal incision that was repaired separately from the fascia (instead of sewing everything up together, my wonderful and brilliant surgeon- the one I have lauded in previous posts- took the care and time to repair the uterus separately from the skin). My risk level for a "spontaneous" uterine rupture (that is, one that wasn't augmented by drugs) is now back down to what it was before I ever had a C-section.

Which brings us back to the OB group. I have now officially met with all of the doctors/care practitioners at this group. This motley crew consists of:

- Dr. Fashion: My (female) main doctor. I originally chose her, as I don't feel comfortable with male care practitioners. She is aloof, albeit professionally friendly, and has so far refused to give me her exact C-section rate. Red flags.

- Nurse Practitioner: The nurse practitioner gave a loud, "Great!" when I affirmed for her that I was indeed trying for a VBAC. She shrugged and said, "Whatever you want!" when I told her that none of the flu vaccines were an option for me.

- Dr. Older Guy: As his name might suggest, he's an older, gentleman doctor. Contrary to my pre-conceived notions, he actually encouraged me about the VBAC saying, "I don't see any reason why it won't happen at this point." He also seemed thrilled that I was doing my own research, and agreed with me that there was no reason to take tests or perform interventions if I felt it was unnecessary (as in, I declined the Gestational Diabetes test, and the nurse nearly laid down on the floor before she passed out and fell).

- Dr. Younger Guy: This doctor was the one who performed my (outpatient, D&C) surgery when my last miscarriage went all kooky. He appears to be even younger than me, but it's possible he's approximately my age. He stuttered and stammered his way through my appointment with him, and simultaneously wanted to make sure "they" had given me the pamphlet on the safety of VBAC (Question: Do "they" give pamphlets about the risks of repeat, major abdominal surgery to mothers who choose an elective Cesarean after a Cesarean?) while at the same time, repeating, "Okay, okay, okay," as I responded that I am confident in my own research.

I do not know if the Nurse Practitioner attends births, but of that list, I really think that I'd prefer to not be near half of these people while birthing.

To be continued...

1 comment:

Brenna Kater, the Oceanskater said...

Always praying for you!